Public and Private Partnerships in Fragile and Conflict Affected Settings

Public and Private Partnerships in Fragile and Conflict Affected Settings

Our series of roundtables aims to identify ways a research partnership platform can help both governments and the private sector respond to a challenge like COVID-19

Public and Private Partnerships in Fragile and Conflict Affected Settings

Last week the Private Sector In Health (PSIH) TWG and the Fragile and Conflict-Affected States (FCAS) TWG co-organised a webinar on ‘Capturing The Landscape of Health Service Delivery and Public /Private Partnerships in Fragile & Conflict Affected Setting‘. This event took place as part of the PSIH TWG’s mutual learning series on ‘Unlocking Private Enterprise for Public Good – Redesigning Health Systems for UHC during COVID-19 and beyond’.


  • Dr Nigel Pearson provided an overview of main findings from a recent study on private sector role in the Middle East region (WHO EMRO).
  • Michael Chommie provided an overview of PSI’s work on developing a social enterprise model for health service delivery in various contexts from a multi country perspective with Dr. Moh Moh Lwin: PSI Myanmar spoke about the Sun Quality Health Network.
  • Dr Harry Jeene explored the efforts to ensure the continuity of drugs supply chain during COVID in Afghanistan.
  • Dr Bothania Attal spoke about the roles and challenges of informal networks for service delivery in Yemen.
  • Dr Abdi Dalmar recounted his experiences establishing and scaling a franchised service delivery model in Somalia.
  • Dr David Clarke, who leads the advisory group supporting WHO to elaborate a strategy to support private sector engagement, reflected back on the cases presented during the panel discussion, conveying the key message to the academic community.

Facilitators: Priya Balasubramaniam, PSIH TWG, Barbara Profeta and Ann Canavan FCAS, TWG

Key Takeaways

  • Private sector initiatives in FCAS tend to develop rapidly, largely in organic ways, and the share of service delivery by private sector actors (profit and not-for-profit) is very high. This generates significant out-of-pocket payments for impoverished populations, but ensures at the same time some level of continuity of healthcare that would be otherwise collapsed. However, rules for engagement are almost non-existing or not respected. While engaging with the private sector in contexts of protracted crises is a complex endeavour with no “zero risk” possible, not engaging is not an option, as the UHC agenda would fail most of the population.
  • The aid industry (mostly humanitarian aid or NGOs, such as PSI) tends to be one of the few reliable sources of information about private sector engagement in FCAS, because country information systems are usually fragmented, if existing, and tend to be biased towards capturing initiatives channelled through the government or international intermediaries. The lack of a proper regulatory framework for private sector engagement in FCAS turns large portions of private sector engagement into informal dynamics that are challenging to systematise.
  • Documenting anecdotal evidence will be key to generate new insights and capture novel approaches to service delivery. However, capturing anecdotal evidence in FCAS – where every crisis scenario is unique and information is resistant to generalisation – is difficult. In order to survive and guarantee continuity of care, numerous dynamics are better off, if they remain unnoticed and informal.
  • In Afghanistan, amongst the established supply chains within a hybrid health system, a new grey one re-emerged. It includes lower quality drugs smuggled in the country and sold through informal medicine shops where quality is often an issue. In the current context, should this channel be better acknowledged and documented as it is offering services in hard to reach areas?
  • In Yemen, where political divisions have affected the health system in different ways in different parts of the country, the COVID response has been disorganised. A mosaic of partnerships have emerged, including informal networks motivated by human solidarity and often headed by (more or less independent) health professionals or occasional business persons, which have played a key role in supplying personal protective equipment and other equipment in hard to reach areas.
  • In Somalia, a portion of the private sector in health has been able to self-regulate in the absence of an established regulatory framework. As an organised group of private sector providers (as opposed to individual businesses), the Caafinet franchise has become a more trusted and recognized partner and interlocutor for the government. As an organised group, private service providers represent a better guarantee the reputation, quality and motivation of the facilities involved and the services provided. This has lead to a first of its kind shift in partnerships in Somalia: testing services initially outsourced to partners in neighbouring countries were entrusted (at least partly) to Caafinet in an official public-private partnership during the Covid-19 response. Something new to the country.
  • WHO is interested in working with the research community to develop a research agenda informed by documented anecdotal case studies in FCAS contexts.
  • The mutual learning platform can help with documenting such anecdotal evidence (focusing not only on the challenges, but more importantly on solutions to challenges) by bringing people together virtually and creating a community on research on public and private partnerships.

Don’t miss our next event in our mutual learning series on 19 November on ‘New Primary Health Care Partnership Models During and beyond COVID-19’.

Our series of roundtables aims to identify ways a research partnership platform can help both governments and the private sector respond to a challenge like COVID-19 and also apply lessons learned to engage beyond this emergency in strengthening future health systems.

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