By Dr. Kim Ozano, Professor Padam Simkhada, Dr. Lorna Porcellato and Rose Khatri
How best should the movement for universal health coverage consider the role of the private sector in delivering and financing health care? This was one of the questions that was considered at the Fifth Global Symposium for Health Systems Research (HSR2018), which took place in Liverpool, UK from 8-12, 2018. In an effort to capture discussions around Primary Health Care (PHC) and the Private Sector during HSR2018, 26 conference rapporteurs collected data in 93 sessions, and 21 interviews were conducted with policy makers, implementers and practitioners from the public and private sector. This has culminated in the publication of a report by the Public Health Institute at Liverpool John Moores University titled ‘Discussions around Primary Health Care and the Private Sector during the Global Symposia on Health Systems Research 2018’.
Key themes and recommendations from the report
HSR2018 provided a plethora of rich discussions on how to achieve Universal Health Coverage (UHC) and the role that the private sector plays or could play in this. There was no lack of enthusiasm for PHC from conference delegates and speakers and particularly those from low- and middle-income countries (LMICs) working in challenging environments. HSR2018 delegates took much pride in their health systems and many had a clear commitment to health for all. However, this is not possible without multi-sectoral collaboration and strong partnerships between governments, the private sector and citizens.
HSR2018 provided a platform to identify not only these challenges, but also the opportunities and the success stories. In one session, the speakers were asked to discuss their interventions with respect to Failing, Learning and Adapting. Health interventions do not always work the first time or take off, the importance of reflection, evaluation and analysis came out strong. Should the future be about building health systems, or rather building systems for health?
Recommendations highlighted in the report include:
- Produce guidance and discussion platforms to support policy makers and implementers to re-orient current verticalized health systems towards a comprehensive model of PHC that allows for integration of social determinants of health (SDOH).
- Improve data collection and analysis to provide evidence to decision makers that PHC is a cost-effective solution to health challenges.
- Use tools that have been tried and tested in similar contexts to build a solid business case for PHC and work with politicians, policy makers and civil society to sell the idea.
- Include non-health actors in the process.
Governance, Leadership and Accountability
- Provide opportunities for government leaders and policy implementers to develop competencies related to leadership, management and partnership working for the delivery of PHC services.
- Support the development of legal frameworks of governance and regulatory measures that protect and include the public and local level authorities in PHC accountability.
Cost of UHC, Health Expenditure and Financial Planning
- Develop and share knowledge, skills and tools of financial planning and procurement processes.
- Develop innovative methods to promote health insurance schemes to populations especially those most vulnerable.
- Identify insurance schemes, which subsidise the poorest sectors of society that are regulated and accountable.
Human Resources for Health
- Establish and/or share existing innovative mechanisms to monitor PHC staff capacity for managing and delivering quality PHC services and the geographical distribution and movement of workers.
- Produce guidance for financial planning of PHC HRH that includes supervision, logistical support and sufficient professional development opportunities.
- Consider the use of technologies to support managing large workforces.
- Increase training of local people in specific tasks to serve their communities.
- The concept of quality must be developed and owned by all levels of the health system and those working in it.
- Developing a culture of quality is key and Kenya provides a good example of embedding quality measures through the SQALE project.
- Promote ‘quality champions’ at all levels of government including and starting with the Minister of Health.
Changing and Emerging Contexts
- Develop guidance and policies that specifically address the complexities of urban environments to support municipalities to develop PHC systems that meet differing population needs.
- In conflict and fragile states, learn from best practice examples e.g. Afghanistan.
- Ensure that PHC plans have policies and procedures that address emergencies related to conflict and environmental changes and those countries with high numbers of refugees work across borders to achieve UHC.
- Work more closely with communities using participatory action research (PAR) approaches to enhance self-reliance and build assets.
Community Health Workers
- Support, value and reward CHWs as a core element of PHC. Reward does not necessarily have to be financial; training, opportunities for progression and ensuring support are important for motivation and retention.
- Develop strong CHW programmes in urban areas.
Data, Monitoring and Evaluation
- Ensure all countries are in a position to collect, analyse and interpret meaningful data to enhance PHC provision and performance in localities/communities as a priority.
- Global indicator demands, whilst important, should not drive local data collection.
- Develop initiatives to better engage, train and support small private providers such as community pharmacists to broaden their role and regulate their prescribing is one way of developing safer PHC services in many urban and rural contexts.
- Urgent policy level exploration is required for recognizing and strengthening public-private links to achieve comprehensive PHC and UHC.
- Develop clear mechanisms and legal frameworks for strategic purchasing and regulation and consider the power of purchasing medicines and supplies across countries within geographic regions.