Partnerships with the Private Sector in Health: What the International Community Can Do to Strengthen Health Systems in Developing Countries

April Harding


Can and should the international community help developing-country governments engage with the private components of their health systems? This report presents the findings of a working group hosted by the Center for Global Development (2008-2009) to examine this question. The working group examined the need for support in this area, and conducted interviews with a broad range of stakeholders to ascertain the demand for assistance and type of support desired. It recommends the creation of a global advisory facility to provide technical and implementation support to strengthen governments’ capacity to work with their private health sectors.

The private sector plays a significant role in delivering health care in developing countries. Developing-country health policy and donor-supported health programmes, however, have largely failed to address the problems or to harness the potential of the private sector in health. While interest is growing in working with the private sector to accelerate progress toward high-priority health objectives, governments in many low- and middle-income countries lack the skills and tools to do this effectively.

The public sector can use a wide range of policy instruments to engage and partner with the private sector in health. These include contracting out, licensing and accreditation, social franchising, social marketing, and vouchers. They have proven successful in advancing health priorities, (such as family planning, tuberculosis treatment, malaria prevention and treatment, and child and maternal health), and in reducing poverty through health care payment subsidies.

Taking advantage of the existence of the private sector to serve public health objectives is challenging, however. A lack of public sector expertise in developing and managing strategies to influence and collaborate with the private sectors is one of many barriers to be overcome.

  • Health officials lack skills and experience in: competitive procurement and health-services contract management; implementing and overseeing facility or professional accreditation in the private sector; and including private-sector actors in policy and planning.
  • The technical support offered by the international donor community to developing-country governments has so far done little to address these skill gaps.
  • Donors typically focus on public-sector programmes. Funding decisions largely fail to consider existing private sector provision, and this omission often undermines programme performance, and sometimes whole health systems.

The advisory facility should support developing-country clients by brokering knowledge, serving as an agent for change, providing strategic advice, and offering technical and implementation support for engagement strategies (for example, contracting, social franchising, and accreditation). A survey confirmed strong interest in these types of services. The facility would:

  • Mobilise experts and organisational partners to provide a wide range of services assisting governments to create, evaluate, or strengthen public-private partnerships in health.
  • Have a strong field presence and a hub-and-spoke organisational structure so as to better respond to demand in developing countries.
  • Have a three-pronged governance and management structure: a council to oversee management and operations; regional technical advisory boards to review regional strategies; and an operational unit to manage daily operations, financial operations, and technical activities.
  • Ideally be hosted by the World Bank-International Finance Corporation (on the basis of its related Health in Africa initiative and its success with the Private Participation in Infrastructure Advisory Facility).


Harding, A., 2009, 'Partnerships with the Private Sector in Health: What the International Community Can Do to Strengthen Health Systems in Developing Countries - Final Report of the Private Sector Advisory Facility Working Group', Center for Global Development, Washington, D.C.