Private organisations are major providers of health care in poorer parts of the world. They come in all shapes and sizes – large hospitals, small clinics, formal and informal, some run for profit and some non-profit. Together, they deliver more than half of all healthcare in Africa. In Brazil, private beds account for 39 per cent of the total and in the Philippines 45 per cent.
We have to recognise that if we are to achieve Sustainable Development Goal 3 and have safe, effective, accessible and affordable healthcare for all then private providers have an essential role to play. But this makes some people uneasy. Critics say private health providers are less accountable and there are not enough checks and balances in the system to ensure the best outcomes for patients and the best deal for governments.
In response to this challenge, CDC Group, the UK’s development finance institution, commissioned the Institute of Global Health Innovation at Imperial College London, to develop a framework to measure the impact that large private for-profit providers have on their patients and the health systems in which they operate.
We know the problems associated with private providers: poor regulation, barriers to access for the poor, incentives to over-treat. If they are to contribute to improved care for patients and provide good value to governments then they must fill gaps in existing services, and be integrated with the local health system.
This already happens in some parts of the world. In Brazil, the International Finance Corporation helped create the Hospital de Suberbio in the state of Bahia, which dramatically improved emergency hospital services for a million people. In India, the private Aravind hospital developed a low cost approach to eye care which has led to similar developments in other specialties such as heart surgery.
We want to ensure private organisations have a positive impact more widely. Our framework starts by asking if the care delivered is safe, effective, of high quality and approved by patients. It assesses access – do patients get the care they need in spite of the financial, organisational, geographical and cultural barriers that may stand in their way?
These are familiar questions. Where our framework breaks new ground is in its assessment of the impact of private providers on the broader health ecosystem. This is critically important, highlighted by all the experts interviewed for the project, but often neglected.
The framework assesses the availability of a properly trained workforce, with sufficient numbers of staff, and examines measures taken by the organisation to contribute to the workforce pool. Where training is offered, strict adherence to medical education regulation is essential to ensure standards are maintained.
It also assesses stewardship – how far the private organisation partners with government, regulatory and accreditation organisations, to strengthen oversight and raise standards. This may involve showing leadership in addressing unmet needs, spreading innovation or participating in health promotion such as reducing overuse of antibiotics.
We tested the framework successfully in Narayana Health, a major private hospital chain in India, which allowed us to refine and strengthen it. Our report, Evaluating the impact of private providers on health and health systems, to be launched on 28 June, shows how it can be used by investors, policy makers and private hospitals themselves to clarify their strategy, assess their performance and increase their impact.
For private providers, the framework will enable them to demonstrate their positive effect on patients and the wider health system, and thereby boost their brand, give them a competitive edge, reassure patients and inspire their staff. Those, surely, are gains worth having.
“Evaluating the impact of private providers on health and health systems” will be launched on 28th June in London. Please see the event registration site for more details and contact Jo Seed at j.seed@imperial.ac.uk if you would like to attend.
