Harvesting What Works, Airing What Doesn’t When the Private Sector Engages in Health
Geneva, 23 May 2018
The private sector is an important partner in achieving the Sustainable Development Goals (SDGs) in women’s, children’s and adolescents’ health, but is there an inherent conflict of interest in making a profit while doing good? That was just one of the issues raised in a lively multi-stakeholder consultation hosted by the Independent Accountability Panel (IAP) as it sought input to its forthcoming report on private sector accountability.
In a free-flowing and wide-ranging discussion on the side-lines of the World Health Assembly (WHA) in Geneva in May, more than 80 representatives from government delegations to the WHA, UN Missions, the private sector, civil society, women’s and youth groups, UN agencies, foundations, the global funds, donors, and leaders of the Every Woman Every Child movement shared their views on what is working and what is not when the private sector is involved in global health.
Participants touched on several subjects related to private sector engagement, including roles and responsibilities of governments and other stakeholders; policies and regulations; health insurance; nutrition and the role of the food industry, alongside concerns about rising obesity and non-communicable diseases, as well as mental health. In their opening remarks, IAP co-chairs Carmen Barroso and Kul Gautam, said the panel’s report will focus on understanding how to engage the private sector in an accountable way so that the benefits to women, children, and adolescents are maximized. They stressed that “accountability is about building a virtuous cycle of learning and acting on those learnings to change how we do things and how we get better results for people’s health, rights and wellbeing. It’s about transforming underlying power dynamics and the structural inequalities that are at the root of the problems in the first place.”
Shaping the Private Sector’s Role
As the world shifts towards more integrated, people-centered care, participants emphasized that the private sector and its role in the global health space is highly complex, and varied, depending on country context. “We don’t know who the private sector is in most countries because they’re very fragmented and many of them are in small- to middle-sized enterprises,” said one participant from a private sector consulting firm.
In some countries, the private sector can help build capacities or has been integrated into the very fabric of the health systems themselves. But in others, with all the different players at different levels within the system, it’s not always clear what responsibility the private sector bears for bringing quality care to underserved populations.
Various participants expressed and acknowledged the important role of the private sector in delivering health services, making essential medicines and vaccines, and improving nutrition. At the same time, where unregulated, serious concerns were raised, such as abuses that violate patients’ rights, including forced sterilization; overreliance on C-sections; and denial of sexual and reproductive health services rooted in discrimination against women, lesbian, gay, bisexual and transgender people and other groups in many countries.
Participants also raised concerns about under-the-table payments and other practices by private sector providers in Eastern Europe that take advantage of the poor; impoverishment in India and elsewhere due to high out-of-pocket expenses for care in commercial hospitals; and the urgent need to stop price gouging by pharmaceutical companies for life-saving drugs. There were also calls for data transparency when industry reports scientific findings.
Several in the audience acknowledged that governments have an important role to play in both policing and incentivizing private sector activity in the health sector. One way is by giving recognition for quality by developing certification and accreditation programs. This can help small- and medium-sized health service providers to grow. “If you want the private sector to improve the health of women, children and adolescents, then it’s very important to have essential medicines available, it’s very important to have economic power amongst women, and it’s very important to have models that are sustainable, including the positive role of accreditation in creating a business opportunity for the private sector,” said one participant from an international nongovernmental organization (NGO).
The availability of quality technical assistance is also important as is making connections between health care providers and those who make and provide the products that people consume daily. Representatives from SMEs wanting to do good to improve nutrition, for example, said that it was difficult because they were not being reached with technical assistance and support. “What I observe in the work that we’re doing is that the health system and the food system are very disjointed,” said a participant from another international NGO. The lack of communications links is one of the conceptual flaws in addressing an issue like obesity, where pressure is being put on the private sector and the food system to shape up and provide more healthy food, while nutritionists are circling in their own circles and designing their own interventions without collaborating with the food system to make sure quality food is available for all.
Leveling the Playing Field: A Call for Stricter Regulations, Clearer Policies
Recognizing the value of what the private sector brings, many participants—including those from private sector organizations—said that the main challenge in terms of accountability is the need for clearly defined policies and regulations so that the different models of private sector engagement can most benefit women, children and adolescents. Participants discussed the need for a whole system approach that would focus on what steps and policies would be required to bring both the public and private sector, alongside other stakeholders, together.
“One of the things that we’ve found is that there’s a huge evidence gap around private sector engagement and what works and what doesn’t,” said one participant from a civil society organization. “A lot of countries don’t have a defined policy on the private sector and they also don’t necessarily have strong governance arrangements and that’s another big problem.” Participants acknowledged that this diversity means that there is no one size that fits all and that private sector engagements have to be nuanced and very country- and context-specific.
Some participants raised the concern that there is no global governance mechanism to regulate industry on such issues as pricing patterns for life-saving drugs that are still under patent protection. They suggested to the panel that the creation of that type of system would encourage greater transparency and promote more comprehensive conflict of interest policies.
The issue of Universal Health Coverage was brought up several times during the discussion, with participants highlighting that regulation is much needed in this area to ensure that women, children, and adolescents can receive essential services without incurring out-of-pocket expenses.
The private sector representatives in the audience emphasized that while they are in business to make a profit, they are also committed to and interested in mobilizing their expertise for public goods. Private companies, however, need guidance in doing good and rely on movements like Every Woman Every Child to help them to align with the set priorities. “A lot of times having worked in a huge private sector company, we sometimes struggle in some countries where there are no clearly defined government policies and no clearly defined pathway as to how the private sector should engage,” said one participant. “The motivation has to be of us trying to help, so I think we need to look at accountability not just of the private sector on its own but how it can be part of an integrated healthcare system.”
The IAP plans to present its report at the UN General Assembly in New York in September.
All photos courtesy of Ieva Ozola