News & Commentary

12 December 2015

Universal Health Coverage and the Private Sector

By Sarbani Chakraborty and Safir Sumer*

The Sustainable Development Goals (SDGs) have been adopted and Universal Health Coverage (UHC) is included there as a target. The question now is: how will countries deliver on this agenda, and what role can and should the private sector play given that:

  • Private financing of health care represents 40 to 70 percent of health spending in low and middle-income countries. As countries transition to more public financing, we need to think of this private financing as domestic resources and maximize their outcomes for UHC – say for example by making sure quality is ensured at all times. [1]

  • The private sector currently provides between 50 to 80 percent of care in many countries. How do we leverage this existing private health infrastructure for UHC?

Fulfilling the vision of UHC will take alignment on policies, financing solutions, private sector involvement and innovation. What is particularly important is supply-side innovations in partnership with the private sector. Sustained financing for UHC is only possible when Ministries of Finance and consumers see that health coverage translates into actual access to quality health services. Otherwise, the dream of UHC will only remain a dream. Moreover, it will reduce the motivation of financing agents to continue to finance health services.

We need broader health care innovation across the public and private sectors that enables access and improves quality. There are many innovations happening globally, but research plays a key role in understanding the process and context of these innovations for UHC and scale-up opportunities. For example:

  • The growing burden of chronic diseases is going to put pressure on health costs, and we need to think of how to improve chronic disease management throughout the value chain. In India, where heart disease is the number one killer, innovations such as the Heart Hospital have shown that it is possible to provide cardiovascular services to the population – rich and poor alike – through a high volume, total quality management approach. The Heart Hospital is even working in association with India’s Space Research Organization and runs one of world’s largest Tele-Cardiology programmes using the organization’s satellite. The results speak for themselves – the Hearth Hospital performs more surgeries per day compared to leading US institutions and with better health outcomes. 

  • We are making daily progress in mobile health and digital technologies. There are 2.5 billion smart phone users in Asia. Africa is often referred to as the ‘mobile continent’ – it currently has 636 million mobile phone users that are predicted to increase to 930 million by 2019. This has to be part of our health care solutions – whether in making care more patient-centric and personalized or in improving efficiency.

These are only a few examples, there are many others. Using a rigorous research framework there is a need to continuously gather and share examples of innovations that show that UHC is not only a dream – it can be achieved through continuous innovation and ‘out-of-the-box’ thinking on service delivery.

One objective of the HSG Private Sector in Health Thematic Working Group’s UHC and private sector research group is to support such research at the country level so that evidence based policies on private sector and UHC can be adopted, tested and scaled up.


[1] In Brazil, China, India, the Russian Federation and South Africa, private financing accounts for anywhere from 40 to 70 percent of total health spending. Source: http://www.who.int/bulletin/volumes/92/6/13-127951/en/#R1


Sarbani Chakraborty, Ph.D. is affiliated with the Center for International Health, Ludwig Maximilian University, University of Munich. She has been working on Universal Health Coverage globally for the last 10 years. She led, along with the Imperial College, the research on Turkey's UHC policies and their impact, which was published in the Lancet.

Safir Sumer is an independent health policy researcher based in Turkey. Safir has consulted for the Ministry of Health in Turkey and the World Bank for over 10 years on UHC policies, especially primary care. Along with Sarbani, Safir was a co-author of the above-mentioned UHC in Turkey Lancet study.


Photo: mHealth in India. Credit: The UN Foundation. 


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