Overview

The key messages of this policy brief published by the European Observatory on Health Systems and Policies are as follows:

• Private sector resources and expertise can enhance the delivery of health goods and services. The private sector played a key part in the COVID-19 pandemic. It also has a wider role in the maintenance of essential health services and in ensuring health system resilience.
• Learning from the experience of private sector engagement during COVID-19 can help countries avoid potential pitfalls and ensure that policy objectives and health system goals and priorities are met. The experience has also generated useful evidence on how to support operational success and maintain financial probity in resource allocation and spending.
• Effective private sector engagements require good governance practices. Policy successes and failures during the pandemic highlighted key governance challenges and provide lessons for countries on how to engage the private sector in their health systems effectively.
• Making the nature of private sector collaboration explicit is an important element of planning and managing effective relationships. This entails:
  • setting out the objectives of both public and private sector actors clearly;
  • identifying how both parties can achieve their objectives within a collaboration; and
  • weighing up shared goals and the reasons for the private sector engagement as well as exploring other means of achieving the stated objectives.
• Goal alignment and compatibility are central considerations in working with the private sector and should be linked to appropriately targeted incentives.
• Transparency and accountability are crucial in ensuring private sector contracts are governed robustly.
  • Open and transparent information is closely linked to public trust and is needed to safeguard the integrity of government bodies dispensing large amounts of public funds.
  • Clear, transparent processes must be followed to identify and consider potential private sector partners and in justifying the choices made in awarding contracts in order to alleviate concerns about the risk of potential corruption. This is particularly critical in the area of public procurement.
• Establishing emergency procurement guidelines for ‘crisis contracting’ now will protect countries in future emergencies.
  • Countries can usefully establish clear guidelines for the application of emergency procurement and set out its legal basis.
  • Pre-vetting companies and potential suppliers using robust selection criteria defined by experts (and including a track record for reliability and quality) can underwrite confidence.
  • Making publicly available a range of information, such as registers of calls for tender and of contracts awarded reinforces the probity of procurement arrangements.
• Building trustworthy partnerships between the public and private sectors is invaluable and can help ensure alignment with the health system’s strategic objectives.
  • Well structured agreements that clearly define roles, responsibilities and expectations help strengthen relationships with private sector partners.
  • Establishing avenues for effective dispute resolution in advance fosters trust.
• Equitable risk-sharing is important for accountability and protection, and needs to be explicitly addressed in private sector engagements.
  • Equitable risk-sharing protects public payers and strengthens private sector accountability.
  • Covering the full range of risks, including health risks, financial risks (to secure expected returns on financial commitments against potential liabilities or losses) and fulfilment risks (to guarantee supply obligations and quality standards) makes agreements more effective.
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