Harnessing the power of the private sector for universal health coverage in Sub-Saharan Africa

The journey toward achieving Universal Health Coverage (UHC) in Sub-Saharan African (SSA) countries has been slow and challenging. Despite the integration of UHC as a goal into national health strategies, only 43 percent of the population in SSA had access to essential health services in 2019 and 2021. This proportion has steadily, but slowly, increased since 2000, from 22 percent. Additionally, the proportion of the SSA population facing catastrophic health expenditures nearly stagnated over these years and stood at 8.8 percent in 2019, indicating a need for urgent action.

Partnering with the private sector offers a promising avenue to accelerate progress towards UHC.

In high-income countries, such partnerships have successfully addressed healthcare challenges, including the lack of infrastructure, services, and equipment. The most common models used are Public-Private Partnership (PPP) and contracting out. PPP is a structured form of collaboration through a mid- to long-term contract between private and public parties, which involves sharing risks, costs, benefits, resources, and responsibilities in planning, building, and/or operating facilities or providing services. Contracting out involves the public sector purchasing services from local private operators. In PPPs, assets generated by the private partner are transferred to the public partner, as opposed to contracting out models, where assets remain private.

In SSA, leveraging the expertise and resources of the private sector is essential.

The private sector already plays a significant role in the delivery of healthcare services in SSA, with the private-for-profit sector and informal private providers providing 35 percent and 17 percent of outpatient care in SSA, respectively. Collaborating with the private sector can help fill the gaps faced by governments in terms of financing, infrastructure, equipment, and human resources.

Several SSA countries have initiated collaborations with the private sector in the health sector through various approaches. Some countries have been employing these models for nearly twenty years. For example, in Ethiopia, the private sector has been providing laboratory services to 200 hospitals nationwide since 2004 through a contracting out model. Conversely, countries like Togo have only recently started implementing their models, while others such as Cabo Verde, are still in the development stage.

While collaborating with the private sector holds promise, it presents unique challenges in low-resource settings.

There are fewer success stories of collaboration between the public and the private sectors in low-resource settings compared to more advanced countries. Establishing contracts with the private sector is an intricate process that requires strong capacities and careful consideration of several factors.

To contribute to the UHC agenda in SSA and beyond, the World Bank and the International Finance Corporation identified key lessons that can inform the development and implementation of successful health PPP and contracting out projects for imaging and laboratory diagnostics. The study covered 15 PPP projects and five contracting out projects in various countries. The results suggest that it is paramount to refrain from blindly replicating contracts from other countries and, instead, undertake diligent assessments of local needs, risks, benefits, and resources.

Leveraging the expertise and resources of the private sector in Sub-Saharan African countries is crucial for accelerating the achievement of Universal Health Coverage. 

Collaborations with the private sector can help address the challenges faced by governments in providing essential health services to their populations. While there are challenges in implementing these partnerships, careful consideration and diligent assessments can lead to successful outcomes. It is essential for all stakeholders involved in healthcare delivery to learn from the experiences and insights shared in the report. By working together, we can make significant strides towards achieving UHC in Sub-Saharan Africa and beyond.