To inform WHO’s Strategy Report on engaging the private health service delivery sector through governance in mixed health systems, Barbara O’Hanlon & Dr. Mark Hellowell analyzed current global health practice in the domain of engagement of the private sector (Private Sector Landscape in Mixed Health Systems, Study 5). This analysis included mapping of the history of engagement of the private sector in health, beginning with large vertical health programs and moving towards market-based approaches. The findings are presented in three “stages”.
Social Marketing (SM) was one of the first approaches to engagement of the private sector in health. By applying the principles of marketing to social goals, countries such as India had success influencing health-seeking behaviours. For example, the Nirodh condom project for family planning and sexuality transmitted infections distributed subsidized condoms through commercial actors in the retail sector.
Following success at country level, SM programmes were taken to a global scale by international organizations. Multiple studies have demonstrated the effectiveness of SM across a range of health areas – including HIV/AIDS, maternal and child health, and FP/RH.
This heavily influenced donor thinking towards the engagement of private sector in health and SM is still utilized in global health.
Global public-private partnerships (GPPPs) were introduced in the 1990s. They involve the collaboration of public and private sectors to overcome market failures at the international scale.
While most GPPPs focus on drug and vaccine development, there are three other types:
- Product based partnerships: drug promotion and bulk purchase of products for public sector programs
- Product development partnerships: address failure of the market to develop products with positive externalities
- System/topic partnerships: coordinate public and private sector involved in a single disease
Around this time, development partners began to invest in innovative financing mechanisms, further facilitating partnership at the global level.
Market-based approaches and engagement of the private sector for health systems strengthening emerged as a result of lack of long-term sustainability of SM approaches.
The Total Market Approach (TMA), Market Shaping, and Managing Markets for Health (MM4H) are examples of market-based approaches that aim to leverage the advantages of all health sectors to enhance health services.
A whole health system approach, where countries govern all stakeholders (both public and private) within the health system, has been highlighted by the WHO following the Strategy Report of the WHO Advisory Group on the Governance of the Private Sector for UHC.
This approach focuses on redressing a gap in governance, and highlights that for governance of both the public and the private sector to be done effectively, it is necessary to use six governance behaviors outlined by the WHO Advisory Group: build understanding, foster relations, align structures, enable stakeholders, nurture trust, deliver strategy.
This approach is reflected in initiatives such as the Country Connector on the Private Sector in Health