For those of us working in global health, our eyes are turned today to the UN’s meeting on universal health coverage (UHC)—catalyzing a movement that is gaining momentum around the globe. I am excited to see so much attention being directed toward universal access and hopeful that government leaders will use this meeting as an opportunity to make a bold political commitment to UHC.
While there has been growing attention to universal health coverage across the global health community, I believe that the private sector role in UHC has been underappreciated to date and will be a critical part of making the UHC agenda a reality.
When working with clients on this topic, I have found we often have to start by being clear on what we mean by “private sector” in this context. When it comes to accessing health care, the “private sector” shouldn’t be treated as a monolith. Instead, it’s important to understand the variety of private actors who could play a role in realizing the vision of UHC:
Private health care providers: Hospitals, health systems, private labs, and pharmacies likely have the largest role to play around UHC;
Corporations: Life sciences and other medical product companies can invest/co-invest in LMIC markets—and private logistics companies can help manage supply chains and distribution in these markets;
CSR and global access divisions of large health care multinationals;
Academic institutions and partners can train the next generation of health care workers to address shortages, as well as provide platforms for identifying and sharing best practices across countries;
Professional networks and associations can serve as formal or informal partners to tackle specific objectives, provide technical assistance, training, and on-the-ground expertise;
Financiers: Financial institutions and payers can provide resources via a variety of mechanisms and channels;
Program implementers: NGOs can support on-the-ground program implementation, in many cases increasing capacity at the point of care
In our work on global health challenges in LMIC, we have consistently seen how the private sector can provide much-needed capacity and capabilities. We have also seen how the private sector is often well-positioned to meet patients where they are, satisfying specific patient preferences that are not well met by the public sector in some markets.
Three examples illustrate how the private sector can be a powerful addition to countries’ health systems:
South Africa: South Africa has committed to UHC and is currently designing and implementing national health insurance. As part of that process, the government recognizes the need to partner with private sector providers to expand access and capacity within the system. Nowhere is this more true than in the field of HIV/AIDS. The public sector is significantly under-staffed when it comes to HIV/AIDS care, which results in long wait times for routine care. Moreover, many patients are lost to follow-up because the care provided in the public sector is not well matched with their needs and preferences. Stronger ties between the public and private sector could dramatically increase access to care for people living with HIV in South Africa—and ultimately help the country reach its goals of 90% treatment compliance.
Indonesia: In Indonesia, approximately 50% of tuberculosis (TB) patients receive care in private clinics or hospitals, yet until recently the national government had very limited data on these privately managed cases and no way to ensure quality of care. Following two USAID reports, supported by BCG, which analyzed the behaviors and preference of patients and providers in the private sector, the Indonesia National TB Program has begun to explore new ways to identify TB cases in the private sector and encourage high quality care at the right level of service. This is another example where capabilities provided by the private sector have proven essential in meeting health needs of the population—and better linking of public and private sectors has begun to improve overall health care delivery, and quality of care provided, to patients.
Private sector innovators of new health solutions, approaches, and products in LMIC markets: There are innumerable examples of local private sector innovators in LMIC markets developing new approaches, care delivery models, and products (digital or not) that are improving health care delivery and access across resource-constrained contexts. Consider Flare, a company in Kenya that offers an Uber for ambulances. Or Sproxil, a start-up serving West Africa that protects consumers from counterfeit medicines. Or the many digital and AI startups across Latin America, Asia, and Africa enabling consumers to access health care without visiting a facility. These private sector innovators are already driving progress towards UHC because their innovations and service models improve health access and delivery, reduce costs, and improve health system efficiency. Integrating these types of private sector innovators into the broader dialogue around UHC will help accelerate progress towards this agenda.
 “Strengthening Private Provider Engagement in Addressing TB In Indonesia: An Institutional Review,” USAID, Indonesia TB Program, November 2018 (BCG support on analysis and development of report).
UHC is not only a critical goal for the global health community in and of itself—but also a key enabler of other global health priorities and of broader progress in reaching the 2030 sustainable development goals. As the world continues on this journey towards UHC, I am excited to see how the public and private sectors can come together to increase equity and improve quality of care for all.