The purpose of this workbook is to assist ministries of health, health managers and practitioners in engaging with the private sector on delivery of quality maternal, newborn and child health (MNCH) services in lower- and middle-income countries. Private health care is one of the fastest growing segments of the health-care system in lower- and middle-income countries, and private providers are an important source of health care. To accelerate progress to reach the Sustainable Development Goals for ending preventable maternal, newborn and child deaths, it is critical that whole health system organizations invest not only in increasing coverage of interventions, but also in quality. The audience for the workbook is those who are involved with organizing and implementing processes for engaging the private sector in delivery of quality MNCH services.

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.

This case study documents the experience of engaging with the private sector in health to maintain the delivery and use of essential health services (EHS) with a specific focus on maternal, newborn and child health (MNCH) and family planning (FP) services during the COVID-19 pandemic in Pakistan. A case study methodology was employed, drawing on desk review and key informant interviews, which were conducted between February and April 2022. Several opportunities were raised through the case study, to seize momentum, to ‘build back’ and nurture trust in the health system eroded by COVID-19 pandemic, harnessing all health sectors. While these were specific to Pakistan, they can be relevant to a wider audience.

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.