This blog is the second installment in a three-part series to engage stakeholders by focusing on sections of 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 actions to address major blockers. Part two of this blog series explores the three major blockers to engaging the private sector to provide Ecosystem Services.
“Start where you are, use what you have, do what you can.” – Arthur Ashe
For many low- and middle-income countries (LMICs), this quote rings true as countries assess their health systems in the face of declining foreign aid. One critical area where LMICs are not always “using what they have” involves engaging local private companies for their skills and expertise, or Ecosystem Services & Products.
Despite experiencing vibrant private sector growth over the last 20 years, LMIC governments rarely engage local private sector companies (or global companies with in-country operations) to provide Ecosystem Services, such as logistics, data analytics and telecommunications. Services that could strengthen their health systems. This is because successful private sector engagement (PSE) for Ecosystem Services requires building trusted partnerships between sectors, which is no small task.
This blog outlines three major blockers, identified in a recent position paper, to increasing Ecosystem Services as a form of PSE in LMICs.
One: Limited Engagement with Local Private Sector
Many LMIC governments do not understand how to engage with the private sector and therefore do not include PSE as a key strategy. Without a PSE strategy, it is difficult for all the necessary stakeholders (governments, funders/donors and technical partners) to work effectively with the private sector. Additionally, without a strategy, the private sector cannot understand where it is permissible to provide Ecosystem Services to public health systems. A recent Africa CDC concept paper “Africa’s Health Financing in a New Era, April 2025,” offers an example of how public sector PSE strategy promotes private sector involvement in local pharmaceutical production, digital health and medical supply chains.
Having a documented strategy outlining national-level PSE priorities and objectives, as well as regulatory frameworks, will help LMIC governments assess what local private companies offer relevant Ecosystem Services for public health systems, and whether those companies offer quality services. With a robust PSE strategy, governments can engage private companies for Ecosystem Services more sustainably, building trusted partnerships that are mutually beneficial.
Two: Low Level of Trust by Government in Private Sector
While there is no doubt that many governments have an ingrained suspicion of private sector motives, practical issues may drive those concerns. Health is an industry that needs to be highly regulated for things such as patient confidentiality and maintaining the quality of health products. Any private sector company involved in health service delivery needs to follow appropriate procedures and quality assurance measures. Appropriate government oversight is critical to provide the needed assurance that companies are, in fact, compliant with relevant standards.
Understanding how to manage health products safely is critical for the private pharmaceutical distribution sector, where importers, distributors and wholesalers buy and supply medicines to hospitals, clinics and pharmacies. This requires independent National Regulatory Authorities (NRAs) to be capable of ensuring the private sector provides Ecosystem Services that comply with international, regional and national standards.
With appropriate regulatory support, governments can ensure the private companies they work with offer quality services in line with set standards.
Three: Challenges in Working with Government Customers
Private sector firms find it difficult to work with governments, who often have long procurement cycles, operational complexity and payment delays. Private sector firms are also less likely to engage with the government if fragmentation is high and the business volume per contract is low. Larger volumes can lead to significantly lower service costs and help private firms justify the necessary investments to meet the government’s specific needs. The challenge is that many public health systems are organized by vertical health programs (immunization, TB, HIV/AIDS, malaria, family planning, etc.), with each program having its own logistics system, call center and data analytics infrastructure.
When governments integrate their health systems, they reduce barriers to health care and increase opportunities for PSE.
Complex Challenges
All three blockers to increasing Ecosystem Services have multiple root causes that make sustainable solutions more complex. These challenges, however, are not insurmountable, and stakeholders can take immediate action. Global health stakeholders in LMICs must start where they are by assessing the local private sector resources they have and do what they can now to make their public health systems more efficient, sustainable and affordable – building toward a future of universal health coverage.
Stay tuned for the final blog in this series, to be published in June, offering practical actions for overcoming these blockers.