Many countries recognize the potential for harnessing the private sector to improve health outcomes and achieve universal health coverage (UHC), but they often struggle to effectively steward these mixed health systems. Despite a myriad of research on public-private engagements (PPE) in mixed health systems, there have been limited efforts to review existing evidence and synthesize actionable lessons that decision-makers and practitioners can use to strengthen mixed health systems.
With support from Merck Mothers, Results for Development (R4D) conducted a systematic review of published evidence to answer two questions:
- What is the evidence that exists that supports or rejects the hypothesis that strengthening mixed health systems and public-private engagements can improve outcomes for maternal and newborn health and help achieve UHC?
- What evidence exists regarding how strengthening mixed health systems and public-private engagement are associated with stronger or weakened health outcomes, including the motivation for creating PPEs, the models and structures of PPEs, and the factors (both external and internal to the engagement) that are associated with outcomes?
We conducted a modified systematic review to map evidence on the effectiveness of health-related PPEs in published literature. We included published articles, representing theoretical literature on PPEs and studies focused on specific PPE experiences across diverse contexts.
Our findings suggest that while stewardship functions related to financing and regulation (environmental factors), and to some extent factors related to models of PPE (structural factors), are common in the literature, even more prevalent are factors related to the dynamics and interactions between engagement actors. These “engagement factors” — the relationship dynamics between actors such as trust, willingness to engage, and mutual understanding, as well as the actors’ capacities — may significantly influence PPE effectiveness.
