In their efforts to improve health systems, developing countries face the challenge of integrating traditional government health resources with a large and growing private health sector, where many poor people seek care. In these “mixed health systems” centrally planned systems operated by government entities exist side-by-side with private markets for similar or complementary products and services. However, most developing country ministries of health and the donors and technical experts that support them have not fully engaged the private health sector in harnessing innovation or mitigating market failures.
Recognizing the extent and neglect of this important component of health systems, the Rockefeller Foundation in 2008 invited proposals for a review and landscaping of key topics related to the private sector in health. Thirteen reports were produced along with a synthesis document, Public Stewardship of Private Providers in Mixed Health Systems (available in print or at www.resultsfordevelopment. org), a companion to this report.
A key component of this initiative was identifying innovative, pro-poor healthcare financing and delivery programs in South Asia and Sub-Saharan Africa that are led by or engage the private heath sector in the context of mixed health systems. This landscaping effort, anchored by the Results for Development Institute with key contributions from the William A. Haseltine Foundation for Medical Sciences and the Arts and other technical partners, had a twofold goal: support the project’s broader research objectives of better understanding the global landscape of existing private health sector programs and identify opportunities for potential support in future phases of the initiative.
This report describes 33 innovative financing and delivery programs selected based on their relevance to broader health systems and potential to achieve positive impact for poor people.3 While these programs range from donor-driven initiatives to large-scale government- subsidized efforts to for-profit businesses, they all involve active participation by the private health sector. These descriptions are not evaluations, as no rigorous third-party analysis of the impact of the profiled models has been conducted or commissioned, but most model descriptions have been reviewed by the implementing organization to ensure its accuracy.
The companion to this report (Public Stewardship of Private Providers in Mixed Health Systems) provides an overview of the Rockefeller Foundation’s broader initiative on the private sector. It focuses on how governments can better steward the large private health markets in developing countries. It assumes that ultimate responsibility for stewarding health systems lies with national governments but recognizes the challenges that many developing countries face in doing so.
One key recommendation is that governments should support innovative models that can be implemented in the face of capacity constraints and serve as stepping stones to broader reforms.
This report of current private sector health innovations identified programs that, while falling short of broad health systems reforms, have the potential to improve health markets and equity in those markets. These interventions typically build on existing structures, attempting pragmatically to improve them rather than replace them.
Many of these programs have been implemented by private organizations with assistance from donor agencies. Some have been employed where there is weak government capacity, little transparency, and low priority on addressing existing private markets and where government reforms are still in progress and longer in term. Ideally, as countries increase capacity, governments will begin to drive these programs and lend them strong support in order to incorporate them into a broader health systems vision.