The complexity of national healthcare systems in Africa, the second largest and one of the most populated continents in the world, presents both economic as well as physical barriers to accessing quality medical services, resulting in poor health outcomes, inevitably trickling down to poor economic outcomes. A robust and integrated health sector with strong governance is essential in ensuring accessible, affordable and quality healthcare, one of the most fundamental human rights.
The goal of Universal Health Coverage (UHC) as stated by the World Health Organization, is to: “Ensure that all people obtain the health services they need without suffering financial hardship when paying for them.” While almost all countries in the world aspire to reach this goal, their journeys differ. One major factor that can accelerate or hinder success is how well resources are pooled and optimized to meet the needs of each country. Integration of UHC as a goal in the national health strategies of African countries is becoming increasingly critical and important as the continent continues to bear a high disease burden (24% globally), has an increasing population and lacks the workforce to meet healthcare demands.
A report by the African Development Bank highlights that Africa’s private sector accounts for over four-fifths of the total production, two-thirds of total investment, and three-fourths of total credit to the economy and employs 90% of the working-age population. Of the total health expenditure of $16.7 billion in sub-Saharan Africa in 2005, about 50% was captured by private providers. These statistics imply that while health may be conceived as a public good and a basic human right, its provision is currently not exclusively delivered by government. It is becoming increasingly important to involve the private sector to supplement and reinforce the services of the public sector.
It has also become popularly known that UHC is less of an economic challenge and more of a political challenge. Optimum effectiveness and output cannot be achieved by investments alone. Additional critical factors such as collaborations that leverage individual strengths, robust frameworks and policies, targeted opportunities for development such as skills development programs, capacity-building, etc. are necessary to stimulate the quest for UHC. On the public side, establishment of public-private partnership units within ministries of health will foster the collaborations led by effective governance and accountability.
Private sector players encompass a diverse range of non-state actors in the health sector, such as multinational corporations, non-governmental organizations, private institutions, faith-based organizations, as well as civil society. Collectively, private markets have the potential and capacity to fill the gaps and constraints faced by government-financed and government-provided healthcare.
The World Bank has outlined four pillars on which UHC sits: health financing, service delivery, inputs (drugs, human resources, etc.), and health-sector governance. Through its financial and innovative capacity, the private sector can play a cross-cutting role in expanding the scope of all these pillars, improving the quality of care.
The scope of the private sector in supplementing the public sector to achieve UHC is diverse and wide-ranging, giving the private sector an immense opportunity for growth.
1. Financial protection
Risk pooling through a mix of public and private funding models, so as not to compromise on equitable models of healthcare delivery that provide both access and affordability
2. Strengthening health service delivery
Private investment in infrastructure, investment in secondary and tertiary-care provision, mobilization of additional resources to meet needs, strong network of supply chain that guarantees effectiveness, introduction of new services and products that enable the ease of healthcare delivery, etc.
Capacity-building through local manufacturing of quality and up-to-standard pharmaceutical products, trained and skilled workforce, data collection, monitoring frameworks, thus also enhancing the economic, social and health output of the continent
4. Good governance
Participatory governance with appropriate channels of accountability and regulation with representation from all aspects of the industry.
5. Fostering innovations
Enabling technology to fill health systems needs and introducing innovations that would benefit the wider populations that don’t have access to education and advanced technology.
The private sector can bring its deep experience in management, capacity-building and research to increase efficiencies and quality, reduce duplication, leverage existing resources and improve coordination whilst ensuring sustainability. This will enable the development, enhancement and scale-up of health programs. While it is not necessary that the private sector shares the same motivations as the government to be supportive of achieving UHC, the economic outputs resulting from the scale-up of health programs can provide a financial incentive to the private sector, holding it accountable for effective and efficient spending.
There is a tremendous need for clear policy direction and framework for public-private collaboration. Without clarity on the goals and objectives, the valuable work of stakeholders in silos will amount to far less than integrated and unified efforts. The private sector has a core delivery function, and it is of paramount importance to establish a consistent public-private sector policy dialogue platform, and an effective system for mainstreaming private sector commitments into the healthcare strategy.
As governments continue to embrace UHC, they will need to invite the private sector to join key conversations to build trust and ensure innovations and initiatives, not only to support long-term goals, but also maximize returns on investments for optimal effectiveness. A unified, multisectoral approach will ensure that adequate resources and knowledge are leveraged for equitable healthcare for all.
Nishit N Shah, Director, Africa Health Business