Launching Healthy Partnerships: How Governments Can Engage the Private Sector to Improve Health in Africa

As we get ready for the launch of the Healthy Partnerships report here in Nairobi, Kenya, there is a strong sense of accomplishment, mixed with nostalgia and hope. This report measures how governments in Sub-Saharan Africa are currently working (or not) with the private health sector in 45 countries we visited a little over a year ago. It has been long in development, but well worth it. We have made a first cut at doing something which some colleagues thought was too difficult. We developed indicators to measure the level of a government’s inclusion of the private health sector in a national health system, allowing cross-country comparison.

The topic has been deemed a high priority by many national governments, private sector providers and international organizations like the World Health Organization, USAID, and the Rockefeller Foundation to mention a few. In Africa, we know that not only are improvements in the health systems urgent, but the private sector is providing half of all services, to rich and poor and to urban and rural populations alike. More than half of all expenditure comes from private sources and studies have shown that patients pay about the same amount for services at the "free" public clinics as they do at private facilities. As long as governments don't properly engage with the private health sector, they are in effect abandoning half of the population seeking care with private providers. This is especially true in the area of maternal and child health, where public health initiatives fall flat when they exclude the private sector and in turn can be far more successful and save more lives when private providers are part of the picture.

One year ago, we found ourselves crisscrossing the continent from Khartoum to Cape Town and from Dakar to Dar es Salaam, as we collected comparable data in these vastly different environments. One thing that stood out for us was the broad range of organizational capacity in both the public and the private sector. While the concept of a capable private health sector organization did not seem particularly relevant in Juba (South Sudan), the group of private providers we met with in Lagos was not only well organized; it included to our surprise the representative of physiotherapists. And with semi-professional flair the group asked both of us to pose for a picture for their website. Most countries don’t engage all private providers in a systematic way. While 39 out of the 45 Sub-Saharan African countries have a policy towards the private health sector, only 12 countries are implementing their policy. Only 13% of the countries have a comprehensive registry of private health facilities. As a result, governments do not have a good sense of the capacities and capabilities of the private health sector. In general, existing regulations were out-of-sync with current practices and the capacity of the government to enforce those regulations. The expansion of health insurance provides an opportunity for improved public-private collaboration in many countries.

Our hope and expectation is that should we find ourselves crisscrossing the continent once more, we would see a more pragmatic and more effective approach for the public and private sectors to work together in other to achieve health goals. Improvements are within reach and many of our colleagues are working with governments to implement the needed changes identified in the Report. For example in Kenya, our colleagues have been working with the government to develop an e-health strategy, bringing ICT into the health sphere and making information exchange (one of the deficiencies in Kenya identified by the Report) more effective. Today we’re happy to be making this important contribution to the conversation and to the improvement of the availability and quality of health care, independent of the service provider’s ownership.

For the full Report and additional information, please see www.wbginvestmentclimate.org/health.