Perspectives on engaging non-state actors in governing the quality of health care

This blog post, written by Dr. Leizel Lagrada-Rombaua, JLN Technical Facilitator, follows a webinar hosted by HFG and the Joint Learning Network for Universal Health Coverage (JLN) on May 3, 2017. The blog post is also available on the JLN website.

Non-state actors’ participation and contribution in delivering health care is widely acknowledged (WHO). They provide healthcare, produce health products and technologies, train health workers and provide health insurance or other financing mechanisms. Their growing size and importance in the health system, particularly in governing the quality of care, calls for effective engagement.

A recent webinar titled “Engaging Non-State Actors in Governing the Quality of Health Care,” held May 3, 2017, gathered 100 participants from 17 countries to hear from global health experts and contribute to the ongoing conversation and global knowledge on how to best engage non-state actors in ensuring quality of care.

Dr. Carlos Cuéllar, international health expert with Abt Associates, identified various challenges in engaging non-state actors, and highlighted the uneven quality of provided health services and the limitations in financing care provide by non-public health care providers. Several mechanisms could be utilized to address these challenges, he said, specifically by integrating the private sector in the health system. This can be done by tapping on organized networks of high quality providers; involving professional associations and scientific societies in policy-making; using regulatory and financing mechanisms to facilitate engagement of private providers; and actively engaging the clients and communities. Some of these techniques are documented in Engaging Civil Society in Health Finance and Governance: A Guide for Practitioners.

Does government have the capacity to ensure quality of care?  Mr. Nat Otoo, Former Chief Executive of Ghana’s National Health Insurance Authority (NHIA), related NHIA’s response to growing evidence of poor quality of care in Ghana and validated through NHIA’s accreditation and medical audits. For instance, only 13 of the 3,949 facilities in Ghana scored Grade A+, an accreditation rating that signifies high quality of care. These findings provide the impetus for quality improvement and financial recoveries for the national insurance agency. But the conversation on government regulating the quality of care in the private sector leaves a trail of haunting questions: How can a weak public sector regulate quality of care in private sector? How can government regulatory agencies enforce requirements among its own health providers?

Can government tap professional associations’ expertise in assuring quality of care? Dr. Raul Quillamor from the Philippines shared his experience as a member of Quality Assurance Committee, a policy advisory committee organized by PhilHealth. He illustrated how the clinical expertise of his specialty society contributed to the adoption of low-cost cervical cancer screening guidelines and setting the reimbursement rate for this benefit package. He also shared various mechanisms to ensure accountability and continuous quality improvement among private providers. However, some questions remain: How can private provider associations ensure that their policy recommendations are free of bias and conflict of interest? How can they enable the equitable distribution of their members so that everyone has access to their clinical expertise?

Can citizens influence governing quality of care? Ms. Paulina Pacheco Estrello showcased Mexico’s more than 15 years’ experience of capturing citizens’ needs and expectations of quality health improvement. Institutionalizing Aval Ciudadano is a means to recover the citizens’ trust in their health institutions and has long become a voice in influencing the government’s policies for resource management and quality improvement efforts. However, challenges remain: How can the government sustain the citizens’ participation without any financial incentive? Is there room for non-institutionalized public participation in governing quality of care?

These different approaches provide excellent examples of engaging non-state actors in governing quality of care. Yet there remain several unanswered questions that warrant the need to continue the conversation and learning. How to align the activities of non-state actors towards promotion of quality care, motivating them in contributing towards more effective governance of health system, and listening to their opinion moving forward will provide for some important steps forward to addressing the challenge.

The countries and development partners continue the discourse, exchanging ideas and experiences on how to effectively engage the non-state actors towards better quality of care – a key component for achieving universal health coverage.

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