The private health sector comprises for-profit, commercial entities, as well as nonprofit organizations, such as nongovernmental organizations (NGOs) and faith-based organizations (FBOs), that provide health services, products or information.
Private providers in developing countries deliver a range of health services and products in a wide variety of venues. Services may include government and donor priorities, such as family planning, reproductive health, child health, and treatment for HIV and AIDS, tuberculosis, and malaria. Venues range from small to large: a practice might operate in a single room in a provider’s home or in a state-of-the-art clinic. Many larger companies, particularly those in mining, textiles, and agriculture, offer health care through workplace clinics. In most countries, the private pharmaceutical sector is the largest subgroup of private providers. In many developing countries, the nonprofit sector, especially FBOs, plays an important role in providing essential services, particularly for underserved populations. Supporting these health care providers are ancillary services such as private laboratories and other diagnostic services.
A private health sector assessment provides a snapshot of private health sector activity at one point in time. The data and accompanying analysis help foster dialogue between government and non-state actors on how to maximize the private sector’s role in the health sector to address health priorities. Assessments also offer recommendations on needed policy reforms, and highlight areas for improved coordination and partnerships between the public and private sectors. The dissemination of findings and recommendations is often the first time stakeholders from both sectors come together to discuss private sector contributions to the health sector and their potential role in addressing public health priorities.
The assessment is a valuable participatory and analytical exercise providing:
- Accurate and reliable data on the scope, size, and activities of the private sector in the overall health sector, or in particular health markets such as family planning, reproductive health, HIV and AIDS, and maternal and child health
- Actionable recommendations on strategies to maximize private sector engagement in health and encourage greater public-private collaboration in health
Ultimately, the assessment answers the question: “How can the private health sector contribute to improved health status?”
A stakeholder is an individual or group who can affect or is affected by an organization, strategy, or policy in health. Below is a list of potential stakeholders for a private health sector assessment.
Commercial private sector
- Health care providers (e.g., doctors, nurses, midwives)
- Health care facilities (e.g., hospitals, clinics, pharmacies)
- Pharmaceutical distributors
- Health insurance companies
- Diagnostic services (e.g., laboratories)
- Mobile health operators
- Multinational companies (e.g., Coca-Cola)
- Private medical institutions
- Private financial institutions (banks, MFIs)
Nonprofit private sector
- NGOs engaged in health
- Professional and medical associations
- Faith-based organizations
- Civil society organizations
- Business coalitions
- National and/or local government officials (Office of Prime Minister, Ministries of Health and Finance)
- Professional councils and regulator boards
- Public service commissions
- Public medical universities and research organizations
- Consumers of health services, products, and information
- International donors (e.g., foundations, foreign national governments)
- Multilateral organizations (e.g., UN, WHO, World Bank)
A big challenge to engaging the private health sector is getting a clear picture of the actors involved and their capabilities. This sector is often misunderstood—but can be a critical partner in meeting public health goals. An assessment can help governments, development partners, and other key stakeholders understand the role the private sector plays with an eye toward identifying areas where partnerships or initiatives can contribute to improving health outcomes.
Assessments can focus on one specific health area such as family planning, HIV and AIDS, or maternal and child health, or can be expanded to cover a range of health priorities.
Private sector assessments have been commissioned to achieve a variety of objectives. Here are some common reasons for conducting an assessment:
- To better understand the size and scope of the private health sector
- To inform or guide the development of a donor-funded private sector program
- To increase efficiency in health system (i.e., capitalize on unique public and private sector capabilities)
- To identify and mobilize untapped private sector resources; this is particularly relevant for countries earmarked for graduation from donor funding
- To identify obstacles to increased private sector engagement (such as laws and regulations) and facilitate public-private dialogue for change
Since 2005, USAID has supported over 30 private health sector assessments in developing countries. The SHOPS project has conducted more than 20 assessments since 2009. Click on the map to access country reports from the SHOPS website.
A core principle of our approach is to engage key actors, from both the private and public health sectors, early on in the process. Involving stakeholders in the early stages not only addresses the challenge of securing local buy-in, but also helps ensure that the focus of the assessment responds to country priorities. Continued engagement throughout the process helps public and private sector leaders agree on the main challenges confronting the health sector, identify appropriate areas for private sector involvement, and jointly develop plans to maximize private sector contributions to health.
A second feature of our approach is flexibility. Based on our extensive experience conducting assessments in over 30 countries, we have learned that one size does not fit all. While all assessments follow a similar approach, this can be individualized based on the context and unique objectives for a particular country. For example, an assessment may cover a broad array of health areas, or it may focus on a specific priority health area, such as HIV and AIDS or family planning.