Article Text
Abstract
Many countries are adopting essential packages of health services (EPHS) to implement universal health coverage (UHC), which are mostly financed and delivered by the public sector, while the potential role of the private health sector (PHS) remains untapped. Currently, many low-income and lower middle-income countries (LLMICs) have devised EPHS; however, guidance on translating these packages into quality, accessible and affordable services is limited. This paper explores the role of PHS in achieving UHC, identifies key concerns and presents the experience of the Diseases Control Priorities 3 Country Translation project in Afghanistan, Ethiopia, Pakistan, Somalia, Sudan and Zanzibar. There are key challenges to engagement of the PHS, which include the complexity and heterogeneity of private providers, their operation in isolation of the health system, limitations of population coverage and equity when left to PHS’s own choices, and higher overall cost of care for privately delivered services. Irrespective of the strategies employed to involve the PHS in delivering EPHS, it is necessary to identify private providers in terms of their characteristics and contribution, and their response to regulatory tools and incentives. Strategies for regulating private providers include better statutory control to prevent unlicensed practice, self-regulation by professional bodies to maintain standards of practice and accreditation of large private hospitals and chains. Potentially, purchasing delivery of essential services by engaging private providers can be an effective ‘regulatory approach’ to modify provider behaviour. Despite existing experience, more research is needed to better explore and operationalise the role of PHS in implementing EPHS in LLMICs.
- Health policy
- Health services research
- Health systems
Data availability statement
No data are available.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Footnotes
Handling editor Seye Abimbola
Twitter @sameen_siddiqi, @wafaftb, @Dr Agnes Soucat, @AlaAlwan1
Contributors SS and AA conceptualised the paper. WA and SS did the literature review and wrote the first draft. AVR, AA and AS provided extensive comments. SS developed the final draft for submission.
Funding This paper is part of a series of six papers to be published as a supplement coordinated by the Diseases Control Priorities 3 Country Translation project at the LSHTM, which is funded by the Bill & Melinda Gates Foundation (OPP1201812). The sponsor had no involvement in paper design; collection, analysis and interpretation of the data; and in the writing of the paper.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.