The health systems of most low and middle-income countries (LMICs) are mixed, meaning that public health services operate side by side with private markets. The private sector may serve as the first point of care, especially for many sexual and reproductive health needs. Without interventions such as clinical social franchising, clients will pay out-of-pocket for variable service quality and limited access — excluding primarily lower-income quintile and vulnerable populations and placing an increased financial burden on users seeking care. The government, however, may lack the motivation, capacity, or mechanisms to support and regulate private providers and strategically purchase services. Still, effective public-private engagement and partnerships are necessary to achieve universal health care coverage (UHC) and advance national health initiatives.
Aggregators, such as clinical social franchisors and health management organizations, organize private, independent health care businesses into quality-assured networks that provide accessible, high quality health services. They can help to address the challenges of public-private disjunction, but face several barriers, including building enough capacity and financial support to deliver services at scale and promote public health goals. Countries making progress towards UHC may have dedicated financing available to support these efforts as harnessing the private sector will be critical to achieve and sustain success.
For private sector aggregators interested in participating in UHC initiatives and strengthening mixed health systems, it is necessary to develop a strong understanding of both the broader health market in which they exist and their role within it to identify potential opportunities for engagement. As part of the USAID-funded Support for International Family Planning and Health Organizations (SIFPO2) project, Population Services International (PSI) partnered with Results for Development to identify how private sector aggregators can access new sources of funding to expand family planning and reproductive health services to the poorest women and girls. This guide was created to help aggregators systematically gather, organize and analyze information to develop promising options for engagement, as well as develop a foundation of knowledge around key health-system principles and functions.
A Practical Guide for Network Managers
This process-orientated guide is intended for organizations working with private health care providers, as well as for health financing experts. It provides technical guidance, templates, and practical country examples for planning and conducting analyses to identify opportunities to connect aggregators and provider networks with domestic and other third-party sources of financing and delivery systems to advance UHC efforts and other national priorities.
What does success look like?
The guide helps network managers and technical experts navigate the steps necessary for gathering, structuring, analyzing and reporting information needed to make strategic plans that improve sustainability and equity.
Successful application of this guide will:
- Advance the understanding of health financing mechanisms and their impact on the quality, equity and utilization of services supported by the aggregator organization;
- Empower aggregators to think and speak about health financing critically in light of the health financing landscape and their role in the health market, and define their value proposition for successful engagement; and
- Enable the development of strategies and action plans for aggregators to effectively sensitize and engage with key government officials, payers and development partners as well as devise implementation approaches.
Authors: Nathan Blanchet (R4D), Adeel Ishtiaq (R4D), Neetu Hariharan (R4D), Cynthia Eldridge (Impact for Health) and Pierre Moon (PSI)