The report, in its first part, destroys three common myths regarding the private health care sector in Africa:
- First, that the private sector is for the rich and the public sector for the poor. As demonstrated here, the poorer segments of the population do use the private sector extensively, and the public sector does substantially subsidize richer people who use its services.
- Second, that health is mainly financed by the public sector. In fact, the public sector finances less than half of total health expenditures. The rest is being financed from out-of-pocket, which goes primarily to buying services from the private sector. In most African countries, the private sector plays a more significant role than government, especially when compared to OECD countries where public financing provides the majority of resources.
- Third, that the private sector is not very developed in most African countries. In fact, in most countries the private sector provides a third or more of all health services.
Yet, in Africa most governments and aid organizations focus on public delivery of health services.
So, how to engage the private sector effectively? The second part of this report tries to answer with examples of some successful public-private partnerships (PPPs), using the broad definition of PPPs in health as any formal arrangement between government and a private entity established for the purpose of providing health services. The report also highlights some of the new trends in public-private partnerships and how to make use of opportunities which present themselves. Finally, it identifies what governments, the private sector, and the World Bank Group could do better.
It’s clear today that unless one considers the health system in its entirety, the full spectrum of options for improving health outcomes will not be utilized. Considering the limitations on public health budgets and the reality of out-of-pocket spending flowing toward the private sector, it is time to bring the private sector into the fold as an ally in the struggle to provide higher quality services to a greater number of people. PPPs are a way to optimize the use of available resources.
It is expected that the information in this paper will be updated every two years or so, as more evaluation data become available and as more public-private partnerships are implemented.