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To engage the private sector in health, we must align goals and share risks

20 November 2023
News release

Photo: Health worker wears personal protective equipment (PPE). Credit: WHO/Egor Dubrovsky  


New policy brief compiles governance lessons from the COVID-19 pandemic

Engaging the private sector in delivering health care and goods requires a sound understanding of how to align resources with the strategic priorities of a health system. The WHO Regional Office for Europe and the European Observatory on Health Systems and Policies have released a new report for policy-makers that analyses governance evidence from the COVID-19 pandemic. 

“The question is not whether we should do it, but what we can do to do it well,” explained Dimitra Panteli, programme manager at the Observatory, who presented the policy brief during a WHO-hosted launch session at the European Public Health (EPH) Conference in Dublin.

Having played a key part in the COVID-19 pandemic, the private sector showed that it holds resources and expertise that can enhance the delivery of health goods and services and help achieve Universal Health Coverage. It also has a wider role in the maintenance of essential health services and in ensuring health system resilience. 

“We cannot have the illusion that we should not work with the private sector, especially as health services struggle to cope with backlogs caused by the pandemic,” pointed out Natasha Azzopardi Muscat, Director of Country Health Policies and Systems at WHO/Europe. 

Taking a governance lens

This collaboration can however present challenges, for example around governance practices. Policy successes and failures during the pandemic provide lessons for countries on how to engage the private sector in their health systems effectively.

Focusing on governance in this exercise helps to safeguard publicly financed health systems from potential misuse and achieve three crucial goals: meeting policy objectives and health system needs to serve populations; succeeding in the delivery of services; and ensuring value for money when allocating resources.

The policy brief utilizes a governance framework named TAPIC to pinpoint the sites of potential governance problems: transparency, accountability, participation, integrity, and policy capacity. It also employs insights from six governance behaviours that can drive private sector engagement successfully. These were identified by the WHO (Headquarters) Advisory Group on Governance of the Private Sector for Universal Health Coverage.

The importance of transparency and accountability

Transparency and accountability are crucial in ensuring that private sector contracts are governed robustly. The authors emphasize that transparent information is closely linked to public trust, and is needed to safeguard the integrity of governments dispensing large amounts of public funds.

Governments also must follow clear processes when considering potential private sector partners and in justifying the choices made in awarding contracts. This is particularly critical in the area of public procurement. “Where public funding is being used to contract the private sector, we need to ensure there is transparency, probity, and no corruption,” emphasized Dr Muscat. 

Equitable risk-sharing is also important for accountability and protection, and needs to be explicitly addressed in private sector engagements. Covering the health, financial and supply risks makes contractual agreements much more effective.

Experts called for the establishment of emergency procurement guidelines for ‘crisis contracting’ to protect countries in future health emergencies. These may include  pre-vetting potential suppliers using robust selection criteria, and making publicly available all calls for tender and contract awards so that they may be scrutinized in a transparent manner.

Photo: Florian Tille, Naomi Nathan, Gabriele Pastorino and Dimitra Panteli (Observatory and WHO/Europe teams)
at the launch of the policy brief in Dublin, November 2023


The potential for successful private sector engagement

Learning from the experience of private sector engagement during the pandemic can help countries avoid pitfalls and meet health system goals.

Using evidence gathered from the Observatory’s COVID-19 Health Systems Response Monitor (HSRM), the policy brief explores a selection of case studies that describe real-life private sector engagements in service delivery, procurement of personal protective equipment, and advance purchase agreements for COVID-19 vaccines during the pandemic.

Italy’s strong tradition of working with the private sector, especially in the Lombardy region, shows the importance of having objectives that are clear and aligned, explained Carlo Signorelli, Professor at the Università Vita-Salute San Raffaele in Italy.

Lithuania and Estonia provide examples of actions to ensure transparency and accountability in procurement practices. Other case studies from Germany and the United Kingdom highlight the significant governance challenges that can arise to prevent the risk of corruption or mismanagement of resources.

Speaking at the EPH Conference, Sara Burke, Associate Professor at Trinity College Dublin, said that in Ireland, the COVID emergency showed that it is possible to establish public-private partnerships in record time: “The government acted quickly and negotiated in days and weeks an agreement with private hospitals.”  

However, as Ireland did not have a surge in COVID-19 patients like other countries did, the private sector was disappointed that their hospitals were not used for such cases – even if this was a positive public health outcome.

According to Dr Burke, the latest research is also showing that the Irish state had a very poor understanding of how the private sector worked. For example, it “failed to understand that medical consultants work independently from the system”. This emphasized the vital need to build capacity of public institutions for private sector engagement.

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