Leveraging the private sector for health system development in sub-Saharan Africa.

Development assistance has historically supported major gains in health and health-system development in sub-Saharan Africa, but recent reductions in development assistance have intensified financing and service-delivery pressures across the region. As governments seek more durable and domestically sustained strategies, the private health sector may play a larger role in expanding financing, specialised care, innovation, workforce retention, and public-private partnerships. However, private sector expansion alone is not sufficient and may worsen inequities if it remains disconnected from national financing frameworks, accreditation systems, quality standards, and public accountability. Here, we argue that private providers should be incorporated into well-regulated mixed health systems that align commercial incentives with universal health coverage, equity, and public health goals. Experiences from Ghana and Kenya have shown that integration depends on timely reimbursement, efficient accreditation, and deliberate efforts to reach underserved populations. Private-sector engagement should therefore complement, not substitute for, strong public health systems.