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The private sector is a critical player in eye health: that statement should surprise no-one. Private companies produce and sell lenses, spectacles and devices; private clinics and hospitals provide treatments; private insurance companies sometimes pick up the bill. These inputs have a huge impact on public eye health and blindness prevention.
The interesting question is: how are these products and services funded, managed and regulated within the broader health system?
In many countries of the Western Pacific, most refractive services and the provision of spectacles is conducted by private providers, some with very basic training who rely mainly on autorefractors. Service quality is patchy, and in many contexts there is data to show that the wrong lenses are being prescribed. How do we improve the quality of these services? Regulation is complicated, and then difficult to enforce. Incentives and softer solutions like subsidized training, minimum standards, the professionalization of optometry and stronger professional bodies are being developed in several countries across the region.
The private sector helps to expand choice and access. In the Philippines, national health insurance has reduced financial barriers to cataract surgery. For-profit providers now dominate this service space (for more info, read the health financing briefs prepared by the Fred Hollows Foundation on our regional site), with most eye health workers in some form of private practice. Numerous examples in the Philippines, and other countries, point to the need for better coordination and regulation of the private sector, and advocacy to ensure the private sector works for public health goals too.
The picture is similar in China. Despite the broad scope of the nation’s public health system, the output of surgeries conducted in China’s private hospitals is now greater than public hospitals. Very positively, hospital groups like He Eye Care (a longtime member of IAPB) have made outreach and social enterprise a centrepiece of their operations. Another trailblazer in China is Aier, one of the country’s largest eye hospital chains. In 2006, the International Finance Corporation (or IFC, part of the World Bank), provided an US$8 million loan to Aier to expand the hospital network, increase access to high quality eye care, and demonstrate best practice. Read the case study to find out more about the hospital’s approach, and the catalytic role played by the IFC and development financing.
Deutsche Bank has also loaned capital for social enterprise and private eye hospitals, with a future round under consideration. Donors such as Australia and the Bill and Melinda Gates Foundation are investing in private health sector initiatives, and more and more, international support and health frameworks seek to involve the private sector and strengthen the stewardship role of government.
In June this year, The Lancet released a series on the private and public mix in health systems and recommended that for universal health coverage, government policy should “encourage a public–private mix that ensures widespread availability of good quality, affordable care so that the health system meets the needs of the population as a whole”. A helpful guide to Working with Private Sector Providers for Better Health Care, is available from the WHO website.
The reality is NGOs and government-run services cannot be everywhere and do everything. Private players to need to feature in a systems approach. At a national workshop this month in Vietnam, we invited Novartis to participate and it was helpful to have a new perspective on discussions related to school screening, national plan development, access to health insurance and raising public awareness.
Remarkably, it is rare it is to see private and for-profit agencies and providers referenced in planning documents or in planning meetings for eye health. So while the private sector is a critical player, it is often forgotten, left out or ignored. Just about everywhere across the Western Pacific, countries are struggling to get accurate service data from private providers and as a result, cataract surgical volumes are being underestimated in many places. This is a big missing piece.
We often look to the private sector as transactional funders of projects, and seek short-term charity through Corporate Social Responsibility. But we need to be seeking deeper collaborations and think of private players as long term partners for planning, advocacy and service delivery. The private sector needs to be seen as part of the health system, and coordinated and regulated alongside other inputs. After all, preventing blindness really is everyone’s business.
Photo courtesy: Brien Holden Vision Institute