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It’s Not About Either/Or. It Is About Health Outcomes.

November 3, 2018

I’m sitting in a dry run for a presentation a colleague is making at the upcoming International Family Planning Conference in Kigali, Rwanda.  The presentation asks us to consider whether there is room for family planning champions to join the movement toward achieving Universal Health Coverage (UHC).  Achieving UHC would mean that a country had covered all of the health needs of its population without anyone facing financial hardship.  This is a tall order but a widely shared goal given how many people globally have trouble accessing quality health care.

The issue my colleague’s presentation posed made me think about a similar question currently being debated: Should there be a role for the private health-care sector in UHC?  I have spent the majority of my career working on private health-sector programs and have seen the growth in government engagement with the private sector to expand access and increase equity. I know that when caregivers seek sick-child care, globally 43 percent go to the private sector. Reasons can include convenience, confidence and shorter wait times.

Given this, I assumed most people would respond with a resounding “yes!” But recently I realized that we private-sector advocates claimed victory too soon.

Last month, I participated in the Fifth Global Symposium on Health Systems Research in Liverpool, England.  For the first time, the private sector was one of the four main conference themes. Abt Global had speakers in many sessions, including a full-day satellite session we co-sponsored on “Engaging Private Providers in Low- and Middle-Income Countries:  Strengthening Quality of Care and Effective Regulation.”

While I was pleased to see the prominence of the private sector, what surprised me was the number of questions from private-sector skeptics. Many raised issues around equity and quality and the perception that the private sector cares only about profit maximization.  I was taken aback. Despite progress, these were the same arguments I’ve heard for the past 15 years. 

The ideological elephant in the room is the notion that health care is a public good and therefore should be free. But the reality is that, in practice, many still choose to seek care from private-sector sources.  For example, more than a third of all women who use modern contraception globally rely on the private sector. Even among the lowest two quintiles, large numbers of women use the private sector (27 percent in Asia and 19 percent in Africa).

However, this should not be an either/or situation.  We shouldn’t pit the public sector against the private sector. Achieving UHC requires consideration of the total health system and all of its resources. Asking whether the private sector should be part of the solution is the wrong question to ask. What are the right questions?

  • How can we help the public sector target resources to those facing the greatest financial risk?
  • How can we strengthen oversight of and participation by the private sector to expand access to quality products and services across a wide range of price points?
  • How can domestic resources from multinationals and other companies help improve health outcomes?
  • How can we strengthen public-private dialogue and collaboration to increase reporting and inclusive training and improve policy? 

As we look toward the International Conference on Family Planning on November 12, I am hopeful that these are the questions we will discuss. Regardless, we should be consistent in our messaging:  It’s not about either/or.  It’s about improving health outcomes. We can’t afford to sideline anyone who can contribute to that goal.

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