Not “If” or “When,” But “How” The Private Sector Can Advance Women’s Health and Well-Being in Africa

Op-ed co-authored with Cynthia Eldridge, Chemonics, Project Director, Frontier Health Markets Engage
and Kaushal Shah, Head of Health Strategy, Africa Health Business
Sub-Saharan Africa is home to about 15% of the global population, but accounts for more than a quarter of the global disease burden in human and financial costs. This challenge is significant, particularly for the half billion female population on the continent. There is a tremendous opportunity to leverage the private sector in ways that improve access to and financing of quality of healthcare products and services for women throughout Africa.
The private sector is indispensable to achieving quality universal health coverage (UHC), but its potential is unfulfilled. While some governments contract private-sector actors to build and operate health facilities on their behalf to deliver health services efficiently and transparently, more often the private sector is targeted as just a source of funding. Reaching UHC2030—making quality health services available for all by 2030—through conventional means remains ambitious at best, so a fundamental rethinking of healthcare is required to enable private sector-led innovation.

The World Health Organization’s (WHO) strategy report outlines six critical governance behaviors for private sector health service delivery within mixed health systems:
1. Build understanding – Collection and analysis of data to align priorities for action.
2. Foster relations – Working together to achieve shared objectives in a new way of doing business.
3. Enable stakeholders – Institutional framework that empowers actors.
4. Align structures – Organizational structures to align with policy objectives.
5. Nurture trust – Mutual trust amongst all actors as reliable participants.
6. Deliver strategy – Agreed sense of direction and articulation of roles and responsibilities.

Over the next five years, the USAID Frontier Health Markets (FHM) Engage project will work with partners to realize these behaviors at the country level by addressing the market environment in which the private sector operates. The market environment heavily influences both the supply and the demand of health services, products, and information. FHM Engage will implement a “market facilitation approach” to catalyze and expand the private sector’s role within in the market environment. External (FHM Engage?) facilitators, or change agents, implement this flexible approach by coaching market actors, including public sector, private sector, communities, and development partners to define local problems, including the root causes of health system underperformance and disfunction.Then, they strengthen local health ecosystems by supporting the co-design of local solutions by harnessing market levers. The key levers to achieve market facilitation are: 1) public sector stewardship, 2) financing and non-financing incentives for capacity, responsiveness, and financial sustainability; 3) institutional norms, rules and regulation, and organization; and 4) market intelligence. The market facilitation approach promotes both individual and system behavior change that is needed to create positive change to transform how governments, businesses, and communities work and think together to intervene in markets to achieve health and health system objectives.
The market facilitation approach embraces the complexity, dynamism, and unpredictability of health markets. It involves actors such as those who are not traditional counterparts and did not previously have a voice in discussions within the health system. Additionally, the market facilitation process takes time, which may strain market actors’ resources and patience. However, despite these perceived challenges, the resulting behavior change in the market actors is worth it as it allows private sector to achieve the governance behaviors, greater outcome reach and sustainability.
As we develop an advocacy and action framework towards UHC and advancing women’s health and wellbeing in Africa, our goal is to create awareness of the need for adopting the governance behaviors by public and private market actors alike. We see the opportunity to use market facilitation to support the positive behavior change needed to improve market environment and enhance support and demand for equitable access to integrated, comprehensive health care for more women.
[1] Quick, Jonathan, Jonathan Jay, and Ana Langer. “Improving women’s health through universal health coverage.” PLoS Medicine 11, no. 1 (2014): e1001580.
[2] Engaging the private health service delivery sector through governance in mixed health systems: strategy report of the WHO Advisory Group on the Governance of the Private Sector for Universal Health Coverage. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.
About FHM Engage
Frontier Health Markets Engage is a global cooperative agreement funded by USAID to provide technical assistance (TA) supporting local actors to improve the ability of health markets to meet supply-side capacity gaps and consumer preferences, contributing to equitable provision of and access to high-quality family planning (FP) and other health services and products in mixed health systems. Led by Chemonics with Results for Development (R4D) as technical co-lead, alongside Pathfinder International and Zenysis Technologies, FHM Engage will work through 16 local, regional, and specialized network implementation partners (NIPs) to deliver lasting results. Building on more than 30 years of USAID investment, FHM Engage focuses on strengthening local health markets by addressing the root causes of market failures in the core market functions to create the necessary behavior change that catalyzes supply and demand and supports sustainable change.
About Chemonics

Founded in 1975, Chemonics is an employee-owned international development consulting firm that works in more than 80 countries around the globe. Our network of approximately 5,000 specialists pursues a higher standard in development everyday to help clients, partners, and beneficiary customers achieve results.

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About AHB
Africa Health Business (AHB) is a pan African boutique consulting firm, headquartered in Nairobi, Kenya, that aims to improve access to equitable healthcare in Africa. Our expert team provides clients with effective, evidence-based solutions for today’s complex healthcare challenges. Clients in government, the development space and the private sector rely on our research and advisory to inform and transform interactions with and use of healthcare systems.

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About AHBS- Africa Women’s Health: The Role of the Private Sector in Advancing Women’s Health in Africa.

AHB curated the Africa Health Business Symposium (AHBS) under the theme: The role of the private sector in advancing women’s health in Africa with the objective to prioritise, explore and strengthen the role of the private sector in advancing women’s health on the continent.

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