Mixed Health Systems

Results for Development works with country governments; private sector providers of products and services; innovators and social entrepreneurs; as well as local, regional and global partners and funders to strengthen mixed health systems and support countries on the road to universal health coverage (UHC). The aim is to improve health outcomes and enable resilient health systems.

The Challenge

There is growing global consensus that achieving UHC and the Sustainable Development Goals (SDGs) will require strengthening “mixed health systems” — to optimize engagement between public and private sectors to equitably deliver quality products and services to consumers. Specifically, there is recognition that public sector delivery systems and supply chains alone lack the capacity to meet the demand in the system created by UHC commitments. However, by effectively stewarding mixed health systems, countries can level the playing field for both public and private sectors and innovators, increasing equity in access and quality of services and products across both sectors. Despite a greater understanding and commitment to strengthening mixed health systems and public-private engagement, the challenge of how to do so successfully remains.

Our Approach

R4D’s work to strengthen mixed health systems is rooted in several principles including that:

  • Mixed health systems and public-private engagement should be fit-for purpose and responsive to a set of shared, validated population health needs, demands, and challenges as expressed by the health system actors;
  • The public health sector should provide strong stewardship of mixed health systems, including: mobilizing, engaging, incentivizing, regulating, and monitoring public and private actors to optimize the health market;
  • The private health sector can be engaged, organized, and shaped to provide high-quality, affordable health services that help countries move toward UHC through government incentives and targeted social investment;
  • Sustainable private sector-initiated innovations should be shared throughout the marketplace; and
  • Both “hard(technical and system-level) and “soft” (engagement and interpersonal) factors must be considered to achieve effective, efficient and resilient mixed health systems.

Employing these principles, R4D’s approach to strengthening mixed health systems includes work in 5 areas:

  1. Support national and sub-national governments to become better system stewards. Work with country governments including national ministries of health and health financing agencies to create policies and practices to more effectively engage and steward private providers of services and products.
  2. Strengthen capacity and self-reliance of private providers, entrepreneurs and innovators. Support defragmentation of the private sector, build capacity of intermediary organizations and networks, while also strengthening the capacity and scalability of providers, entrepreneurs and innovators, including their ability to engage with the public sector.
  3. Act as neutral brokers and incubate platforms and processes for dialogue. Facilitate deliberative dialogue processes to foster trust and mutual understanding among public and private sector, and incubate, structure, facilitate and sustain platforms to support public-private engagement.
  4. Strengthen country enabling environments and technical assistance ecosystem for mixed health systems. Strengthen system processes and institutions to regulate and provide quality oversight, develop and integrate financing mechanisms, foster political will, and organize service delivery. Collaborate with local mixed health systems strengthening experts and partners to ensure work is properly tailored to each context and that the evidence used to help inform decision-making processes builds on recent activity and avoids duplication of previous efforts.
  5. Facilitate global, regional and local cross-learning on mixed health systems. Enable, structure, facilitate and sustain networks and platforms for joint learning on mixed health systems at the sub-national, national and global levels. Act as a knowledge translator of learning and information on mixed health systems.

Our Work

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