Dual practice, the combination of public and private practice in the same or different sites, is ubiquitous in most national health systems. Within the literature, there has been more focus on the dual practice of physicians and specialists, although nurses, midwives and other health workers also engage in the practice. The adverse consequences of dual practice for universal health care vary by context, and evidence is largely descriptive and fails to quantify and analyse its effects. Governance response also remains inherently contextual and varies by level of implementation intensity and capacity. Overall, the effects of different governance tools in response to dual practice remain unexplored in the literature. Studies do not elicit much insight into the process of policy reform in response to dual practice.

The private sector’s role in healthcare is growing across many settings. However, the sector remains under-governed in many contexts, particularly in low- and middle-income countries. Furthermore, the understanding of the evidence-base relating to private sector governance remains inadequate, with limited information available on the effectiveness of various approaches, and factors which facilitate or hinder their functioning. This scoping review was commissioned by the World Health Organization (WHO) to address this gap by synthesizing the available literature on the governance of mixed health systems.

Public health emergencies continually reinforce the need for an integrated approach to health systems strengthening, underpinned by a public health approach, helping to build health systems resilience. As part of a collaboration between the USAID Office of the Health Systems and the WHO Integrated Health Services Department, a strategic meeting was convened on 14 April 2021. This had wide-ranging representation which included WHO Deputy Director-General, Executive leadership from USAID, IANPHI and WFPHA. The overarching aim was to examine this topic together and identify actionable steps to build an integrated approach to health system strengthening that brings together health security, humanitarian, disease-specific and life-course-specific programmes. The specific objectives of the meeting were to: facilitate strategic discussions on prevailing practices in health systems resilience for health protection and high-quality health services, to determine actionable next steps for global guidance; inform policy options for WHO, USAID and partners to maximize joint country support for health systems resilience; and identify immediate priorities for next steps following the meeting. To inform and support the proceedings of this meeting, complementary desk reviews were conducted to synthesise evidence, and inform the discussions and way forward. Together, this package consists of (i) a technical meeting report and (ii) two complementary desk reviews. The package was co-developed with and has received concurrence from the USAID Office of the Health Systems.

This brief outlines an operational definition of the private sector in health service delivery, developed in collaboration with the WHO's Technical Advisory Group on the Governance of the Private Sector for Universal Health Coverage. The absence of a common definition was recognized as a challenge, potentially leading to an underestimation of the private health sector's impact on health systems. The private sector encompasses various subcomponents, including direct provision of health care, management of health care institutions, manufacturing of health care goods, and financing of health care. The focus of this definition is on private sector entities involved in service delivery.