What Asia Can Learn from Africa About Creating Public-Private Dialogue In Health

Africa and Asia share many of the same challenges in providing health care. Photo credit: ADB.

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In some parts of Africa, there is a bold and direct dialogue between the private and public sector in health care.


Many African and Asian countries face similar health care challenges. More than half of the people in Africa go to the mostly unregulated private health care sector to get diagnosed and treated, and they pay out-of pocket. The same is true for Asia and the Pacific.


For the poor, this means they have to spend a large share of their already meagre income on health care. The poor’s share of out-of-pocket health expenditure is actually higher than the non-poor. For the middle class and the rich, this means they pay for services which are not regulated by the public sector, leaving many questions open about the quality of the care. Their trust in their countries’ healthcare providers is often low and if they can afford it, they seek care outside the continent. It is estimated that Africans spend more than $1 billion every year on health care abroad, and in fact many African governments encourage this by having separate funds for high-level government officials to pay for their health care overseas.

The East African Healthcare Federation (EAHF) was established to change this. An alliance of private health care providers which seeks a dialogue with the public sector, the EAHF’s goal is to improve regulation for quality health care, establish a sustainable financing mechanism, and ultimately create an enabling environment for the private sector to spur investments in health care across Africa.


At the recent EAHF Annual Conference held in Kigali, Rwanda, there was a bold and direct dialogue between the private and public sector. For the public sector—represented at the highest level by the country’s prime minister, its health minister and the health minister of Uganda—it is clear that they cannot achieve the promise of universal health coverage without the private sector. And the private sector knows that without improved public sector governance they cannot thrive and provide quality and affordable care.

The good news is that there are many examples of very productive public-private partnerships in East Africa which give hope to the success of the EAHF. In Uganda, for example, the government is partnering with a private sector pharmaceutical manufacturer to produce high quality affordable anti-malarial and HIV drugs; in Rwanda, the government has created an enabling environment for private sector investments and developed a medical tourism strategy which aims for the country to become a center of excellence for medical services in the East African region; and Kenya already has a flourishing private sector, providing primary to tertiary care and interesting models for the population to finance such services. These models range from micro to national level insurance models, and in all East African countries the public and private sector collaborate on private sector-led health federations to find solutions together for stronger partnerships.


What was clear to everybody at the conference, is that even if public and private sector foster a close dialogue, true partnership needs to be built on equals: equal commitment and equal accountability.

Governments not only in Africa but also in Asia and the Pacific must step up and reinforce good governance in the health sector to allow innovative financing through health insurance that actually works and reaches people; infrastructure is in place and functioning, including electricity and water supply in healthcare facilities; and an enabling legal and regulatory environment for the private sector to flourish and governments move away from input-based to performance-based health care management.

This requires a shift in mindset, which can take a generation – but even if it takes time, what’s important is that the change has started.

Susann Roth
Advisor, Office of the Principal Director, Department of Communications and Knowledge Management, Asian Development Bank

Susann Roth launched ADB’s first Futures Thinking and Foresight Program and ADB’s first Technology Innovation Challenge and led the design of ADB’s new Knowledge Management Action Plan. She advises the World Health Organization on foresight, digital health, innovation, and knowledge management.

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