May 22

Dr. Naveen Rao

In Pursuit of Universal Health Care: Time to Take Public-Private Partnership to the Next Level

The buzz around public-private partnership (PPP) keeps getting louder. And yes – PPPs are everywhere, operating in virtually every industry sector around the world, including health.

As an approach, and if structured well, a PPP holds tremendous promise for pulling in resources and expanding capacities beyond what the public sector and any one development agency can do on its own. For these reasons and more, both public and private sector players are paying greater attention to PPPs as the way for developing countries to achieve universal health care and meet other important Sustainable Development Goals (SDGs).



This attention is good. But we also need action – concrete steps within countries to formalize the approach and make public-private collaboration an integral part of national health policies seeking better quality, access and outcomes. It is time to recognize the critical role that private sector providers and other actors can and must play in public health, particularly at the state and local level. It’s time for governments to harness the local private health sector – not just big multilateral organizations, multinational corporations and NGOs – as partners in health system strengthening.

Think of the family doctor in a poor town in India, the local midwife in the Kenyan countryside – or other solo practitioners who may operate outside regulatory frameworks but who are the go-to health care professionals for their communities. Depending on the country and region, somewhere between 40 percent and 70 percent of the developing world’s population is already seeking health care from private facilities. These providers must be recognized and incentivized, while being offered opportunities to train and become certified/ accredited – not to mention fairly compensated. This is how we strengthen the supply side of a failing health market. It’s how we move the needle on making quality health care available – and affordable – to all.



Nigeria, for one, is being very proactive in this regard. Under the leadership of its federal Ministry of Health, the government has already started mobilizing private sector providers as partners in strengthening the delivery of reproductive, maternal, newborn, child and adolescent health and nutrition services (RMNCAH+N), beginning with five states in the country’s fragile northeast region. The aim is to expand service delivery at the community level under a financing arrangement that makes payment contingent upon performance. Cameroon and the Democratic Republic of Congo have also started using performance-based financing contracts with both for-profit and not-for-profit private-sector providers to help fill gaps in RMNCAH-N services.

The Global Financing Facility, launched to support the UN’s Every Woman Every Child initiative, offers a useful framework for these PPPs, and an effective vehicle for leveraging outside support for country-led SDG-related initiatives. It will be important to monitor and evaluate the impact of all of these activities and continue to refine the approach going forward.

In India, one of the focus countries for Merck for Mothers’ own investments, the Federation of Obstetric and Gynaecological Societies of India (FOGSI) is working to scale up a new quality certification program for private maternity care providers, structured as a state-level PPP. Participating providers who demonstrate compliance with quality standards are recognized by state regulators and included in government-backed financing schemes. As the program progresses, it will be important to heed the lessons of previous PPPs in India that were hampered by inadequate financing mechanisms, data and technology, and a misalignment of incentives that kept private provider participation low.

In the months ahead, a new public-private working group has formed to strategize and course correct in India. The group is comprised of representatives from government and non-governmental organizations, civil society and the local and global private sector (including Merck for Mothers). Its initial recommendations include streamlining administrative processes and increasing capacities for collecting, sharing, using and protecting data. In implementing these improvements, India’s new National Health Policy, which advocates in favor of PPPs to help fill critical gaps in care, provides a much-welcomed push from the top.



There may be practical considerations and internal adjustments to make in order to clear legal and regulatory hurdles and create the enabling environment for PPPs to flourish within particular countries. Certainly, there needs to be greater trust and transparency all around. There is a bounty of technical expertise and tools that can be shared to help countries create PPPs that work for them, within their own unique systems and given their own unique sets of challenges.

There can also be a role for other private sector actors in areas that are outside (yet still connected to) health. Governments can contract with these actors – like those who build roads, provide transport or handle supply chain logistics – to improve health coverage and strengthen overall health systems. For instance, in Senegal, the government has hired local privately held companies for last-mile deliveries of essential medicines, contraceptives and other health products. This is improving efficiencies and solving a critical issue in population health – chronic stock-outs of potentially lifesaving supplies.



There’s a long road ahead to achieve the SDGs. Countries that enlist their local, state and national private sectors as partners in public health will have a better chance at sustainable progress. In the process, many will bring in more private capital to help finance health efforts, create shared value opportunities for global and regional companies, and co-opt private sector innovations for public health service delivery. But in every instance, the private sector role must complement the government’s.

As the World Health Assembly convenes in Geneva this week, I hope to find greater openness toward and increased appetite for PPPs within developing countries. If they’re well-structured arrangements that leverage skills from both sectors and unite them behind a common objective, these partnerships have a unique potential to serve patients and save lives.


Naveen Rao leads Merck for Mothers, an initiative of Merck & Co., Inc.

Photos courtesy of Merck




Finance, Health Care
Base of the Pyramid, nutrition, public health, public-private partnerships