This blog is the first in a three-part series to engage stakeholders around our new position paper “Increasing Local Private Sector Engagement in LMIC Public Health Systems”. This in-depth paper identifies the need to integrate private sector Ecosystem Services & Products into public health systems, outlines the major blockers to this integration, and offers stakeholders practical solutions to address major blockers. In part one of this blog series, we define Ecosystem Services and why they are critical for more resilient health systems.
Shocks and stressors in global health often shine a light on public health system gaps, challenges and opportunities. These events are most often disease outbreaks, natural disasters or conflicts that significantly strain health systems in low- and middle-income countries (LMICs). The recent significant reduction in foreign aid from high-income country governments is the latest shock to LMIC health systems. Reduced funding has left many LMICs with a limited supply of health products and a reduced health workforce, hindering their ability to deliver routine and emergency health services.
But as the global health community tries to fill immediate gaps, stakeholders working in this space also must consider long-term solutions that decrease LMIC government’s dependence on foreign aid and prioritize local resources for more resilient health systems. This will require stakeholders to be both resourceful and innovative as we work with LMIC governments to increase domestic resources for health, including how we engage local private sector companies to support public health systems.
The Opportunity: Ecosystem Services & Products
Private sector engagement (PSE) in LMIC public health is not a new concept. Many development organizations and multilateral institutions already promote PSE to capitalize on the sector’s financial resources, specialized skills, physical assets and technologies. However, many stakeholders have a limited view of how best to leverage private sector capacity for public health systems.
Private Sector Engagement options.
In a 2022 paper, VillageReach identified three major PSE options for LMIC governments and their partners looking to engage the private sector. While all three options are important, we believe there is an overemphasis on Funding & Technical Assistance and Health Service Delivery & Health Products (options A & C in Figure 1). Funding & Technical Assistance is when private companies or foundations give donations or resources to LMIC governments and their implementing partners. This type of PSE is often the priority of multilateral donors’ PSE teams who secure contributions to procure medicines and develop health systems strengthening activities. Health Service Delivery & Health Products is when the private sector directly provides health services to consumers/patients via private hospitals and clinics and when private pharmacies supply medicines and other health products to those private hospitals and clinics. This system often runs parallel to public health systems.
The largest opportunity to increase PSE, especially now as LMIC governments must utilize all local resources for health service delivery, is through Ecosystem Services & Products. This PSE option needs strong public-private collaboration because it requires LMIC governments to oversee and collaborate with private companies as they operate and maintain different functions within the health system. LMIC governments have limited resources and do not have all the expertise necessary to operate the health system efficiently (e.g., deploy digital solutions, conduct data analytics or transport and store medicines and other health products). LMIC governments can engage local private companies to fill health system gaps and meet evolving health needs, allowing governments to be more efficient and effective with their resources.
Additionally, when these partnerships work, LMIC governments can be more adaptable to shocks and stressors and more responsive to domestic health needs. For example, in LMICs many donors fund the procurement and distribution of specific health products (i.e., HIV, malaria, family planning), creating parallel supply chains operated and managed by external partners. If LMIC governments work directly with local private logistics firms for integrated health products delivery, transport operations can be maintained, even when one external funding source goes away.
Progress Takes Time
At VillageReach, we focus our PSE activities on Ecosystem Services, which supports our organizational strategy to build more responsive primary health care systems. We bring together governments and private sector partners to collaborate in the design, development and operation of solutions like outsourced transport, telehealth and telemedicine and electronic immunization records.
We have seen significant progress in engaging LMIC governments to utilize the private sector for Ecosystem Services. But this progress was not easy, and it did not happen overnight. Public and private sector actors do not automatically know how to work together effectively, nor do these stakeholders always trust one another. Real blockers hindering the uptake of Ecosystem Services must be addressed, but we cannot let these blockers stop us from seizing the opportunity.
Learn more about the blockers and root causes affecting Ecosystem Services uptake and practical solutions to address these challenges in our new position paper, “Increasing Local Private Sector Engagement in LMIC Public Health Systems”. The next blog in this series will provide a deeper dive into one of the major blockers and will be published in April.