Passing the Test: How public and private health services can align to fight COVID-19

In any communicable disease outbreak, health systems must react quickly to test, identify cases, isolate, and treat the infected to increase their chances of recovery and to prevent the disease from spreading.

For governments, testing is a critical tool for both flattening the COVID-19 curve to prevent health services from being overwhelmed , as well as for enabling their economies to safely reopen. In the words of the World Health Organization’s (WHO) Director General: “You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.”

What is clear is the pandemic response needs to be coordinated and involve all partners—including the private sector and civil society—to mobilize the capacity and resources needed to beat COVID-19.  The International Finance Corporation (IFC) is committed to supporting governments in their efforts to leverage private sector resources to improve people’s access to healthcare , including vital laboratory services, which are critical for governments to understand the prevalence, spread, and contagiousness of the disease. Due to the many unknowns that still surround the virus, testing is even more critical for fighting this disease.

In South Korea, they used large-scale testing (300,000 tests) to identify and isolate people infected with the virus to successfully halt the spread. Yet, many countries are struggling to acquire the lab capacity needed to undertake large-scale diagnostic testing. As reported by The Guardian, when questions surfaced about testing capacity in the United Kingdom, the UK health secretary said, “We have the best scientific labs in the world, but we do not have the scale.”

Like many developed countries, reaching meaningful testing levels in emerging countries has been a challenge. At the same time government testing capacity is overstretched, there is anecdotal evidence that private labs are seeing a slowdown due to patients being asked to delay non-urgent medical procedures and tests to reduce the burden on overstretched health services. Some countries have taken notice of this and have chosen to leverage this spare capacity to help public efforts in fighting COVID-19.

In Austria for example, 40 laboratories are able to perform 15,000 tests a day with the cost of prescribed tests covered by insurance. Of the 40 labs approved to conduct COVID-19 testing, half are private. While in Thailand, a total of 227 public, military, university, and private hospitals have been certified to test for COVID-19, with testing covered by the Royal Thai Government for qualified patients.

As part of its national strategy to come out of lockdown, the French government defined a list of public and private labs to perform COVID-19 testing with the objective of performing 1 million tests per week in September 2020, with tests covered by the national health insurance fund. This goal could not be achieved without incorporating private sector testing capacity into the national program. Meanwhile in Jordan, the Ministry of Health contracted Medlab and Biolab, two private lab chains, to increase its testing capacity, with the labs adhering to government guidelines and standards and identifying positive tests to help the government track and isolate the spread of the virus.

According to lessons from the Global Delivery Initiative, cooperation across a wide range of partners and stakeholders is crucial in epidemic situations, and the WHO has called on all governments to adopt a “whole-of-government and whole-of-society” response to the COVID-19 pandemic that includes the private sector.

Effectively partnering with the private sector to increase testing capacity at this crucial time requires regulatory frameworks that align public and private efforts. In developing these frameworks, there is vast global experience in designing diagnostic public-private partnerships (PPPs) that governments can tap into. Governments can use many of the disciplines and processes widely used in structuring diagnostic PPPs, such as: The ability to define and specify service requirements; well-developed performance-based contracting with clearly defined key performance indicators; transparent procurement process.

By having well-defined and specific service requirements, governments can leverage private sector capacity to target specific testing needs for the national response where government capacity is inadequate. Using performance-based contracting, a key element in developing PPPs, enables governments to attach quantitative and qualitative targets to private sector testing to ensure enough tests are being conducted at the right standards—both in terms of quality and turnaround time—to meet government knowledge requirements for slowing the spread of the virus. The PPP design can include clearly defined referral processes to ensure lab services are in line with the national testing strategy. Additionally, if the local market conditions allow, governments can use competitive bidding processes to create competition between several providers to obtain the best value for the country.

Stopping the rapid spread of COVID-19 is a global imperative. By combining public and private capacity, innovation, and expertise, we can successfully combat this pandemic.