Private sector engagement in public health systems

Rafael Cortez, Meaghen Quinlan-Davidson

Research output: Working paper


The aim of the literature review was to provide evidence on private health sector engagement globally, with a specific focus on the South Caucasus. The analysis focused on private sector engagement through the lens of policy dialogue, information sharing, regulation, financing, and private sector provision, including performance and private sector engagement modalities. Results showed that the private sector in Armenia, Azerbaijan, and Georgia is heterogenous. Regulation aimed to increase health coverage with quality services and increase the institutional capacity of the Ministries of Health to collect and analyze data to know better how the private health sector operates and promote private-public partnership to respond to public health challenges. The creation of an autonomous health superintendence would help improve the performance of the private sector: overseeing and supervising the service delivery of private providers and ensuring a strong regulatory environment within countries with high levels of out-of-pocket payments. This entity should enforce transparent behaviors of doctor practices, licensing of physicians, and accreditation of private providers. In addition, the South Caucasus countries can adopt a mix of payment systems with private providers and establish arrangements that ensure a strong private-public partnership (PPP) in health through well-defined contracts. Health facilities with management autonomy should also ensure quality-based purchasing. PPPs would be an optimal way for the South Caucasus to engage with the private sector. Political will, legislative environments and regulatory frameworks, transparency, public sector capacity, complete and flexible contracts, and broad stakeholder engagement are essential conditions to expand PPPs. Learning from best practices globally and expanding research on how health systems create and regulate mixed public-private services are also essential to improve quality, equity, and efficiency of these systems, as countries work to achieve universal health coverage.
Original languageEnglish
Number of pages59
StatePublished - Sep 2022
Externally publishedYes

Publication series

NameDiscussion paper
PublisherHealth, Nutrition, and Population Global Practice of the World Bank


  • Regulation
  • Private-private partnership
  • Universal health coverage
  • Health systems


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