Private capacity, public payment: private business participation in government initiatives to improve access to critical health services

Insight Health Advisors research provides new thinking on what is needed to design effective government policy initiatives in low and middle income countries that work through private providers to deliver health services to the poor.

Companies in low income countries often fail to understand government policies designed to engage the private sector in health systems, and lack the skills and capacity that qualify them to participate in these initiatives. This research identifies challenges related to information and capacity, financial insecurity, organisational cultures and corruption, and provides recommendations aimed at making health services more accessible to the poor.


To capture the dynamics between public and private sectors in health, the research team used a health markets approach to guide the selection and analysis of mechanisms or policy tools that governments use to engage private sector players in health. Through a detailed desk review of existing studies and databases compiling examples of market-oriented health programmes as well as interviews with experts, we developed four policy case studies: 1) health vouchers, 2) government health insurance schemes, 3) co-location of healthcare services, and 4) service contracting. For each policy type, we explored country examples from Kenya, Uganda, and India using both published documents and key informant interviews, exploring the following:

  • Barriers private health businesses face in learning about and participating in government schemes
  • Strategies that successful private businesses have employed to participate in government initiatives to deliver health services
  • Specific skills and capacities needed for private health businesses to qualify for these government programmes
  • The role governments can play to facilitate greater private sector participation in delivering pro-poor health services.


The report discusses in-depth the five key areas where government and private providers experience challenges when trying to work together: 1) information deficit, 2) weakness in management capacity, 3) insecure funding environment, 4) mismatch in organisational cultures, and 5) corruption, with practical examples. Based on the existing evidence as well as the interviews conducted for the research, the research offers specific recommendations to governments, private providers, development partners, and health market practitioners

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