Using Private Health Systems Assessments (PHSAs) to facilitate cross-sector dialogue

On September 4, the Strengthening Health Outcomes through the Private Sector (SHOPS) project hosted a webinar to discuss the role of the private health sector and present Assessment to Action. This new web-based tool guides interested stakeholders through the composition of a private health system assessment and presents best practices, tips and examples to a variety of actors in healthcare policy, advocacy, and development. Such tools and assessments are necessary to frame discussions on the role of the private health sector and its potential contribution to national health objectives.

Who makes up the private health sector?

The private health sector varies by country, and includes non-profit and for-profit health organizations, entities that improve health (labs, supply networks, NGOs etc.), and both formal and informal providers. Because it can be difficult to gather standardized information about this sector, its role in the broader national health agenda is often misunderstood. Thus, there is a need to not only identify and unify approaches taken to improve health, but also to assess the approaches within this sector. It is the hope that these assessments will provide evidence and lead to discussions on the larger role the private sector can play in the public health space.

How is the private health sector assessed?

Currently, the private sector operates in a partially regulated environment where market forces and internal structures dictate its mode of operation. To determine this sector’s impact on health, health analysts are employing Private Health Systems Assessments (PHSA) that capture standardized data and results. A PHSA systematically explores the contributions of the private health sector to one or more health areas: family planning, HIV/AIDS, malaria, health financing, and supply chains. Strong PHSAs review primary and secondary data coming from at least one health area concerning both health status and health systems.

Five main steps one should consider before conducting a PHSA are highlighted in the diagram below.

Step 4, "Share" may perhaps be the most important part of assessing systems.  The “Share” step encourages learning and knowledge exchange among policy makers, members of the private health sector and other stakeholders. PHSAs can therefore serve the purpose of opening dialogue between the public and private health sectors. Primary gains revolve around private sector resource mobilization, and improving program efficiency to increase the chances of better health outcomes.

Key Lessons Learned

No two Private Health Systems Assessments are exactly alike, and there are tradeoffs between choosing to assess members of the private sector versus the mobilization of resources. However, irrespective of scope, location and focus of PHSAs, there are some similarities across the board.

SHOPs’ analysts found that generally:

  1. PHSAs reveal that analysts tend to underestimate the size of the private sector.  In the case of both Kenya and Namibia, PHSAs revealed higher numbers in the reports than anticipated.
  2. Private sector providers serve a broad clientele. The percentage of mothers from low, middle and high income brackets that visited private health sector providers in Namibia was 25%, 35% and 50% respectively.
  3. PHSAs have exposed consistent limited interaction between private and public sector health providers. The lack of co-ordination between the public and private health sectors was seen across several health efforts. Many blame regulations imposed by the government on this sector while others blame the private sector’s mistrust of the public sector. Either way, PHSAs affirm that better coordination between the sectors will result in greater program efficiencies.
  4. Incomprehensive policies in low and middle income countries neglect the role of the private health sector, creating barriers to entry and restrictions on the services that members of this sector are able to provide. For example, in Tanzania, private sector nurses are not allowed to provide HIV or PMP testing services.


Moving forward

Private health sector providers are commonly misperceived as unwilling participants in national health strategies such as preventive primary health care, reproductive health, and family planning. However, it is unfavorable market conditions and policies that steer them away from partnerships with the public sector. In the process, the public health sector not only misses the opportunity to leverage private health sector resources, knowledge and innovations, but more importantly the opportunity to include the private sector in dialogue that could inform national programs. SHOPs’ Assessment to Action webinar concluded that before conversations can take place between the two sectors, health policies and market conditions need to be reformed to accommodate the role of the private health sector. Private Health Systems Assessments are one emerging tool that can inform the reform process, and open greater collaboration between the public and private sectors. 


Learn more about the Assessment to Action tool at

Photo ©SHOPS