Globally advocating for achieving universal health coverage (UHC) on is one thing; designing and implementing health system reforms to make it possible in countries is another story.
There is a growing global consensus that in many countries, achieving the Sustainable Development Goal of UHC (SDG 3.8) will require a strong public capacity to steward mixed (public/private) health systems, along with mobilization of private actors to engage with the public sector. Strong mixed health systems, grounded in accountability, will be critical for countries to deliver quality primary health care (PHC), expanding access to PHC for the poor and vulnerable, and accelerating progress towards UHC.
Strengthening stewardship of mixed health systems has been a topic of growing importance among the JLN countries. The JLN country representatives from Kenya, Nigeria and Ghana recently led discussions and shared their insights at the Africa Health Agenda International Conference (AHAIC), held March 7-9, in Nairobi, Kenya. The event, formerly known as Health Africa International Conference (AMREF), gathered industry leaders, researchers, policymakers and practitioners on the theme “Towards a healthier Africa: people, systems and innovations”.
The “Moving toward UHC: the Critical Role of Effective Stewardship of Mixed Health Systems” panel discussion brought unique perspectives from the JLN members, including global health experts, policy-makers and leaders from private sector, shedding light on how governments can move towards effective stewardship for greater public and private engagement.
Effective public sector stewardship: highlights from stakeholder discussions
The following highlights salient points from joint learning on effective stewardship:
- Self-regulation and accountability – To drive engagement of the private sector, governments must first look at self-regulation and accountability of the public sector and build confidence of civil society – the stakeholders that hold the public sector accountable;
- Mechanism to allow the choice – As stewards, governments would need to create an environment of regulation that puts public and private sectors on a “level playing field;”
- Bridge the gaps – There is a need to bridge the large gap in trust between the public and private sectors. There is also a need to unify the terminology used by the public and private sector actors and converge their interests;
- Prioritize integration of services – Although the private sector often has a significant role in the provision of healthcare, in many African countries, governments often utilize a delivery model that is mainly public sector oriented and does not attempt to integrate the private sector;
- Develop new models for revenue generation and innovative financing; and
- Leverage social capital to be more effective in service delivery.
JLN strengthening stewardship of mixed health systems
Countries in the JLN have prioritized strengthening stewardship of their mixed health systems in moving towards UHC.
Leading the AHAIC panel discussion, Mr. Nathaniel Otoo, former Chief Executive Officer of Ghana National Health Insurance Authority and former Convener of the JLN Steering Group, shared the JLN progress where practitioners and policymakers from several countries are leveraging the joint learning approach to develop knowledge and tools on the how-to’s of building the stewardship capacity of public agencies to enable a healthy ecosystem of public and private actors – where there are incentives for private sector participation and investment, and rules that define the environment and guide the behaviors of health system players.
The tools co-produced by JLN member countries, such as “Engaging the Private Sector in PHC to Achieve UHC: Advice from Implementers to Implementers” manual, capture practical experiences and offer a global resource that countries can adapt to their health systems to achieve progress towards UHC.
The JLN members recognize, achieving the SDG of ensuring healthy lives and promoting well-being for all requires robust collaboration of government and the private sectors – a challenge that requires strong stewardship.
The JLN plans to build on the AHAIC joint learning session to launch more exchanges focused on improving public stewardship of mixed health systems, building on the PHC knowledge and other related areas of interest. Additional priority topics could include strategic purchasing, regulating quality in the private sector, and engaging private actors to provide key business or value-added services for national health insurance agencies.