In many LMICs, the private sector in health is large, fragmented, and growing. The way the private sector is organised and operates is significantly influenced by the organisation and behaviour of the public sector, with well governed and competent public health systems generating complementary, reasonable-quality private healthcare service delivery. In contrast, countries with weak governance and an unregulated private health sector may also have an inefficient and inequitable public health system. How accountable a country’s health system is to consumers of healthcare depends to a large extent on the degree of accountability between the public and private sectors. Where there is inadequate accountability, a culture of mistrust and ‘blame shifting’ may exist. This has formed part of the COVID-19 response narrative in many contexts. Response has varied, “from swift and proactive at best to haphazard and negligent at worst”.
This rapid review seeks to understand why and where there has been swift and proactive action, to build better governance of national COVID-19 response.