Engaging the Private Sector

This page describes work being done in Liberia by a consortium of organisations: Open Development LLC, D-tree International, Results4Development, Mangologic.


The worldwide movement towards Universal Health Care (UHC), illustrated by the Sustainable Development Goals, will entail an increased demand for health services. This will be particularly marked among poor pregnant women as financial barriers to accessing quality care are reduced and governments launch campaigns to encourage women to give birth in facilities.

However, this increased demand may overwhelm the public health system’s ability to provide quality care to everyone. Rationing, long lines, and informal fees could result in worsening quality and health results as the public sector races to meet patient needs. Governments can bolster their capacity to provide health services by engaging the private sector using public finance. By giving patients more choice in where to seek care, both the private and public health sectors will be more accountable to citizens and the government.

Challenges of engaging Private Sector

Fostering public-private partnerships to deliver quality maternal and neonatal care is not without its challenges:

  • Governments need to ensure that they are getting quality services following clinical guidelines
  • Governments need to know that the services are good value for money;
  • Private providers need assurances that they will be paid promptly by the public sector; and
  • Patients need to be feel confident that they will receive quality, respectful care at a price that is free or at least affordable and transparent.

At D-tree International, the first challenge has always been core to our mission. We have long championed the utility of mobile decision support tools in assisting health workers adhere to countries’ clinical guidelines and report utilization data.

But access to decision support tools alone does not always motivate healthcare workers to use them. Could tying provider payment to decision support drive or improve its use? And how do you translate data from a decision support tool into payments that incentivize appropriate care?

In UHC provision by the private sector, there is need not only for quality care, there is also the need for data. Private clinics who provide care for the government must submit requests for payment along with information about the care provided. We know that classic D-tree digital health systems produce data as a by-product of care.

If we think back to the discussion of UHC, we see an opportunity -- by using data generated from decision support applications, we can create algorithms to calculate payment amounts based on pre-determined financial schemes. This incentivizes private health care providers to follow clinical guidelines and enables routine submission of government HMIS data.

The data by-product from an episode of care can play several roles in the system, including as automatic requests for payment from the clinic which provided that care.

As a result, the data collected during a patient visit can play several roles in the system, including:

Community enrollment permits pregnant women to be assigned to private facilities for ante-natal and post-natal care
Clinics commit to use mobile app to manage treatment for clients registered on the scheme, providing government with transparency through the provision of data.
Decision support logic gives the government confidence in standards of care
Payments schedule encoded in software on server generates appropriate billing automatically as soon as data reaches server (with network, this would be in real-time of the clinic visit)
Mobile money API permits sums computed from visit data to be transmitted immediately to clinic.
Data is not only for insurance payments of course. Both the government and facilities have an interest in looking in detail at non-payment related analyses to get a better understanding of the functioning of individual clinics and the health system as a whole.
The overarching goal is that the use and scale of such an approach will accelerate the reduction of maternal and neonatal mortality by fostering trust.

Trust by the pregnant woman and her family that this will result in access to respectful, quality care throughout her pregnancy. Trust by the healthcare provider that he will be paid promptly, allowing him to reinvest profits to strengthen his practice, and to view impoverished pregnant women as valued clients. And finally, trust by the government that the care provided in the private sector is good value for money, and that the approach strengthens its stewardship over the entire health ecosystem. We think this kind of approach can empower national and local authorities in Liberia and throughout sub-Saharan Africa and South Asia to overcome many of the key operational challenges for engaging the private sector in UHC.

D-tree International


Created By
D-tree International


Created with images by D-Stanley - "Mesurado River" • Erik Cleves Kristensen - "Monrovia" • Veronica Sparks - "4463" • Prof Ken Harper - "Liberia – By Ken Harper" • DFAT photo library - "Rose and Susan in the treatment room at Susa Mama health clinic, Port Moresby General Hospital, PNG" • DFAT photo library - "Rose in the treatment room at Susa Mama health clinic, Port Moresby General Hospital, PNG" • DFAT photo library - "Susu Mama's, Port Moresby General Hospital" • Synergos Institute - "namibia - drc clinic - synergos 2014-52" • Synergos Institute - "namibia - drc clinic - synergos 2014-62"

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