It's typical to assume that managing public health challenges in the developing world is the primary responsibility of the public sector. And that's not wrong: a well-functioning public health system is fundamental to saving more lives and keeping more people healthy. But government hospitals and clinics are not always the first choice for millions of health consumers in the developing world. What's been missing from the discussion is how the local private health sector is an integral part of a comprehensive health system. World Health Day, April 7, marks an important opportunity to shed light on the significant, but often overlooked, role that private providers and health businesses can play in public health.
A dynamic private health care system is emerging or already thriving in many low- and middle-income countries, complementing government and NGO efforts to deliver health goods and services. Independent doctors, midwives, pharmacists, hospitals and clinics -- as well as related businesses like transportation operators, mobile services providers and health insurers -- are critical components of the health system. These groups are rooted in the communities they serve and attuned to local needs, so customers are motivated to seek their services. The care they provide might be costly at times -- and the quality may be variable, often due to a lack of regulation -- but these private providers are playing an increasingly important role in healthcare for many of the poorest and hardest-to-reach communities in the world.
By supporting private providers and health businesses in innovative ways, we have an opportunity to save more lives and keep more people healthy. The challenge is to help health businesses become healthy businesses that deliver health products and services of assured quality to the poor, serve a high proportion of their target market and remain financially sustainable.
As we recommend in our report, "Fostering Healthy Businesses: Delivering Innovations in Maternal and Child Health", there are several concrete steps we can take to help healthy businesses to take root, serve hard-to-reach groups and grow in ways that will help to address some of the world's most pressing health challenges:
- First, create a more enabling commercial environment by assisting businesses with the basics: registering with government, securing loans, obtaining construction permits and gaining access to electricity. Registered companies, for example, are easier to accredit, which can improve the overall quality of goods and services by encouraging businesses to meet a set of transparent standards.
- Second, provide more incentives to increase demand for goods and services from health businesses. Government voucher programs, tax rebates, micro-insurance schemes and financial cooperatives help to provide poor customers with the financial wherewithal to access private services - and make it economically attractive for businesses to expand their customer base to serve this population.
- Finally, incubate small businesses and provide them with access to the capital necessary to expand their range of products and services. Capital helps businesses maintain stocks of vital products, upgrade medical facilities and equipment and expand their capacity to serve more patients.
Many businesses are making great strides along these lines, creating sustainable business models that are serving more people with high-quality but affordable goods and services.
For example, Ziqitza Health Care Limited, an emergency transportation company in India, operated just 10 ambulances in Mumbai in 2007. Through a self-sustaining model that charges higher-income patients a rate that can cover the cost for lower-income patients, Ziqitza has grown to more than 860 ambulances across five Indian states. Ziqitza is also serving poorer populations in rural regions. It has created partnerships with the state governments of Bihar, Trivandrum, Punjab and Rajasthan through which it provides free or low-cost transport to patients in need. To date, Ziqitza has connected more than 1.7 million people with emergency care.
In Kenya, Changamka MicroHealth partners with health facilities and insurers to sell a maternity "smartcard" that helps women pay for maternal health care. By providing women with this smartcard -- which functions as a savings account -- and also accrediting hospitals and clinics within its network, Changamka is connecting women to affordable, quality care throughout their pregnancies, helping to bring down the country's high rates of maternal mortality.
On World Health Day, there are fewer than 1,000 days left before the Millennium Development Goals deadline in 2015. We must do more. As the world's developing and emerging economies continue to grow at a rapid pace, our efforts to foster healthier societies will hinge, in part, on how well we can foster healthy businesses.
This post is co-authored by Frederik Kristensen, M.D., Senior Advisor, Norwegian Agency for Development Cooperation.
Naveen Rao is the Lead of Merck for Mothers, Merck's 10-year, $500 million initiative to create a world where no woman dies giving life. Frederik Kristensen is a Senior Advisor for the Norwegian Agency for Development Cooperation (NORAD), the foreign aid directorate under the Norwegian Ministry of Foreign Affairs. Drs. Rao and Kristensen were co-chairs of the Every Woman, Every Child Task Force on Sustainable Business Models, which issued its report, "Fostering Healthy Businesses: Delivering Innovations in Maternal and Child Health," in September 2012.