This document discusses private sector engagement to advance universal health coverage. It provides background on private health sectors in the Eastern Mediterranean region. A framework is proposed with five strategies: 1) Develop a policy framework for private sector engagement 2) Develop strategic purchasing options from private providers 3) Improve private sector quality 4) Ensure regulatory mechanisms are enforced in the private sector 5) Establish monitoring of private providers. The strategies aim to expand access, assure quality, establish benefits packages, enhance financial protection, and enforce regulations. Member states are urged to endorse this framework to effectively engage private sectors for universal health coverage.

1. Private sector engagement
for advancing universal health coverage
Agenda item 5(c)
65th Session of the Regional Committee for the
Eastern Mediterranean
15‒18 October 2018, Khartoum

2. 2
Region

3. 3
Current
status
Why
engagement
Framework
for action

4. Share of out-of-pocket payment in total health expenditure (2014)
Regional average
High-income: Bahrain, Kuwait, Qatar, Saudi Arabia, Oman and United Arab Emirates
Middle-income: Egypt, Iran (Islamic Republic of), Iraq, Jordan, Lebanon, Libya,
Morocco, Palestine, Syrian Arab Republic, Tunisia
Low-income: Afghanistan, Djibouti, Pakistan, Somalia, Sudan, Yemen 4

5. Duality of practice between public and private sectors
Concentration of private workforce in urban areas
Limited data on workforce distribution, salary structure and multiple
jobs
Private health workforce – issues and challenges
5
Percentage of physicians working in
public and private sectors in selected countries
0
10
20
30
40
50
60
70
80
90
100
Saudi Arabia Oman Kuwait United Arab
Emirates
Jordan Iran (Islamic
Republic of)
Percentage
Public
Private

6. 6
Utilization of private and public sector outpatient clinics in
selected countries
Assessment of private health sector in 12 countries. Cairo: WHO
Regional Office for the Eastern Mediterranean; 2013 (unpublished).
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Private sector
Public sector

7. Egypt Jordan Iraq Morocco Palestine
Syrian
Arab
Republic
Tunisia Yemen
Source of modern methods
of contraception
44 56 90 NA 74 NA NA 46
Place of delivery 71 34 11 11 36 56 15 37
Diarrhoea treatment for
children under 5
78 41 NA NA NA NA NA 63
Acute respiratory infection
treatment
78 40 43 NA 62 69 45 68
Percentage of outpatient/ambulatory health services provided by
the private health sector in selected countries
7

8. Percent
Source: Demographic and Health Surveys
85
62 63
0
10
20
30
40
50
60
70
80
90
100
Public Private Public Private Public Private Public Private
Pakistan Egypt Morocco Jordan
Poorest Middle Richest
Use of outpatient clinics (private and public providers)
8

9. Develop a policy framework
for engaging PHS providers
Develop strategic purchasing
options from PHS
Improve the quality
of services in PHS
Ensure that regulatory mechanisms for
health systems are enforced in the PHS
Establish monitoring and reporting
mechanisms for PHS providers
9
Framework for action on effective engagement with the private health
sector to expand service coverage for UHC
Recommended strategies
9

10. Framework for action. Effective engagement with the private health
sector to expand service coverage for UHC
Strategies
(levels of
engagement)
Continuum of
engagement
Actions/interventions Support from WHO and
other development
partners
2. Develop strategic
options for private
health sector
engagement,
including strategic
purchasing;
facilitate and
institutionalize
private health
sector engagement,
including staffing
and capacity-
building
Consultation 2.1 Identify appropriate models of private health sector
engagement/partnership options and financing methods, including
contracting, strategic purchasing and other options, as appropriate in
the country.
2.2 Identify health financing possibilities and relevant information
systems to incorporate activities undertaken through engagement
with the private health sector.
• Help develop
financing methods for
contracting,
purchasing,
information systems
and other options to
engage the private
health sector.
• Build capacities to
develop a UHC priority
benefit package.
Involvement 2.3 Develop the institutional system to implement private health
sector engagement, including financing methods, purchasing
authorities, contracting and management units at the ministry of
health.
2.4 Define relevant provider payment methods to ensure effective
delivery of the identified services/interventions by private health
sector providers.
Partnership 2.5 Jointly define the scope and range of services and interventions to
be provided, by the private health sector, either jointly with the public
sector or separately.
2.6 Identify the target populations to becovered by private health
sector providers under the partnership.
10
One-time or short-term
involvement, e.g. focus group,
meetings, interviews
Ongoing participation in the
process as a source of feedback,
involvement in planning, etc
Involvement in decision-making

11. Expand equitable
access to health
services
Assure improved
quality of services
provided by the PHS
Establish a national
UHC priority
benefits package
Enhance the
financial protection
goal of UHC
Develop strategic purchasing options from private providers
11
Enforce PHS
regulations and flow
of information

12. Conclusion
1. Involvement of the private health sector is necessary and provides a unique
opportunity to advance universal health coverage
2. There is a need to build the capacity of ministries of health to design, manage,
monitor and evaluate effective engagement with the private sector for health service
delivery
3. Many information gaps remain and there is no system to collect information from
private providers in most countries of the Region
4. Member States are urged to endorse the framework for action on effective
engagement with the private health sector to expand service coverage for UHC
12