Perspectives on Mixed Health Systems

Sania Nishtar, the founder and president of Heartfile, a health sector NGO think tank in Pakistan, recently published her fourth book, Choked Pipes, in May 2010. In Choked Pipes, Sania explores the challenges of Pakistan’s health system, namely the difficulty of balancing public and private delivery in a mixed system.

The systematic neglect of the health market domain stems from the mistaken notion that the role of the market in health conflicts with the principles of equity and health for all. For most developing countries with mixed public and private health systems the market could be a mechanism to deliver publicly financed common goods in health and failure to harness their potential a missed opportunity.

A wide analytical and normative gap needs to be bridged in this space. We need to know how health markets function in different settings, who the actors are, what it would take to establish a meaningful public-private interface in order to achieve equity in service delivery and how incentives could be institutionalized so that markets could contribute towards achieving health systems fairness and broader universal coverage health goals.

In many western developed countries, which are considered to be the bastions of welfare, states have been able to achieve equity by successfully regulating private sector’s participation. There are lessons to be learnt from these experiences—with a caveat however. Successful engagement of the market in public domains is critically dependent on the capacity of stewardship agencies to harness their potential. Countries cannot remedy their own inefficiencies by seeking to yoke the private sector on their own uncertain carts.

Read more about Sania’s recently published book Choked Pipes.