making public–private partnerships work for all
The news when I attended the World Health Summit last week was sobering.
The launch of the latest Global Burden of Disease (GBD) Report revealed that in 2023 alone, an estimated 4.67 million children under-five died of preventable causes such as pneumonia, diarrhoea, malaria, and complications at birth. While some progress has been made since the early 2010s, the pace of improvement in preventing children dying is slowing.
Save the Children hosted a side event to explore how the private sector can help deliver health for all – including preventing children dying without creating financial barriers. Our panel brought together five actors – GSK, Kumwe Hub, Reach52, and Gavi, including the World Health Organization – who are all trying to improve access to healthcare but who are each using very different tactics.
It made for a lively debate. More than that, it pointed to ways forward.
How accessing health care can lead to poverty
Catastrophic health costs afflict millions of families across low- and middle-income countries. According to the World Health Organization, in 2019, healthcare costs pushed around 344 million people globally further into extreme poverty. At the same time, governments struggle to fund health services due to cuts in official development assistance, particularly because of the shutdown of USAID.
When families must choose between paying for medicine, education or food, health care is a driver of poverty. Children and communities become trapped in a vicious cycle of hardship and marginalisation.
Better is possible
It doesn't have to be this way. A well-funded and functioning primary health care system which can be accessed without financial hardship is the foundation of Universal Health Coverage. Save the Children believes health care should be free at point of use so that those struggling to make ends meet can access it when they need it.
It means a mother can visit a nearby clinic for antenatal care without travelling for hours, knowing a trained health worker will be there and there won’t be any hidden fees she’d have to take out a loan to pay. It means she can trust the system and be sure to come back when her children need care. And it means preventable child deaths are exactly what they should be: prevented.
But for millions of families right now, that’s just a dream. The reality is that people living close to the poverty line around the world fear the indebtedness, poverty and hopelessness that result from the cost of accessing quality health care.
What works
Governments bear the ultimate responsibility for health and equitable access to health care, but the private sector is an essential partner.
When national healthcare systems don’t prioritise access and quality for hard-pressed communities, people living in poverty are at risk of costly out-of-pockets spending, of discrimination and of low-quality private-sector services. That’s why it’s critical the private sector uses its resources to build infrastructure and train health personnel. So, when hard-pressed families must pay for healthcare, they get value for money.
Partners at the session shared examples of how the private sector can deliver quality, equitable health care with dignity for the poorest and most marginalised people.
GSK shared how its partnership with Save the Children in Nigeria and Ethiopia – two countries with high numbers of zero-dose children (who have never received a single vaccine) – is expanding immunisation coverage through community-based programmes.
Kumwe Hub – an investment initiative for start-ups, small businesses, and entrepreneurs in Africa – is empowering nurses to become ‘nursepreneurs’, combining healthcare delivery with entrepreneurship. By training and equipping nurses to manage small clinics, Kumwe Hub is strengthening local capacity and creating jobs which can sustain families.
Reach52, a social enterprise operating across Southeast Asia and Africa, uses mobile technology to reach the 52% of people who live beyond the reach of formal health systems by connecting communities to essential medicines and diagnostics through digital supply chains.
Gavi, the Vaccine Alliance, continues to play a catalytic role by supporting governments to strengthen immunisation systems while at the same time asking governments to contribute their own domestic resources to avoid overreliance on foreign development assistance.
What makes a good public–private partnership?
As the panellists made clear, the private for-profit sector will expect a return on investments.
At the same time, it’s important to plan from the start how a visit to a health facility will not lead to poverty. A strong health system ensures that everyone without discrimination can access good-quality care.
5 lessons
I identified 5 lessons from the panel discussion about how public–private collaboration can be made to work in the interests of people living in poverty.
Build government capacity to regulate: Public–private partnerships only work when governments can design, regulate and oversee them, ensuring they serve public interest. A hospital can’t be built or equipped without private suppliers, but good procurement systems, governance and anti-corruption mechanisms ensure that such investments truly serve people. If done well, government investment in health will be an investment rather than a cost.
Domestic resource mobilisation is critical: The private sector is vital to health but if unregulated, it can prove harmful. Tackling illicit financial flows and ensuring that companies contribute fairly to domestic taxes and health financing are crucial to making health a public good that everybody can benefit from. Our health – and the health of the world’s poorest people in particular – must not be reduced to a business opportunity.
Engage all sectors: The health system is more than hospitals, clinics, and health personnel. Logistics, telecommunications, and supply chains run by private actors are the backbone of effective health systems. By working together, it’s possible to think of creative, effective, and money-saving solutions. Why spend hours delivering medicines by road if you can do it faster and cheaper with a drone?
Data is critical: To target scarce government resources effectively, we need to understand who’s being left behind and who faces catastrophic health costs. Without accurate data, decision-making on how to spend precious tax funding is partly guesswork.
Piloting and scale-up: The private sector is often more agile and willing to experiment. Governments can then help scale up what works, ensuring predictability, accountability, and equitable access.
A shared responsibility
Health is a human right and one of the best economic and social investments governments can make. When children survive and learn, societies thrive. Health is a public good.
The private sector cannot replace governments’ responsibility here, but it can accelerate progress on healthcare. Governments cannot act in isolation, but they can set the rules that make partnerships with the private sector fair and effective. Civil society must hold both accountable.
The discussions at the World Health Summit made one thing clear: achieving health for all is not just about more aid but about expanding the partner base and rethinking the system.
Health is the end. The private sector is a means.
