Bridging the Gap: WHO's Strategy for Public-Private Healthcare Integration in Developing Nations

The WHO review highlights the need for stronger governance in low- and middle-income countries to integrate and regulate the private healthcare sector, emphasizing structured partnerships, effective data-sharing, and enforcement mechanisms to improve access and quality of care. The proposed "Progression Pathway" guides countries toward cohesive public-private health collaboration for sustainable outcomes.

The World Health Organization (WHO), with contributions from Oxford Policy Management, has released a scoping review on governing the private healthcare sector in low- and middle-income countries (LMICs), exploring how governance approaches impact the effectiveness, efficiency, and accessibility of healthcare services. This review responds to the rising role of the private sector in healthcare and the associated challenges in regulation, oversight, and integration with public health objectives. While private healthcare plays a significant role in meeting health demands across LMICs, the sector is frequently under-regulated, especially in countries with limited resources. Fragmented oversight, minimal collaboration, and often inadequate data-sharing practices have created a situation where the private and public healthcare sectors operate in silos, complicating efforts to ensure cohesive governance and equal access to quality care. The review, organized around six WHO Governance Behaviours Deliver Strategy, Enable Stakeholders, Foster Relations, Build Understanding, Align Structures, and Nurture Trust examined over a hundred studies to explore effective practices for private sector integration within national health systems.

Clear Strategies with Gaps in Implementation

In terms of Deliver Strategy, the review found that while most countries acknowledge the private sector’s role in health policy, few offer structured frameworks that actively incorporate it into achieving national health goals. For example, Ghana and Uganda have established specific private-sector strategies that underscore the importance of partnerships in achieving universal health coverage. Yet, in most cases, the potential of the private sector is underutilized due to a lack of formalized 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 often do not translate into actionable frameworks, resulting in an opportunity gap where the private sector’s capabilities remain largely unleveraged. To address this, the review highlights that strategic inclusion should be prioritized but underscores the need for more concrete plans to guide such engagements.

Regulations Are Set but Rarely Enforced

The Enable Stakeholders category investigates regulatory measures, and findings suggest that while regulatory structures are in place, enforcement remains sporadic, mainly due to inadequate resources and personnel. Without consistent enforcement, private providers in many LMICs bypass licensing standards and quality protocols, leading to disparities in care quality. Kenya and Mongolia are examples where some success has been achieved, with regulatory efforts leading to registered and recognized private facilities. However, even in these contexts, a complex legal environment, coupled with limited inspection capacity, makes it challenging to ensure that all private entities adhere to established standards. The report suggests that the fragmented regulatory framework not only impedes comprehensive governance but also weakens the public’s trust in healthcare services, as variations in service quality can lead to distrust and reluctance to seek care within the private sector.

Building Bridges Across Sectors

Fostering Relations between public and private stakeholders is essential to promote cooperation and alignment of health objectives. However, the review reveals that mistrust and conflicting interests hinder these relations, as private entities often prioritize profit motives, sometimes at odds with public health goals. Public-private dialogues, especially those led by donors or external agencies, have shown promise in strengthening relations, but these efforts often dissolve once donor support concludes. Ensuring sustainability in these dialogues is crucial for long-term improvements in healthcare access and quality. Another key aspect of effective governance is Building Understanding, which focuses on data-sharing and evidence-based policy development. Many LMIC governments lack detailed information about private sector activities, which restricts informed governance decisions. Although some progress has been made in collecting data from private entities, compliance remains low. Inadequate data limits the ability of governments to develop policies based on real-time needs and to evaluate the private sector’s impact accurately. Integration efforts to include private data in national health systems are underway in several African countries, yet challenges in standardization and interoperability still limit the effectiveness of these approaches.

Working Together on Essential Health Programs

Aligning Structures within healthcare delivery, the WHO review notes that private sector participation is critical in achieving cohesive health outcomes, particularly in national programs like immunization and tuberculosis (TB) control, where private providers often supplement public services. Despite these achievements in priority programs, there are limited mechanisms to expand this level of collaboration to other essential health services, resulting in underutilized private healthcare capabilities. Alignment in service delivery remains a fragmented process, as different sectors frequently lack cohesive objectives or shared standards. Nurturing Trust emphasizes establishing structures that protect patient rights and ensure fair interactions between patients and private healthcare providers. However, many LMICs lack frameworks to enforce these protections due to under-resourced regulatory bodies. The absence of accessible mechanisms for redress leaves patients vulnerable and detracts from the legitimacy of private healthcare services.

The Path Forward for Public-Private Health Collaboration

The report concludes with a strong emphasis on the challenges and opportunities in governing the private healthcare sector, recognizing the need for policies that integrate public and private health resources effectively. The WHO’s proposed "Progression Pathway" aims to assist countries in systematically improving governance frameworks, enabling them to better coordinate healthcare resources and improve service delivery through structured phases of development. The review acknowledges that addressing the complex governance needs of LMICs will require a balance of regulatory rigour, strengthened partnerships, and increased investment in data infrastructure to track progress. As private healthcare plays an increasingly central role in LMICs, a robust, integrated governance strategy that aligns the efforts of both sectors is essential to improve healthcare outcomes, particularly for underserved populations. The WHO’s framework thus serves as both a guideline and a call to action for LMICs to foster sustainable healthcare partnerships that will enhance access, quality, and accountability across their health systems.