UHC - The Role of the Private Sector.pdf

7/27/2019 UHC - The Role of the Private Sector.pdf

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DISCLAIMER: This document is not a consensus statement, and should not be viewed as necessarily expressing the individual or

collective views of the panellists or organisations associated with this symposium.

World Health Summit 2013

Universal Health Coverage: The Role of the Private Sector

Symposium, 22 October

Welcome Address

Dirk Schattschneider I Director General for Planning & Communication I German Federal Ministry for Economic

Cooperation and Development


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RAPPORTEUR NOTES

Definitions

The panel began by discussing different definitions of the key terms Universal Health Coverage(UHC) and the private sector. It was debated whether Universal Health Coverage (UHC) should

refer not only to providing access to services for all, but also to ensuring that those services are of

high quality and operate in combination with some form of financial protection that will protect

patients from falling into poverty due to out of pocket payments. However, it was suggested that

UHC can only be a means to an end, the end being improved health status, which is dependent on

many other factors including the social determinants of health.

The value of the term non-state actors was also discussed as potentially offering a more inclusiveterm for referring to (and recognising the diversity of) the private sector, which was suggested as

encompassing a wide range of providers from the larger for-profit, non-profit and faith-based

institutions to pharmacists, village doctors and traditional healers at the local level.

It was debated that while health may still be viewed as a public good and indeed, a basic humanright this does not mean that it is the exclusive responsibility of governments to deliver health

services. An example provided by Khama Rogo of a pregnant woman seeking treatment in Kampala

was used to illustrate the reality of many people in moving frequently between all kinds of public

and private health providers, and the associated challenges patients can face when these services

are poorly integrated with each other. It was suggested that in the eyes of the patient, the cost,

quality and accessibility of care are more important than if the provider is public or private.

A number of panel members agreed that governments alone cannot achieve the health outcomesrequired for their populations, and that the role of non-state actors is still largely overlooked due to

poor awareness of their potential contribution and a lack of capacity within governments to engage

effectively with the private market. The notion that achieving UHC is itself dependent on the non-

state sector being acknowledged and harnessed as an equal partner in providing healthcare was

also debated, in light of some of the comparative advantage NSAs may have in generating

resources, undertaking R&D, piloting new innovative approaches and (primarily) their potentially

deeper penetration into the harder-to-reach communities.

Regulation and Financial Protection mechanisms

The positioning of health as a basic human right rather than a marketable good was debated,leading to discussion around the potential importance of regulation in preventing a profit-driven

market distorting the ability of all citizens especially the poor to afford and access quality

services. Panel members debated the role of legal, regulatory, financial and ethical frameworks in

creating an enabling environment that would allow NSAs to make an effective, appropriate and

integrated contribution to quality health care for all.

Panel members discussed the apparent lack of government regulation of non-state actors indeveloping countries, and a perceived trend towards medicalising the idea of health as being

based around the consumption of drugs rather than attention to an individuals broader wellbeing.


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The issue of regulatory enforcement was also discussed, and it was noted by some that while UHCcan be enshrined in a constitution, the reality can sometimes be very different for patients who

must pay bribes and informal payments at the point of service.

The panel members debated the previous experiences of governments in introducing regulatoryframeworks, and the potential value of inviting NSAs to the table as a government partner in order

to co-produce regulatory frameworks relevant to the particular health priorities of that country.

The capacity building needs of both parties in this context were also debated, as was the need to

more effectively incentivise NSAs to comply and report against these frameworks and assist

governments in being able to effectively enforce and evolve regulatory frameworks as appropriate.

Mechanisms to provide financial protection to patients (e.g. health insurance schemes or patientsubsidies) were debated from the perspective of helping to prevent patients from falling (deeper)

into poverty as a result of out-of-pocket costs when seeking healthcare services. It was

acknowledged that national health insurance schemes are now becoming more common, with the

African Union recently mandating that every African country must introduce some form of social

health insurance scheme. The appropriate balance and respective contributions of both public and

private actors in such schemes was debated, and many panellists expressed support for the idea

that governments must take the lead in developing and overseeing these schemes, but that NSAs

should also play a role to enhance sustainability and efficiency. The challenge of making these

financial protection schemes both equitable and pro-poor was discussed, with some panellists

suggesting that these schemes should promote healthy wellbeing as well as medical treatment, and

include transparent risk-sharing arrangements between the public and private partners to cover

the diversity of patient needs. One panellist also highlighted the importance of increasing access to

finance for private investment in helping the private sector participate in these schemes, referringto the apparently high interest rates in many African countries that are potentially preventing many

NSAs from providing business models that serve the poor as well as the rich.

Issues for further discussion

The panel discussion and ensuing Q&A with the audience demonstrated that there are still diverseopinions around the idea of health, and what is within and outside this sector. It was suggested by

some that the diversity of health care services now required in the 21st

century is such that it

demands an equally diverse group of actors (i.e. public and private) to deliver them. The panel also debated the potential value to be found in balancing the current perceived trend

towards combatting specific diseases (e.g. malaria) with recognition and investment in the more

basic needs associated with shelter, clean drinking water and nutritious food, which may have a far

greater impact in improving the health of impoverished communities. As one panellist suggested,

this approach would be more effective in focusing on the life of the individual and not just the

survival of a patient.

The symposium concluded with a discussion around how to develop greater sophistication inhealth systems in order to respond to changing patterns in the burden of diseases, e.g. with the

rapid increase of non-communicable diseases now affecting the poor as well as the rich. One

suggestion put forward by a panellist was to invest in creating a more informed and educated

patient population able to identify, select and evaluate healthcare services appropriate to them.

Documents

UHC - The Role of the Private Sector.pdf