1. The role of the private sector in
the post-2015 development
agenda
Dr Eva Jané-Llopis
Director Health Programmes
World Economic Forum
Margarita Xydia-Charmanta
Project Associate
World Economic Forum

2. The World Economic Forum
2
Neutral platform to move the needle in different topics, from
environment, to infrastructure, from gender parity to health

3. In the next 15 minutes
3
• MDGs: Lessons learned and the role of public-private partnerships
• The post -2015 Development Agenda: the role of different stakeholders
• Leveraging core competencies of the private sector to achieve the
SDGs
• Harnessing innovation capacity to promote healthy lives and increase
healthcare coverage
• Challenges in involving the private sector in the post-2015 agenda

4. In the next 15 minutes
4
• MDGs: Lessons learned and the role of public-private partnerships
• The post -2015 Development Agenda: the role of different stakeholders
• Leveraging core competencies of the private sector to achieve the
SDGs
• Harnessing innovation capacity to promote healthy lives and increase
healthcare coverage
• Challenges in involving the private sector in the post-2015 agenda

5. Progress towards the MDGs has been uneven
Proportion of low and middle-income countries progressing or
regressing on MDGs, 2010
5
Source: Overseas Development Institute “Millennium Development
Goals Report Card”

6. Public-private collaboration in the MDGs have …
6
Sources: Development Cooperation, Ministry of Foreign Affairs of the Netherlands (2011) “Public-private partnerships. Ten ways to achieve the Millennium
Development Goals”, GAVI Alliance, UNDP Europe and CIS, the UN Millenium Project, Lucci P. (2012) “Post-2015 MDGs. What role for business?”, Overseas
Development Institute
• Tripled investments in medication for HIV/AIDS, tuberculosis and
malaria
• More medicines available: eg. reach > 40 million people with
African river blindness in > 30 countries
• Vaccination: four in every five children worldwide protected by
vaccines; 40% drop of number of children dying before their fifth
birthday to fewer than 7 million
Outside health:
•Better market access (e.g., small farmers in Kenya floriculture sector)
•Code of practice for a sustainable horticulture (Ethiopia)
•Higher incomes for cocoa producers (Cote d’Ivoire)

7. In the next 15 minutes
7
• MDGs: Lessons learned and the role of public-private partnerships
• The post -2015 Development Agenda: the role of different stakeholders
• Leveraging core competencies of the private sector to achieve the
SDGs
• Harnessing innovation capacity to promote healthy lives and increase
healthcare coverage
• Challenges in involving the private sector in the post-2015 agenda

8. As with MDGs, we need all capacity we can for
delivering the Sustainable Development Goals
(SDGs)
8
Source: UNDP Europe and CIS
Civil
Society
Public
Sector
Private
Sector

9. Top 150 largest
economies
-Wal-Mart: revenues > GDPs of 174 countries
employed > 2 million people.
-Shell: > revenues than the combined GDPs 6th
+ 7th
most populous nations in the world > 350 million
Together, the 44 companies in top 100 have revenues
over 9% of global GDP
All businesses (micro-, smes) are:
-drivers of our economic societies
-create jobs, provide households
-have large capital and present an opportunity to shift
goods, services and revenue for health
-an important resource of capacity
9
44% of the 100 top largest economies are not
countries but corporations (2009)

10. 10
Taskforces
& progress:
•water
•gender
equality
•climate
change

11. Comparative advantages and disadvantages:
the private sector
• Greater management flexibility
• More innovation
• More attentive to consumer/patient convenience
• Accountability for consumer/patient satisfaction
• Adaptable access to infrastructure
• Flexible employment
• Quicker response to changing market conditions
11Source: Harding, A and Preker, A (2003) Private Participation in Health Services, The World Bank
• Equity issues (purchasing power)
• Services concentrated in urban areas
• Little attention to public health services
• Emphasis only on curative care services
• Focus on a narrow range of customer needs
• Some private sector products, like tobacco,
are harmful to public health
+
-

12. 12
• MDGs: Lessons learned and the role of public-private partnerships
• The post -2015 Development Agenda: the role of different stakeholders
• Leveraging core competencies of the private sector to achieve the
SDGs
• Harnessing innovation capacity to promote healthy lives and increase
healthcare coverage
• Challenges in involving the private sector in the post-2015 agenda
How can we leverage the key competences of
the private sector in the SDG agenda?

13. The post-2015 Development Agenda:
Interconnection – we need a systems approach
13Source: United Nations (2013) “A renewed global partnership for development”
They are all
interconnected

14. 14
Approaches go beyond CSR for a more
inclusive green growth agenda :
-Eliminating waste + more efficient use
of resources
(e.g walmart global supply chain carbon footprint)
-Redesigning how make and deliver
(sustainable production processes, e.g., cradle to
cradle, limited use toxic chemicals)
-All institutions for sustainability (e.g.,
innovative business schools developing a new
generation of business leaders)
The sustainability agenda is more advanced in
leveraging the private sector
Leading companies have:
- 25% higher stock value - the fastest growing stock value
- deliver superior financial performance - are better investment risks
Sources: http://www.oecd.org/greengrowth/Rio+20%20brochure%20FINAL%20ENGLISH%20web%202.pdf
Alignment of policies and incentives continue to be key

15. The post-2015 Development Agenda:
need for supportive policies to advance action
15Source: United Nations (2013) “A renewed global partnership for development”
Healthy Lives
Universal Health
Coverage
Policies across
all sectros that
might have an
influence to
healthy lives
Systems approach

16. Core competencies of the private sector that can
be leveraged
16
Source: Lucci P. (2012) “Post-2015 MDGs. What role for business?”, Overseas Development Institute
• Find different ways of raising funds using international capital
markets and new financial products

17. Creating a system level change for
healthy lives
17

18. Innovation from the private sector to healthy
lives
18
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Process and product reengineering

19. Innovation to leverage from the private sector to
increase healthy lives
19
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems

20. Greenstar, as an NGO, has used the private healthcare
system to create an extensive network of family
planning franchises
DescriptionDescription
• Social marketing organization for family planning
and access to contraceptives
• Leverages / uses the private healthcare system
(70% of Pakistanis) to act as franchisees to:
- Counseling and advice
- Outlet for purchasing
affordable contraceptives (26%)
Cost advantage and qualityCost advantage and quality
• Low income non-users, thru total market
approach – different price points per
segment
• Cross subsidisation increases access
• Funding from large international
organizations and Governments
• Per capita GNP is low, 70%
accesses care in the private sector,
• Affordability and access to quality health
products are needs
• 59% of family planning
services delivered by public
sector
• Greenstar can grow (though
it is fairly large)
• Constant funding support
shows replicability
27
38
35
ProductsProgram CostsOperations/Admin
Moderately low
operating and
administrative costs
30
59
KeySocialMarketing
CommercialSector Greenstar
NGOSector
Publicsector
30
70PublicPrivate
Source: world economic forum 2010
Share of family
planning services in
Pakistan
Within the private sector,
there was
• Significant need for family
planning services
• Underutilised capacity to
provide these services
• Low levels of knowledge
and skills
RelevanceRelevance ScalabilityScalability

21. 21
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Innovation to leverage from the private sector to
increase healthy lives

22. 22
Prevalence of physical inactivity*
• High rates of physical inactivity across countries independent of income level
• Except India and China, over 40% of the population (>14 yrs) is physically inactive
• Saudi Arabia and the UK have the highest rates of physical inactivity
• In these countries, women are less active than men
* Physical inactivity - the percentage of the population aged 15 or older engaging in less than 30 minutes of moderate activity five times per week or less
than 20 minutes of vigorous activity three times per week, or the equivalent
Source:WHO2011

23. Sedentary time will continue to increase
Source: Ng, Popkin. Obesity Reviews, 2012
USA
P1: 2009
UK
P1: 2005
Brazil
P1: 2007
China
P1: 2009
India
P1: 2005
P1
23

24. 24
Estimated gains in life expectancy with elimination of physical inactivity
Source: I-Min Lee et al, Lancet, 2012

25. 25
Creating a social movement
Digital platforms have:
•amplified the message for a healthier generation
•engaged younger audiences
•motivated healthier choices
personalization and
empowerment,
enable that systemic
approach, getting
the right message
to the right people
From video games to social
media challenges
Supportive
policies
across
sectors:
-Environnent
-Transport
-City planning

26. Leapfrogging innovation from the private sector
to increase healthy lives
26
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Process and product reengineering. This reduces costs and
offers and alternative to the traditional product
Alignment of policies across relevant sectors
continue to be key

27. Universal Health Coverage, 2010
27
Source: adapted from PNHP, WHO and SEARO

28. Health care expenditure increasing in emerging economies -
with still significant catching up with developed economies
0%
5%
10%
15%
+ 1.6 pp
+0.8 pp
+0.9 pp
+3.1 pp
Low income
5.8%
4.0%
Lower middle income
4.4%3.8%
Upper middle income
6.1%5.3%
High income /
Developed economies
12.3%
9.5%
2011
1995
Upper middle income countries: Algeria, American Samoa, Angola, Antigua and Barbuda, Argentina, Azerbaijan, Belarus, Bosnia and Herzegovina, Botswana, Brazil, Bulgaria, Chile, China,
Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Gabon, Grenada, Iran, Islamic Rep., Jamaica, Jordan, Kazakhstan, Latvia, Lebanon, Libya, Lithuania, Macedonia,
Malaysia, Maldives, Mauritius, Mexico, Montenegro, Namibia, Palau, Panama, Peru, Romania, Russian Federation, Serbia, Seychelles, South Africa, St. Lucia, St. Vincent and the
Grenadines, Suriname, Thailand, Tunisia, Turkey, Turkmenistan, Tuvalu, Uruguay, Venezuela
Lower middle income countries: Albania, Armenia, Belize, Bhutan, Bolivia, Cameroon, Cape Verde, Congo, Rep., Cote d'Ivoire, Djibouti, Egypt, El Salvador, Fiji, Georgia, Ghana,
Guatemala, Guyana, Honduras, India, Indonesia, Iraq, Kiribati, Kosovo, Lao PDR, Lesotho, Marshall Islands, Micronesia, Moldova, Mongolia, Morocco, Nicaragua, Nigeria, Pakistan, Papua
New Guinea, Paraguay, Philippines, Samoa, Sao Tome and Principe, Senegal, Solomon Islands, South Sudan, Sri Lanka, Sudan, Swaziland, Syrian Arab Republic, Timor-Leste, Tonga,
Ukraine, Uzbekistan, Vanuatu, Vietnam, West Bank and Gaza, Yemen, Zambia
Low income countries: Afghanistan, Bangladesh, Benin, Burkina Faso, Burundi, Cambodia, Central African Rep., Chad, Comoros, Congo, Dem. Rep., Eritrea, Ethiopia, Gambia, Guinea,
Guinea-Bissau, Haiti, Kenya, Korea, Dem. Rep., Kyrgyz Republic, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Myanmar, Nepal, Niger, Rwanda, Sierra Leone, Somalia,
Tajikistan, Tanzania, Togo, Uganda, Zimbabwe
Source: World Bank, BCG analysis
Total healthcare expenditure as % of GDP by country income group (2011 vs. 1995, %)
Mostly driven by increase
in donor funding
Emerging economies

29. 0
25
50
75
100
100 0255075
Out-of-pocket2
expenditure on health (2011, % of private expenditure on health)
United States
France
Kazakhstan
Brazil
Vietnam
Turkey
Government expenditure on health (2011, % total expenditure on health)
Tanzania
South Africa
Senegal
Saudi Arabia
Rwanda
Russia
Philippines
Nigeria
Mexico
Indonesia
India
Ghana
Ethiopia
Colombia
Angola
Thailand
Very high heterogeneity in source of financing among
emerging economies: Several clusters are present
Lower health coverage
Higher health coverage
1. 2011, PPP int.$ 2. Out-of-pocket is a core indicator of health financing systems capturing the relative weight of direct payments by households in health expenditures; high out-of-pocket
payments are strongly associated with catastrophic and impoverishing spending, according to the WHO
Source: WHO; BCG analysis
Size proportional to per capita
health care expenditure1
Countries of focusReference
Moderate public with
limited private coverage
High public with limited
private coverage
High public with high
private coverage
Moderate public with
moderate private coverage
Lower public with very
limited private coverage High private coverage
• Out-of-pocket = Relative weight of direct payments by households in health expenditures
• Low government expenditure associated with high out-of-pocket spend suggests low healthcare coverage
• High out-of-pocket payments are strongly associated with catastrophic and impoverishing spending, according to the WHO

30. 30
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Provision of affordable high quality care services -
Leveraging private sector innovations
Increasing outreach patients through telemedicine
Optimizing human resources
Lower operating costs through simplified medical
services
High volume and low unit costs

31. 31
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Provision of affordable high quality care services -
Leveraging private sector innovations
Increasing outreach through telemedicine
Lower operating costs through simplified medical
services
High volume and low unit costs
Optimizing human resources. By shifting tasks to
trained lay people, have reduced operating costs,
increased availability of staff, and empowered the local
community

32. In Kenya, eLearning has eased the healthcare HR crisis:
have used mobile technology to support knowledge transfer
and its application for scalability
In Kenya, Enrolled Nurses (ENs)
comprise 70% of nursing and
45% of the health workforce
• First point of contact for
communities
• But inadequately skilled to
manage diseases like
HIV/AIDS
Objective: upgrade 22,000 ENs
• From ‘enrolled’ to ‘registered’
level w/in 5 years
• Via eLearning methods
Main achievements to date:
• 7,000 nurses upgraded
• 32 colleges and schools
participating
• Over 500 computer-equipped
training centers (incl. in
remote/marginalized districts)
eLearning vs. traditional methods
for upgrading ENs
In Kenya, chronic shortage of
highly skilled nurses
In Kenya, chronic shortage of
highly skilled nurses
Intriguing progress since
start of program in Sep. 2005
Intriguing progress since
start of program in Sep. 2005
High potential of eLearning
vs. traditional methods
High potential of eLearning
vs. traditional methods
Source: WHO, AMREF website, Press search, BCG analysis
10
15
20
0
25
5
2017
2005
(K)
2016
2225
2015
2014
2013
2012
2011
2006
Traditional classroom method eLearning
22,000 ENs to upgrade
~1,000 ENs
upgraded/yr.,
cost ~ $2.5M
~100 ENs
upgraded/yr.,
cost > $50M

33. 33
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Provision of affordable high quality care services -
Leveraging private sector innovations
Increasing outreach to patients through
telemedicine
Optimizing human resources
Lower operating costs through simplified medical
services
High volume and low unit costs
the support and know-how of
mobile and communications industry
is instrumental for going to scale

34. 35
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Provision of affordable high quality care services -
Leveraging private sector innovations
Increasing outreach through telemedicine
Optimizing human resources
Lower operating costs through simplified medical
services
High volume and low unit costs

35. RelevanceRelevance ScalabilityScalability
Aravind Eye Care System has grown into the largest
and most productive eye care facility in the world
DescriptionDescription
• Eye care to poor and wealthy in India through
5 owned hospitals, 4 managed hospitals, etc.
• Mass marketing and industrial engineering to
creat an eye care model combining:
• high service volumes and quality
• with low cost and innovation to meet
needs
• Conducts over 285,000 eye
surgeries and provides 2.4M
with outpatient eye care per year
Cost advantage and affordabilityCost advantage and affordability
• India has 12M blind people, more than any other
country, and 200M people in need of eye care
• Restore vision:
• 7.5 M through cataract surgery
• 2.4M through refraction and spectacles
• Aravind pioneered reach the poor and rural blind
- Provided care free of charge to patients unable to
pay for care
- Held aye camps in rural villages using community
workers
- Local sponsor organizations also provide
transportation and food for patients needing
surgery at an Aravind hospital
- Growth over 3 decades:
- 1978–87: Seeing up and developing
hospitals
- 1988–97: Refining and scaling up internally by
adding more hospitals, Aurolab, LAICO, education
- 1998–2007: Foundation for scaling up externally
establishing managed hospitals, growth in specialty
care, R&D
• LAICO now works with >250 hospitals across Central
& South America, Africa and Asia to increase
capability and capacity
0
200
400
Cost of intraocular
lens (IOL) ($)
2,400%
Average
100–150
Aurola
b
4–6

36. 37
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Provision of affordable high quality care services -
Leveraging private sector innovations
Increasing outreach through telemedicine
Optimizing human resources
Lower operating costs through simplified medical
services
High volume and low unit costs
Alignment of policies across relevant sectors
continue to be key

37. Price of open-heart surgery, ($)
Narayana Hrudayalaya provides top quality open-
heart surgery for ~50% the cost of private hospitals:
government policy could support further
DescriptionDescription
• Narayana Hrydayalaya (NH) 2001 one
largest provider of pediatric heart surgeries
- provides affordable quality cardiac
healthcare to the masses / poor
• NH drives down unit costs (which it passes
onto the patients) through a high-volume
standardised strategy
• The philanthropy wing helps
those unable to afford the care
Cost advantage and qualityCost advantage and quality
• Comparable level of quality – half the cost:
- High-volume by high capacity utilisation and
staff productivity
- High procurement of medical supplies
- Constant technological innovation
- Partnerships support subsidizing poor (farmers)
- Good human capital management
RelevanceRelevance
• The number of cardiac diseases in India is higher than
most countries - 45% of the world's incidence of
coronary heart diseases with the figure due to rise
• In 2004, 2.4M heart surgeries were needed, only 60,000
were performed
• Lack of options for poorer segments of Indian population
- Private hospitals are often too expensive for lower-
income Indians, don't offer surgeries on
compassionate grounds to those who are less well off
- Government hospitals did not have adequate capacity
to treat large numbers of patients
ScalabilityScalability
• A barrier to growth is the overly bureaucratic
public sector. Media coverage and public
awareness has increased the government
supporting certain areas (e.g., low cost
insurance) but no forthcoming
- Large duties on consumables such as heart
valves
- Regulatory hurdles in the way of new
colleges to train doctors and nurses
$2.3K
Private hospitals
$1.5–6K
Narayana Hrudayalaya

38. Presentation Outline
39
• MDGs: Lessons learned and the role of public-private partnerships
• The post -2015 Development Agenda: What to expect from the SDGs?
• The role of various stakeholders in achieving the SDGs
• Leveraging core competencies of the private sector to achieve the
SDGs
• Leapfrogging innovation from the private sector to increase healthcare
coverage
• Challenges in involving the private sector in the post-2015 agenda

39. 40
Source: Bhattacharyya et al. (2010) “Innovative health service delivery models in low and middle income countries -
what can we learn from the private sector?” Health Research Policy and Systems
Core competencies from private sector that can be
leveraged – health in all policies can help
Increasing outreach through telemedicine
Optimizing human resources
Lower operating costs by simplified medical services
Franchising
High volume and low unit costs
Process and product reengineering
Social marketing

40. Challenges in private sector involvement in health
–
lack of mechanism to address them
41
Source: Center for Global Development (2009) “Partnerships with the private sector in Health”
Do we need
HEALTH as a stronger
workstream within the
UN COMPACT work?

41. Bringing stakeholders together:
What dialogues should we engage and what environment we need to
create to overcome these issues?
Conceptual issues? Strenthening policy? Geographic issues?

42. THANK YOU
43