The World Health Organization (WHO), with contribution from Oxford Policy Management, has published an exploratory study on private health sector governance in low- and middle-income countries (LMICs), exploring the impact governance approaches on effectiveness, efficiency and accessibility. health services. This review responds to the growing role of the private sector in health care and associated challenges in regulation, surveillance, and integration with public health goals. Although private healthcare plays an important role in meeting health demands in LMICs, the sector is often under-regulated, particularly in resource-constrained countries. Fragmented surveillance, minimal collaboration, and often inadequate data sharing practices have created a situation in which the private and public health sectors operate in silos, complicating efforts to ensure cohesive governance and equal access to care. quality. The review, organized around six WHO governance behaviors: ensuring strategy, enabling stakeholders, fostering relationships, building understanding, aligning structures and nurturing trust, examined more than a hundred studies to explore effective practices for integrating the private sector into national health systems.

Clear strategies with implementation gaps

In terms of Deliver strategy, the review found that while most countries recognize the role of the private sector in health policy, few provide structured frameworks that actively integrate it into achieving national health goals. health. For example, Ghana and Uganda have implemented private sector-specific strategies that highlight the importance of partnerships to achieve universal health coverage. Yet, in most cases, the potential of the private sector is underutilized due to the lack of formal agreements, clear guidelines and mutual accountability between sectors. Even in countries where private sector strategies exist, weak implementation and inconsistent government commitment mean that these policies are often not translated into action frameworks, creating a lack of opportunities where government capacity private sector remain largely underexploited. To address this, the review highlights that strategic inclusion should be a priority, but highlights the need for more concrete plans to guide such commitments.

Regulations are established but rarely enforced

The Enable Stakeholders category studies regulatory measures and findings suggest that while regulatory structures are in place, enforcement remains sporadic, primarily due to insufficient resources and staffing. Without consistent enforcement, private providers in many LMICs circumvent licensing standards and quality protocols, leading to disparities in quality of care. Kenya and Mongolia are examples where some success has been achieved, with regulatory efforts leading to the registration and recognition of private facilities. However, even in these contexts, a complex legal environment, coupled with limited inspection capacity, makes it difficult to ensure that all private entities comply with established standards. The report suggests that the fragmented regulatory framework not only hinders comprehensive governance, but also weakens public trust in health services, as variations in the quality of services can lead to distrust and reluctance to seek care in the private sector.

Building bridges between sectors

Fostering relationships between public and private actors is essential to promote cooperation and alignment of health objectives. However, the study reveals that distrust and conflicting interests hamper these relationships, as private entities often prioritize profit motives, sometimes at odds with public health goals. Public-private dialogues, particularly those led by donors or external agencies, have shown promise in strengthening relationships, but these efforts often fail once donor support ends. Ensuring the sustainability of these dialogues is crucial for long-term improvements in health care access and quality. Another key aspect of effective governance is Building Understanding, which focuses on data sharing and evidence-based policymaking. Many LMIC governments lack detailed information on private sector activities, limiting informed governance decisions. Although some progress has been made in collecting data from private entities, compliance remains low. Insufficient data limits the ability of governments to develop policies based on real-time needs and accurately assess the impact of the private sector. Integration efforts to include private data in national health systems are underway in several African countries, but challenges in standardization and interoperability still limit the effectiveness of these approaches.

Working together on essential health programs

Aligning structures within health care delivery, the WHO study notes that private sector participation is key to achieving consistent health outcomes, particularly in national programs like immunization and control. tuberculosis (TB), where private providers often complement public services. Despite these achievements in priority programs, there are limited mechanisms to extend this level of collaboration to other essential health services, leading to underutilization of private health care capacity. Aligning service delivery remains a fragmented process, as different sectors often lack coherent objectives or common standards. Nurturing Trust focuses on creating structures that protect patients’ rights and ensure equitable interactions between patients and private healthcare providers. However, many LMICs lack frameworks to enforce these protections due to lack of resources from regulatory bodies. The lack of accessible redress mechanisms leaves patients vulnerable and undermines the legitimacy of private health services.

The Path Forward for Public-Private Collaboration in Health

The report concludes with a strong focus on the challenges and opportunities related to private health sector governance, recognizing the need for policies that effectively integrate public and private health resources. The WHO proposed “pathway” aims to help countries systematically improve governance frameworks, enabling them to better coordinate health resources and improve service delivery through structured development phases. The review recognizes that meeting the complex governance needs of LMICs will require a balance of regulatory rigor, strengthened partnerships and increased investment in data infrastructure to track progress. As private health care plays an increasingly central role in LMICs, a strong and integrated governance strategy that aligns the efforts of both sectors is essential to improve health care outcomes, particularly for populations under poor health. served. The WHO framework therefore serves as both a guideline and a call to action for LMICs to foster sustainable health care partnerships that will improve access, quality and accountability across the board. their health systems.