Let’s Talk About Private and Public Health Care

The discussion on the role of private health sector in low and middle income countries is often met with mixed feelings. Different paradigms on whether health is a public good versus a business underlie the discussions.

The private health sector is undergoing massive growth within low and middle income countries

The private health sector is undergoing massive growth within low and middle income countries. In Africa, the private health sector delivers about half of Africa’s health products and services. Moreover, a study shows that, the majority of South Asia depends on private health care services despite it being more expensive than public health care – a common trend in other developing nations around the world as well. This has been attributed to the substandard investment in the public health system, which has led to a decrepit state of public health facilities.

In Africa, the private health sector delivers about half of Africa’s health products and services

Insufficient financing of the public health sector in addition to weak health system governance - a feature in most developing countries - has led to a lack of credibility of the system and of the people operating within it. Frequently, despite having sought medical assistance in public health facilities, patients have to seek further care such as buying treatment and/or paying for laboratory and radiological tests in private facilities. This pictures, quite rightfully, the public health sector as inefficient and unreliable.

This gap has allowed growth of the private health sector which is minimally regulated, leading to an inability to control costs and services offered. Unfortunately, rather than filling in the gap left by the poorly-resourced public health system, growth of the private health sector is amplifying existing health inequities. Most private health facilities are located within the urban areas and offer services at unaffordable rates for the majority of the population. This has led to a rise in out-of-pocket payments, pushing people further into poverty. 

In India, which has one of the biggest private healthcare industries, about 39 million people are pushed below the poverty line as a result of healthcare expenses

For example, in India, which has one of the biggest private healthcare industries, about 39 million people are pushed below the poverty line as a result of healthcare expenses; while in Morocco, which passed a law allowing foreign investors to buy healthcare clinics, out-of-pocket expenditure accounts for more than 50% of total health care expenditure. What these two countries have in common is their weak public health system that contributes to significant inequities.

The private sector has been left to work on the edge of the health system, often being left out of the debate on health systems strengthening

Strengthening health systems is a major focus in the field of global health. Of note however, are the inadequate discussions on how to best include the private sector within the health systems framework. The private sector has been left to work on the edge of the health system, often being left out of the debate on health systems strengthening.  The private sector is not going anywhere, thus the need to have this conversation at global and national scale, if we hope to achieve universal health coverage (UHC) and the ‘Health for All’ goal of the Sustainable Development Goals (SDGs).

It's imperative to establish platforms where private health sectors are included in the health systems strengthening agenda

According to the International Covenant on Economic, Social and Cultural rights, Member States have the duty to ensure that everyone has the right to enjoy the highest attainable standard of physical and mental health. In this respect, not only are they stewards to ensure provision of affordable, accessible and quality health care for all their citizens, they also have a role to ensure that anyone acting towards the fulfilment of citizens’ health does the same. In the case of the private health sector, this could entail establishing regulations and social accountability mechanisms towards meeting the health system goals.

For example, the government can set a specific price charge for basic medical services such as basic laboratory tests (full hemogram, liver and kidney function tests), radiologic tests (x ray) and essential medicines within the private health sector. This will make these services accessible and affordable for the majority of the population. In order to achieve this, whether in policies or organizational structure, it's imperative to establish platforms where private health sectors are included in the health systems strengthening agenda, at the national and global level. This is a crucial step if we want to achieve Universal Health Coverage!