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Abstract Background More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with the private health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them. Methods A case study approach was adopted with review of all available literature followed by five Key Informant Interviews to understand the case through a primary descriptive exploration. Grounded theory approach was used to generating the single theory of the case itself that explains it. Results Kerala state has taken a variety of interventions to ensure universal access to TB care for citizens reaching the private sector with documented improvement in the quality of TB care. Key learnings from these initiatives were (i) patients need to be at the centre of partnerships, (ii) good governance is essential for ensuring Universal Health Coverage in a mixed health system, (iii) data intelligence is required to guide partnerships, (iv) identification of the correct ‘problems’ is crucial for effective design of partnerships and (v) a platform for meaningful dialogue of key stakeholders is needed. Conclusion Kerala experience demonstrated that if governments take a proactive role in engaging the private sector, in an informed and evidence-based way, they can leverage the advantages of the private sector while protecting the public health interest.

Background: More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with the private health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them. Methods: A case study approach was adopted with review of all available literature followed by five Key Informant Interviews to understand the case through a primary descriptive exploration. Grounded theory approach was used to generating the single theory of the case itself that explains it. Results: Kerala state has taken a variety of interventions to ensure universal access to TB care for citizens reaching the private sector with documented improvement in the quality of TB care. Key learnings from these initiatives were (i) patients need to be at the centre of partnerships, (ii) good governance is essential for ensuring Universal Health Coverage in a mixed health system, (iii) data intelligence is required to guide partnerships, (iv) identification of the correct 'problems' is crucial for effective design of partnerships and (v) a platform for meaningful dialogue of key stakeholders is needed. Conclusion: Kerala experience demonstrated that if governments take a proactive role in engaging the private sector, in an informed and evidence-based way, they can leverage the advantages of the private sector while protecting the public health interest. [ABSTRACT FROM AUTHOR]

Objective: Private sector engagement is crucial for the success of health programs, as it brings in additional resources, expertise, and innovation. The main objective of this review is to understand private sector engagement in healthcare delivery. Methodology: A descriptive case study design using an analytical framework was used. Literature from well-researched articles was reviewed. Only articles written in English language between 2012-2022 were considered if they talked about private sector engagement in health delivery. The strategy and procedure involved searching for articles using scholarly search engines, namely Google Scholar, Scopus, and Semantic Scholar. Results: Findings demonstrated an in-depth understanding of the challenges faced by healthcare delivery in developing countries, which included 58.2% of private sector involvement by the government, 34.29% inadequate human resources, 30% inadequate budgetary allocation, and 8.45% bordering on meagre leadership and management. Employing various private sector engagement could provide resources required for strengthened health systems. During COVID-19 pandemic, it was established that four contextual factors were very critical in dealing with the pandemic. Individual features, economic crises, a weak health system, and a multi-sectoral response to COVID-19, were the main important factors established. Other contextual factors that impact the success of private sector involvement included human resource management, financial capacity, and multisectoral response to the pandemic. Conclusion: The private sector plays a critical role in supporting provision of healthcare but is mostly recognized only during health disasters like COVID-19 Pandemic. Challenges faced by healthcare can be addressed when steps to involve the private sector are deliberately made to garner support for provision of healthcare through Private Sector Engagement initiatives for the sustainability of health programs.

Abstract Background The private sector is an important yet underregulated component of the TB treatment infrastructure in India. The Joint Effort for Elimination of Tuberculosis (Project JEET) aims to link private sector TB care with the constellation of social support mechanisms available through the Indian National TB Elimination Programme (NTEP), including the provision of free fixed-dose combination (FDCs) drugs to patients. This quasi-experimental study analysed routinely collected data to determine the impact of free drugs on patient follow-ups and treatment outcomes. Methods We used data for private sector patients enrolled with Project JEET who were diagnosed with pulmonary and extrapulmonary TB between 1 January 2019 and 31 March 2020, and completed treatment by 31 December 2021. Propensity score matching was used to create a dataset to compare the number of follow-ups and proportion of successful treatment outcomes for patients on free drugs to a control group who paid out-of-pocket. 11,621 matched pairs were included in the analysis. Logistic regression and ordinary least squares regression models were used to estimate the impact of free drugs on number of follow-ups and treatment success, where latter is defined as treatment completion or cure. Results After controlling for potential confounders, patients on free drugs received on average 2.522 (95% C.I.: 2.325 to 2.719) additional follow-ups compared to patients who paid out of pocket. This equates to a 25% mean and 32% median increase in follow-ups for patients availing free drugs. For treatment success, patients receiving free drugs had 45% higher odds of a successful treatment (Odds Ratio: 1.452, 95% C.I.: 1.288 to 1.637). Conclusions Patients receiving free drugs were found to follow up with their treatment coordinator more frequently, in part likely to enable drug refilling, compared to patients who were paying out of pocket. These additional contacts would have offered opportunities to address concerns regarding side effects, provide additional treatment information, and connect with social support services, all of which subsequently contributed to patients’ continual engagement with their treatment. This potentially represents the unmeasured effect of free drugs on continual social support, which translates into a higher odds of treatment success for patients.

Background: Reported coverage estimates for vaccine have the inherent problem of missing private entity data, to circumvent this, the National Health Mission, Ernakulam, designed and implemented an Immunization Information System (IIS) to collect routine vaccination reports from the private sector. This study attempted to identify the barriers to reporting by the private sector. Methodology: The study was conducted in Kerala's Ernakulam district. The design of the study was cross-sectional. The end–users, who are from the private sector, were the participants of 28 in-depth interviews in the study. Results: The new reporting system has increased private sector involvement in information exchange, all 78 private hospitals (100%) were reporting to NHM Ernakulam. But the completeness of reporting was not uniform. Major barriers identified were the lack of IIS interoperability with the hospital information system (HIS) being used by the private hospitals, variance because of lack of training of staff entering the data, and the unavailability of dedicated staff for reporting data. Conclusion: Addressing these barriers could improve the reporting of routine vaccination data from the private sector.

Background: The private sector is an important yet underregulated component of the TB treatment infrastructure in India. The Joint Effort for Elimination of Tuberculosis (Project JEET) aims to link private sector TB care with the constellation of social support mechanisms available through the Indian National TB Elimination Programme (NTEP), including the provision of free fixed-dose combination (FDCs) drugs to patients. This quasi-experimental study analysed routinely collected data to determine the impact of free drugs on patient follow-ups and treatment outcomes. Methods: We used data for private sector patients enrolled with Project JEET who were diagnosed with pulmonary and extrapulmonary TB between 1 and 2019 and 31 March 2020, and completed treatment by 31 December 2021. Propensity score matching was used to create a dataset to compare the number of follow-ups and proportion of successful treatment outcomes for patients on free drugs to a control group who paid out-of-pocket. 11,621 matched pairs were included in the analysis. Logistic regression and ordinary least squares regression models were used to estimate the impact of free drugs on number of follow-ups and treatment success, where latter is defined as treatment completion or cure. Results: After controlling for potential confounders, patients on free drugs received on average 2.522 (95% C.I.: 2.325 to 2.719) additional follow-ups compared to patients who paid out of pocket. This equates to a 25% mean and 32% median increase in follow-ups for patients availing free drugs. For treatment success, patients receiving free drugs had 45% higher odds of a successful treatment (Odds Ratio: 1.452, 95% C.I.: 1.288 to 1.637). Conclusions: Patients receiving free drugs were found to follow up with their treatment coordinator more frequently, in part likely to enable drug refilling, compared to patients who were paying out of pocket. These additional contacts would have offered opportunities to address concerns regarding side effects, provide additional treatment information, and connect with social support services, all of which subsequently contributed to patients' continual engagement with their treatment. This potentially represents the unmeasured effect of free drugs on continual social support, which translates into a higher odds of treatment success for patients. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has not only affected public health but has also significantly impacted the economy. Bandung, a bustling city in Indonesia serving as a satellite to the capital, has been hit hard due to its high population density, mobility, and reliance on the tourism, trade, and transportation sectors. Using a Computable General Equilibrium (CGE) model developed at the interregional level of Indonesia, this study investigates the microeconomic indicators of several economic activities in Bandung, namely, the transportation, accommodation and food–beverage, water supply, and trade (MSMEs) sectors, to assess the impact of the pandemic. Additionally, the study examines the role of private sector actors in contributing to the sustainable recovery efforts toward achieving the Sustainable Development Goals (SDGs) amidst the pandemic. The findings reveal that Bandung's transportation, accommodation, food and beverage, water supply, and trade sectors experienced a significant decline in economic activity. However, there was a gradual recovery, with increased economic activity between 2019 and 2021. Private sector actors and the health sector were the main drivers of economic recovery, with other sectors also contributing to the effort. [ABSTRACT FROM AUTHOR]

• A global framework for potential private sector investment targets. • Two-thirds of the world's population could benefit from private sector interventions. • Middle-income countries realize greatest benefits from private sector investments. Water security remains a critical global development challenge, compounded by persistent public funding shortfalls. Society urgently needs to identify opportunities for innovative private sector engagement in water security solutions. To identify feasible and impactful solutions, quantitative tools are needed to delineate complex environmental and socioeconomic water challenges and prioritize private sector investment opportunity spaces to address these challenges. We introduce the first global and regional-scale maps showing where threats to water security coincide with private sector opportunities to address them. The successful deployment of water solutions is contingent upon the societal and governance landscape that underpins a nation's capacity to support sustainable water threat interventions and water-related business activities. By delineating areas with substantial pressures on water resources and assessing nations' enabling environments to support private sector investments, we find nearly two-thirds of the world's population could benefit from private sector interventions today, with middle income countries realizing the greatest benefits. In the face of global economic development and climate change, such solutions will become increasingly essential in future decades. [ABSTRACT FROM AUTHOR]

Abstract Background The private sector plays a large role in malaria treatment provision in Nigeria. To improve access to, and affordability of, quality-assured artemisinin-based combination therapy (QA-ACT) within this sector, the Affordable Medicines Facility-Malaria began operations in 2010 and transitioned to a private sector co-payment mechanism (PSCM) until 2017. To assess the impact of the scheme on the ACT market, cross-sectional household and outlet surveys were conducted in 2018 to coincide with the final stockages of ACT medicines procured under the PSCM. Methods An outlet survey was conducted targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability and cost of anti-malarials, including artemisinin-based combinations subsidised under the PSCM (called green leaf ACT on account of their green leaf logo) and those not subsidised (non-green leaf ACT). A concurrent household survey was conducted to determine demand-side factors related to treatment-seeking practices, ACT brand preference and purchase decision. Data were compared with previous ACTWatch surveys to consider change over time. Results Availability of artemisinin-based combinations increased significantly over the PSCM period and was almost universal by the time of the 2018 market survey. This increase was seen particularly among PPMVs. While the cost of green leaf ACT remained relatively stable over time, the cost of non-green leaf ACT reduced significantly so that by 2018 they had equivalent affordability. Unsubsidised brands were also available in different formulations and dosages, with double-strength artemisinin-based combination reported as the most frequently purchased dosage type, and child artemisinin-based combinations popular in suspension and dispersible forms (forms not subsidised by the PSCM). Conclusions The PSCM had a clear impact on increasing not only the reach of subsidized QA brands, but also of non-subsidised brands. Increased market competition led to innovation from unsubsidised brands and large reductions in costs to make them competitive with subsidised brands. Concerns are drawn from the large market share that non-QA brands have managed to gain as well as the continued market share of oral artemisinin monotherapies. Continued monitoring of the market is recommended, along with improved local capacity for QA-certification and monitoring.

Private sector engagement (PSE) is increasingly acknowledged in both literature and practice as a necessary mechanism to sustainably address development challenges. Despite increased practitioner and academic interest in these partnerships, there have been negligible attempts to systematically investigate cross‐sector partnerships to distill best practices from the multiple environments in which they are employed. This manuscript presents a robust review of the social science and business literatures on cross‐sector partnerships, yielding an interdisciplinary, evidence‐based framework detailing archetypes of three prominent partnership characteristics of purpose, context, and relationship enablers. This work integrates a wide range of best practices and values pertinent to businesses and society, enabling researchers, practitioners, and partnership managers to characterize and evaluate partnerships systematically. The introduced framework also enables partners to situate and evaluate their partnership activities to optimize outcomes for each partner and impact on the challenge at hand. [ABSTRACT FROM AUTHOR]

Bangladesh reduced malaria incidence by 93% from 2008 to 2020 through the action of governmental and non-governmental organizations. The Bangladesh context is unique to South Asia because its successful public sector malaria control programs have historically not engaged corporate partners (as undertaken in Sri Lanka and proposed in India). However, ∼18 million people continue to live at risk of infection in Bangladesh and for-profit private healthcare providers, catalytic for malaria elimination in many countries, are expected to benefit the national program. We distilled (from a large and complex literature) nine distinct strategies important in other developing settings and weighed them in the context of Bangladesh's flourishing private health care sector, driven by patient demand, self-interest and aspirations for public good, as well as heterogeneity in providers and malaria-prevalence. We propose a new model dependent on five strategies and its immediate deployment considerations in high endemic areas, to empower Bangladesh's phased agenda of eliminating indigenous malaria transmission by 2030., Competing Interests: No funding was received for the formulation of this manuscript. The authors declare no competing interests., (© 2024 The Author(s).)

Background: To avoid misuse of anti-malarials, correct diagnosis of fever prior to drug prescription is essential. Presumptive treatment in the private healthcare sector is a concern in Nigeria, where availability of affordable artemisinin-based combination therapy (ACT) is high following the implementation of subsidy schemes from 2010 to 2017. Similar subsidies have not, however, been implemented for malaria rapid diagnostic tests (RDTs). A market survey in 2018 predominantly designed to assess the ACT market in the private sector also collected data related to RDTs, results of which are presented herein. Methods: A 2018 market survey consisted of (i) an outlet survey targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability of RDTs (defined as having stock available for purchase at the time of the survey) and (ii) a household survey to determine demand-side factors related to knowledge of RDTs, healthcare-seeking practices and affordability. Results: Availability of RDTs at the time of the survey was low in both outlet types and significantly lower in PPMVs (22.1%, 95% CI) among pharmacies versus (13.6%, 95% CI) among PPMVs (p < 0.01). Reasons for not restocking RDTs included low demand and no supply. The majority of households diagnose malaria based on experience, while one-third would visit a PPMV or pharmacy. Half of households had heard of RDTs (48.4%) and 38.6% thought they were affordable. Conclusions: Low availability of RDTs among PPMVs and pharmacies may be attributed to lack of demand, supply-side issues and cost. Increasing household knowledge of RDTs may aid increasing demand, while subsidized RDTs may address supply and price issues. Addressing the deficit in RDT provision is important for targeting of ACT medicines. [ABSTRACT FROM AUTHOR]

More than half of the people with TB in India seek care from the private sector, where suboptimal quality of care is a concern. Significant progress has been made over the last five years to expand the coverage and to involve more private sector providers in TB care under the National TB Elimination Program (NTEP) in India. The objective of this review is to describe the major efforts and the progress made with regard to the engagement of the ‘for-profit’ private health service delivery sector for TB care in India, to critically discuss this, and to suggest the way forward. We described the recent efforts by the NTEP for private sector engagement based on the literature, including strategy documents, guidelines, annual reports, evaluation studies, and critically looked at the strategies against the vision of partnership. The NTEP has taken a variety of approaches, including education, regulation, provision of cost-free TB services, incentives, and partnership schemes to engage the private sector. As a result of all these interventions, private sector contribution has increased substantially, including TB notification, follow-up, and treatment success. However, these still fall short of achieving the set targets. Strategies were focused more towards the purchase of services rather than creating sustainable partnerships. There are no major strategies to engage the diverse set of providers, including informal health care providers and chemists, who are the first point of contact for a significant number of people with TB. India needs an integrated private sector engagement policy focusing on ensuring standards of TB care for every citizen. The NTEP should adopt an approach specifically tailored to the various categories of providers. For meaningful inclusion of the private sector, it is also essential to build understanding and generate data intelligence for better decision making, strengthen the platforms for engagement, and expand the social insurance coverage.

Background: The private sector plays a large role in malaria treatment provision in Nigeria. To improve access to, and affordability of, quality-assured artemisinin-based combination therapy (QA-ACT) within this sector, the Affordable Medicines Facility-Malaria began operations in 2010 and transitioned to a private sector co-payment mechanism (PSCM) until 2017. To assess the impact of the scheme on the ACT market, cross-sectional household and outlet surveys were conducted in 2018 to coincide with the final stockages of ACT medicines procured under the PSCM. Methods: An outlet survey was conducted targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability and cost of anti-malarials, including artemisinin-based combinations subsidised under the PSCM (called green leaf ACT on account of their green leaf logo) and those not subsidised (non-green leaf ACT). A concurrent household survey was conducted to determine demand-side factors related to treatment-seeking practices, ACT brand preference and purchase decision. Data were compared with previous ACTWatch surveys to consider change over time. Results: Availability of artemisinin-based combinations increased significantly over the PSCM period and was almost universal by the time of the 2018 market survey. This increase was seen particularly among PPMVs. While the cost of green leaf ACT remained relatively stable over time, the cost of non-green leaf ACT reduced significantly so that by 2018 they had equivalent affordability. Unsubsidised brands were also available in different formulations and dosages, with double-strength artemisinin-based combination reported as the most frequently purchased dosage type, and child artemisinin-based combinations popular in suspension and dispersible forms (forms not subsidised by the PSCM). Conclusions: The PSCM had a clear impact on increasing not only the reach of subsidized QA brands, but also of non-subsidised brands. Increased market competition led to innovation from unsubsidised brands and large reductions in costs to make them competitive with subsidised brands. Concerns are drawn from the large market share that non-QA brands have managed to gain as well as the continued market share of oral artemisinin monotherapies. Continued monitoring of the market is recommended, along with improved local capacity for QA-certification and monitoring. [ABSTRACT FROM AUTHOR]

This paper seeks to learn lessons about the role of the private sector in subnational governance by analysing the UK's Local Enterprise Partnerships (LEPs). The paper outlines the public justifications for LEPs using documentary analysis, and then considers these against findings from interviews and network analysis, concluding that the justifications are problematic. LEPs were established on the assumption that civic and business leaders needed to be brought together in business-led institutions. However, network analysis shows most civic leaders also hold private sector roles, undermining the assumed need for a 'bringing together'. Three further justifications of the LEP model are also challenged. Firstly, business leaders were supposed to enable knowledge flows, but analysis shows that this knowledge is skewed by unrepresentative LEP boards. Secondly, it was assumed that LEPs would catalyse networks, but the networks have been built around individual interests, without transparency. Finally, LEPs were meant to mirror business structures, but this has undermined democratic accountability. Taken together, these findings suggest that the creation of LEPs has attempted to solve the wrong problem in the wrong way. The paper concludes by proposing guiding principles for the role of the private sector in the Levelling Up agenda: representation, transparency and accountability. [ABSTRACT FROM AUTHOR]

More than half of the people with TB in India seek care from the private sector, where suboptimal quality of care is a concern. Significant progress has been made over the last five years to expand the coverage and to involve more private sector providers in TB care under the National TB Elimination Program (NTEP) in India. The objective of this review is to describe the major efforts and the progress made with regard to the engagement of the 'for-profit' private health service delivery sector for TB care in India, to critically discuss this, and to suggest the way forward. We described the recent efforts by the NTEP for private sector engagement based on the literature, including strategy documents, guidelines, annual reports, evaluation studies, and critically looked at the strategies against the vision of partnership. The NTEP has taken a variety of approaches, including education, regulation, provision of cost-free TB services, incentives, and partnership schemes to engage the private sector. As a result of all these interventions, private sector contribution has increased substantially, including TB notification, follow-up, and treatment success. However, these still fall short of achieving the set targets. Strategies were focused more towards the purchase of services rather than creating sustainable partnerships. There are no major strategies to engage the diverse set of providers, including informal health care providers and chemists, who are the first point of contact for a significant number of people with TB. India needs an integrated private sector engagement policy focusing on ensuring standards of TB care for every citizen. The NTEP should adopt an approach specifically tailored to the various categories of providers. For meaningful inclusion of the private sector, it is also essential to build understanding and generate data intelligence for better decision making, strengthen the platforms for engagement, and expand the social insurance coverage.

Greenhouse gas emission reduction and decarbonization goals drive citizens' interests in alternative fuel vehicles and have created fast-growing demands on alternative fuels. While governments are promoting the transition to alternative fuel vehicles, the lack of refueling and recharging infrastructure for the vehicles is a key barrier to the adoption. At the same time, the public sector cannot solely provide needed alternative fueling infrastructure due to limited financial resources. Consequently, governments in the U.S. have been working on facilitating the private sector's investment in alternative fueling infrastructure. The most common approach was financial incentive programs and policies, but the U.S. also promotes self-organized collaborative governance of alternative fuels across sectors at the local level. This paper asks whether these two approaches stimulate the private sector's engagement in providing alternative fueling infrastructure. This study uses the case of the Clean Cities program that targets the reduction in petroleum usage, adoption of alternative fuels and creation of self-governance at the local level. Local private businesses, local government agencies and non-profit organizations voluntarily participate in the local transition to alternative fuels. Therefore, this governance aims at facilitating more sustainable actions and business choices in the private sector. This paper tests the hypotheses of whether the local self-governance of Clean Cities increases privately-owned alternative fueling infrastructure using panel fixed-effects Poisson regression models. Based on the data of counties in 12 states from 2004 to 2015, the results of empirical analysis suggest that both self-governance and financial incentive programs are effective in increasing the engagement of private actors in providing alternative fueling infrastructure. [ABSTRACT FROM AUTHOR]