Engaging the private sector to deliver COVID-19

tools and achieve Health for All

How to landscape the private

sector to identify relevant
private groups to rollout covid-
19 vaccines

Module 7
LEARNING OBJECTIVES

By the end of the module, participants should be able to

• landscape key private sector actors.

WHY ENGAGE THE PRIVATE SECTOR IN VACCINATION?

The COVID-19 pandemic has stretched many health systems, with many countries facing
constrained resources and difficult environments. With the urgent need to rollout the COVID-19
vaccine globally, a large-scale collaborative effort with creative solutions including engaging the
private sector in health both at the global and country levels is needed.

By necessity, it is time for all hands-on deck. That is, governments must adopt a whole of
government, whole of society approach which entails mobilizing all available resources to roll
out the vaccine while keeping health systems functioning.

The World Health Organization (WHO) recently commissioned a review to identify barriers for
Ministries of Health in low- and middle-income country to mobilize the private sector in health to
collaborate in their national efforts to administer the COVID-19 vaccines. They found
governments face six major policy challenges. Key among them was countries were unsure of
how best to include the private sector in planning for the national response efforts. A possible
barrier to mobilizing the private sector is a lack of understanding on who the private sector in
health is in their country and which private sector actors are actively– or could potentially – be
involved in the COVID-19 vaccine response.

OBJECTIVES

This brief focuses on how to landscape – that is identify and prioritize – key private sector actors
that can support countries with the COVID-19 vaccine rollout. The brief presents a simple
process and tools to landscape relevant private stakeholders in health. Although the brief
focuses on COVID-19 vaccine rollout, it is good practice to always start any type of public-
private collaboration by landscaping the private sector related to the policy issue, health priority
and / or system gap you wish to address.

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This approach can be used by any Ministry of Health (MoH) official and/or staff person –
whether it be a ministry planning department facilitating the 5 Year Strategy Planning process,
or the ministry financing department drafting a Health Financing strategy, or the ministry
Immunization Department developing the COVID-19 National Deployment and Vaccination
Plan. Landscaping relevant stakeholders – both public and private – is a helpful tool for all types
of governance and programmatic functions.

PRIVATE SECTOR IN HEALTH DEFINITION

The first module offers a comprehensive definition for Box 1. WHO definition
the private sector in health. Box 1 offers WHO’s All entities - individuals and
working definition of the private sector in health, but organizations - whose primary
purpose is to promote, restore or
one can further “unpack” this definition – the private
maintain health.
sector has:
• different ownership structures – both for-profit and non-profit entities, including religious
or secular voluntary organisations;
• different legal structures – both formal and informal sector entities;
• different geographic ranges – both domestic and international businesses;
• different industrial sectors – including manufacturers and distributors that act as
suppliers to the private sector in health, alongside educational institutions that produce
health workers; and the private health insurance sector; and
• a range of representative entities – associations that represent (and in some cases
regulate) both healthcare professionals, and private health facilities and businesses, in
public affairs.

LANDSCAPING PROCESS

There are four steps in the process by which to map out and prioritize the key private sector
actors a Ministry of Health can use to identify private sector partners for the COVID-19 vaccine
roll-out.
• Step 1: Define the scope for the landscaping exercise
• Step 2: Define the relevant private sector actors
• Step 3: Assess private sector capacity and interest
• Step 4: Prioritize private sector actors

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Step One: Define the scope for the landscaping exercise

Box 2. Define the scope of landscape exercise

Before starting a landscaping exercise, it is
Factors to consider are:
essential to make sure that the scope of the • Use
landscaping exercise is clearly defined. As Box 2 • Geographic scope
illustrates, there are four factors to define a • Level of detail
• Resources
landscaping exercise’s scope.

Use: As noted earlier, there are many uses for a landscaping exercise. Different uses include
determining which stakeholders, both public and private, should be involved. A few examples of
potential use for a landscaping exercise include: (i) drafting a policy or regulation, (ii) drafting a
strategy and/or plan, and (iii) designing a program involving the private sector. The use for the
landscaping exercise will also determine other factors such as geographic scope, level of detail,
and resources needed.

Geographic focus: Another factor to consider in defining the scope is geographic reach for the
landscaping analysis: Is it national? And regional? Or in specific regions or localities?

Level of detail: The level of detail required for the analysis depends on the use of the landscape
analysis. For example, in designing a consultative policy process and/or public private dialogue,
the analysis focuses on stakeholder interest, capacity, and expertise in the activity. The
stakeholder interview questions will be few and more open-ended. While developing an
understanding private sector capacity to administer the COVID-19 vaccine will require more
detailed questions about staffing capacity and an inventory of infrastructure and medical
equipment inventory.

Resources: Before moving forward, it is crucial to TIP #1 Small team approach

mobilize funds and/or resources to conduct the Form a team comprised of 2 to 3 MoH
staff, 2 to 3 private sector leaders and 1
landscape analysis. The most important resources are consultant to carry out the landscaping
staff and data both of which may be in short supply. exercise. The team creates legitimacy and
builds trust among both public and private
Ideally, a health ministry would form a small team
sector stakeholder groups.
consisting of ministry staff, private sector
representatives, eventually supported by a consultant (see Tip #1). Including two to three
representatives from the private sector who are knowledgeable of the overall private sector in
the design and analysis of the landscaping exercise serves two purposes: (i) creates legitimacy

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and builds trust among private sector stakeholder groups as well as (ii) opens doors and
creates access to private sector and their data. There is a number of factors to consider when
selecting private sector representatives, including:
• are they knowledgeable of the private sector related to the specific problem?
• are they respected by other private sector stakeholders?
• do they have the authority to speak on behalf of the segment of private sector in health?
• do they have the time and interest in participating?

Hiring a consultant can help the MoH quickly design and carry out the landscaping exercise as
well as collect additional data and information needed. The consultant can perform tasks that
the MoH do not have the time for, such as organizing meetings, drafting interview guides,
conducting stakeholder interviews, collecting additional information and documenting the
analysis.

Step Two: Identify relevant private sector stakeholders

The private sector in health is diverse, broad, and complex. To start the identification process, it
is critical to clearly define the priority problem and bottlenecks to narrow the segment of the
private sector to be included in the landscaping exercise. Returning to COVID-19 vaccine, the
small public-private team will need to conduct a rapid analysis of the National Vaccine
Deployment Plan to identify and prioritize the government implementation objectives and
capacity gaps. For example, the small public-private team may agree that insufficient
warehouse and cold storage capacity is a major bottleneck to the government’s vaccine rollout.
The small public-private team will then narrow the landscaping exercise to the range of private
sector actors related to warehouse and cold storage.

It is important to note that a “problem” can be a priority health area, such as reducing maternal
mortality, or increasing vaccination coverage. Or it can be a health system gap, such as
frequent stockouts in public health facilities or inoperable labs in public hospitals. This rapid gap
analysis can greatly reduce the type and number of private sector stakeholders to be included
in the landscaping exercise. The small public-private team can carry out the NVDP analysis as
well as brainstorm on who are the key private sector actors in just a couple of hours.

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Once the problem and its critical bottlenecks have been defined, the small public-private team

Definition of stakeholder
A ‘stakeholder’ is a person or
group that has an interest or
‘stake’ in and/or the power to
influence - either directly or
indirectly - the collaboration or
partnership in COVID-19 roll
out.
can map the relevant public and private sector stakeholders.
In the case of the National Vaccine Deployment Plan, you will
note that the private sector in health can play a role in all
aspects of a country NVDP. There are seven components,
and each component implies a different set of private sector
actors.

Regulatory preparedness

Resources and funding

Vaccine, cold chain & logistics

Communication and demand generation

Service delivery

Human resources management, training & supervision

Monitoring and evaluation

Regulatory preparedness: Regulatory preparedness section tackles a wide range of regulations

governing quality, scopes of practice, pricing, and provider reimbursement modalities in addition
to introduction of a new vaccine into the system. Collaborating with the private sector to rollout
the COVID-19 vaccines requires examination of a wider range of regulations. For example, do
the current regulations permit private providers to
Possible private sector actors impacted
administer the COVID-19 vaccine? Do scopes of practice
by regulations include:
allow task shifting to a wide range of private health cadres • Private facilities and pharmacies
• Private provider associations
to deliver the COVID-19 vaccine? Do quality standards for
• Private supply chain companies
vaccine cold storage allow private warehouse to store the • Private health insurance

vaccine? Will private health insurance be required to

reimburse for the cost of COVID-19 vaccine? Is there regulation to prohibit qualified private
sector entities to provide vaccine service?

Depending on the delivery strategy and bottlenecks, a Ministry of Health will need to include
those stakeholders directly affected by these potential regulatory barriers. They include private
health facilities and pharmacies, associations representing different types of health facilities and

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healthcare professions, and full range of private companies involved in supply chain
management.

Resources and funding: As the COVID-19 pandemic has Possible private sector groups in
resources and funding include:
demonstrated, the private sector has contributed
• Commercial companies
significant resources for prevention and treatment. The • Private health insurance
private sector – particularly large companies in banking,
telecom, agrobusiness, hospitality and extractive industries to name a few – can be a potential
source of funding, infrastructure, and expertise to governments to rollout the COVID-19 the
vaccine as well. For example, the Department of Health in the Philippines established “Test,
Trace, Test” – T3 Task force between the government agencies and private sector to mobilize
and centralize private funds and expertise to accelerate the COVID-19 vaccine rollout.

Vaccine cold chain management: An increasing Possible private sector businesses in

number of LMICs are outsourcing specific areas of the vaccine cold chain management
include:
supply chain to private companies to leverage their • Importers
comparative advantage in storing, handling, and • Wholesalers
• Warehouse / storage
transporting vaccines. These actors include importers, • Transporters
wholesalers, warehouse / storage companies, and
transport companies to name a few. For example, Nigeria, Lagos State outsources its entire
vaccine supply chain to private vendor and the Ministry of Health in Senegal contracts multiple
third-party logistics providers to manage delivery of a variety of public health products.

Service delivery: Private sector providers – both not-for-

Possible for-profit and not-for-profit
profit and for-profit –have infrastructure and staff they providers in vaccine delivery include:
can quickly mobilize, particularly in later phases of • Physicians
• Nurses
COVID-19 vaccine rollout to reach large sections of the • Physician/Nurse Assistants
• Pharmacists
general population. In the Republic of Korea, up to 60%
of private providers offer vaccinations. In Afghanistan, the government donates vaccines to the
not-for-profit providers for administration and in exchange, they report vaccine given to the
national immunization registry. In these examples, a wide range of private providers administer
vaccines, from physicians, nurses, clinical officers, and pharmacists in multiple settings
depending on the type of vaccine. Not-for-profit providers are often located where vulnerable
and marginalized groups are as well as remote areas.

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Communication and demand generation: In the past,
Possible private sector actors in
the private sector has played important roles in vaccine communication and demand generation
include:
advocacy. Private sector expertise in behaviour
• Marketing and PR firms
change, marketing and advertising have been assets in • Private companies and non-profits
• Telecom companies
raising a population’s awareness during vaccination
• IT firms
campaigns. There are many examples where the • Private healthcare providers

private sector has played a role in generating demand.

Research in multiple countries – both high and LMIC – has documented the benefits of enlisting
private (for-profit, non-profit, faith-based and community-based) providers to educate their
clients on the benefits of vaccination and to provide counselling to address their fears about
vaccine side-effects. GAVI has leveraged its vast network of global corporations and non-profits
to harness their expertise in communications to increase vaccination coverage worldwide. In the
Philippines, the Department of Health’s relies heavily on private partners’ expertise and capacity
in the COVID-19 communication, including tapping into their social media platforms, working
with telecom providers, and developing software solutions.

Human resources management, training, and supervision: Possible private sector actors in HR
Governments need to ensure that healthcare workers who management, training and supervision
include:
can administer vaccines are properly licensed, trained • Private facility associations
• Private healthcare professional
and supervised. This also includes ensuring private
associations
providers involved in vaccine delivery receive adequate • Private medical training institutes

training. In several African countries, country level private

healthcare federations are sponsoring, with government support, training in a wide range of
vaccine related areas such as administration, storage, etc.

Monitoring and evaluation: The COVID-19 vaccination

Possible private sector actors in
rollout will need to be closely monitored to ensure the best monitoring and evaluation include:
• Private facility associations
use of scarce resources and to continuously adapt the
• Private healthcare professional
strategy to supply, demand, logistical, and adverse events. associations
• Private IT firms
Yet, a recurrent problem is private sector underreporting of
data. Private facility and healthcare professional
associations can play an instrumental role in encouraging private providers to boost their
reporting. Also, private IT firms have created software and mobile apps to facilitate ease of
reporting and monitoring.

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Step 3. Assess private actors’ interest and capacity

Once a preliminary key stakeholders map organized TIP #2 Brainstorming stakeholders

When mapping the relevant private sector
by NVDP strategy areas is developed, the team will
group, get as specific as possible. Not only
need to collect data to assess private sector list the segment, but also the names of
major players and a contact person.
stakeholders’ capacity and interest in collaborating on
the COVID-19 vaccine rollout. There are two primary ways to gather data: document review and
interviews.

Potential public sources of documents include: DHIS2 service delivery data, private sector
assessments, MOH and donor project reports involving private sector. Private sector sources
include professional association membership lists and even the telephone directory. Remember,
this is a rapid assessment and not a research paper. Both the document review and interviews
should be a “light” touch. Typically, you want to learn about (see Diagram below):

INFORMATION:
Capture: data, local
knowledge, maret
analysis, etc.

PROFESSIONALS:
clinical staff,
INFORMATION:
specialists,
Dissemination:
volunteers, logistic
publication, media,
experts,
social media, etc.
administrative
support, etc.
What can
the private
sector
bring?
INFRASTRUCTURE:
ACCESS: To policy Health facilities,
makers, private warehouse space
sector leaders, and supplies,
communities etc. medical equipment,
etc.

EXPERTISE: Clinical,
technical, business
and management,
etc.

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What health infrastructure does the private sector own and operate? Key questions to ask
include: How many facilities? What type of facilities? Where are the facilities? What type of
services does the private sector deliver? Where do they operate? What type of equipment do
they have?

What many healthcare professionals can the private sector mobilize? Key questions to ask
include: How many staff? What type of staff? What level of training? What clinical expertise?
Where are the staff located?

What expertise can the private sector bring? Key questions to ask include: Does the private
sector have critical clinical expertise (e.g., respiratory therapy)? Or capacity (e.g., cold storage)
missing and/or insufficient in the Ministry? What business management and logistical skills?
What critical information does the private sector have? Key questions to ask include: What
information does the private sector possesses on local market knowledge as well as detailed
inventory of infrastructure, equipment, and staff. Also, what information and dissemination
channels, like social media, does the private sector control?

What type of access or political influence does the private sector group/actor have? Private
sector stakeholders can also have access to influential people, like policymakers, industry
leaders, development partners and can help mobilize critical intangible resources like
legitimacy, funds, influence.

In addition to learning about tangible and intangible

private sector resources, you also want to learn
about the private sector perception about public –
private collaboration to see: If they are currently
partnering with the public sector and under what
type of arrangement (e.g., MOU, contract, health
insurance). If not, why not? And finally, what is the
quality of the working relationship between the
sectors? Collegial? Antagonistic?
TIP #3 Assessing capacity and interest
In many countries, there may be too many
segments of the private sector relevant to
NDVP strategic areas and too many private
sector groups / providers to interview. Look
for stakeholders who are most representative
of that segment in the private sector.
Professional Associations are good starting
point and add several private providers.
Interview approximately 10 for each segment
and stop when the answers begin to converge.

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Step 4. Prioritize private sector actors

Through the interviews and document review, the small public-private team will have a good
understanding of which segments of the private sector are relevant to bottleneck in a country’s
NVDP. But you can still become overwhelmed by the breadth, scope and number of the
different private sector actors. Or you may have a small number, but you want to determine if
they make the “first” cut. Prioritization is an important step.

Once again, a simple brainstorming exercise among

the small public-private team can quickly eliminate
certain segments and/or provider groups. With a piece
of paper, create a simple matrix with names of
stakeholders interviewed and criteria based on the
categories of questions asked. One can rank the
stakeholders using a simple check (see table below) to
indicate if the stakeholder has capacity or use a scale
to measure the strength of each capacity area.
TIP #4 Prioritizing stakeholders
This rapid analysis will help narrow the
private sector segment and even the
names of specific private sector providers
and businesses to include in the Action
Planning. At this time, you do not need in-
depth information on each of these
stakeholders and may have to go back for
more comprehensive assessment of their
capacity as you get closer to defining the
type of collaboration.

Organization Staff Infrastructure Expertise Information Access Relationships

Grace Hospital ✓ ✓ ✓ ✓
Hope Clinic ✓ ✓
Consumer
CSO ✓ ✓
Transport
Express ✓ ✓ ✓ ✓
ABC
Pharmacies ✓ ✓ ✓ ✓
Warehouse Big ✓ ✓ ✓

CONCLUSION

This brief presents how to conduct a landscaping exercise to identify and prioritize relevant
private sector groups and providers. The landscaping exercise is a 4-step process that can be
carried out by a small team of MoH staff and private sector leaders with support from a

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consultant. By the end of the exercise, the MoH will have a short and manageable list of
relevant private sector stakeholders that can potentially become collaborators and partners in
implementing a country’s NVDP.

Although the brief focused on landscaping actors to assist a government to rollout out the
COVID-19 vaccine, one can apply this process to any public-private initiative. Indeed, it is good
practice to always start any type of public-private collaboration by landscaping the private
sector related to the policy issue, health priority and / or system gap you wish to address.

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