Table 1.
Description and key diagnostic questions for the governance behaviours
| Governance behaviour | Rubric options |
| Align structures. Government takes the required actions to align public and private structures, processes and institutional architecture to create a fit between policy objectives, organisational structures and culture. | |
| Are private sector entities integrated into health system organisational arrangements? (formal, informal health actors, as well as digital self-care models of care, etc) | A. No evidence of integration |
| B. Limited integration (eg, larger urban entities) | |
| C. Moderate integration (eg, a base of large, medium and small providers) | |
| D. Full integration of private entities in the health system | |
| E. Do not know | |
| Do private sector entities deliver a publicly defined essential healthcare package? | A. No essential benefits package |
| B. Essential benefits package defined but not used to align/engage the private sector | |
| C. Essential benefits package defined and partially delivered by private sector entities | |
| D. Essential benefits package is fully aligned and delivered by private sector entities | |
| E. Do not know | |
| Are systems used to align public and private providers? (eg, referral, quality assurance, supervision) | A. No systems used |
| B. Systems used on an ad hoc basis | |
| C. Systems used but coverage is limited | |
| D. Systems used across a range of public and private entities | |
| E. Do not know | |
| Deliver strategy. Government establishes strategic public policy framework which sets out the vision, priorities, principles and values for the health system, and works out how to translate these priorities, principles and values into practice. | |
| Does national health policy/strategy include the private health sector? | A. Private sector is not mentioned in national health policy |
| B. Private sector is included in national health policy but vaguely referenced | |
| C. Private sector is included in national health policy with some specificity on entities and roles | |
| D. Private sector is included in national health policy with clear identification of entities and roles | |
| E. Do not know | |
| Is national health policy/strategy used to guide the private sector towards public health goals? | A. National health policy is not used to guide the private sector |
| B. Limited use of national health policy (not reflected in operational plans) | |
| C. Moderate use of national health policy (reflected in operational plans but limited implementation) | |
| D. Demonstrated use of national health policy (operationalised plan/roadmap and tools) | |
| E. Do not know | |
| Is there an inclusive process for national health policy review? (eg, formal review as part of the policy cycle) | A. No policy review |
| B. Policy review (public sector only) | |
| C. Policy review (selective participation of private and civil society) | |
| D. Policy review is inclusive of private sector entities and civil society | |
| E. Do not know | |
| Are there defined national health policy monitoring mechanisms in place that include the private sector? | A. No monitoring mechanism |
| B. Monitoring mechanism defined, but no evidence of use | |
| C. Monitoring mechanism used in a limited way (eg, at time of policy review, or only by the public sector) | |
| D. Monitoring mechanism used consistently | |
| E. Do not know | |
| Build understanding. Government facilitates information-gathering and sharing about all elements of service provision in the health system to provide intelligence to contribute to better health system outcomes. | |
| Are private sector entities included in national health information systems (HIS)? | A. No private sector reporting in HIS |
| B. Limited private sector reporting in HIS (eg, larger facilities, faith-based facilities) | |
| C. Moderate private sector reporting in HIS (eg, wider spectrum of entities) | |
| D. Universal reporting by private sector entities (eg, meets WHO threshold of 80%) | |
| E. Do not know | |
| How confident are health actors in using private sector data from national HIS? (eg, completeness, timeliness, quality and consistency of information) | A. No confidence in private sector data |
| B. Limited confidence in private sector data | |
| C. Moderate confidence in private sector data (efforts in place to improve quality) | |
| D. Confidence in private sector data (eg, routine data quality review/assurance) | |
| E. Do not know | |
| Are other sources of private sector data/information available and used? (eg, surveys, assessments, research) | A. No other data sources available |
| B. Other sources available but not recognised/used | |
| C. Other data sources partially recognised/used | |
| D. Evidence of triangulation of information sources and their use | |
| E. Do not know | |
| Foster relations. Government should establish mechanisms that allow all relevant stakeholders to participate in policy-making and planning and forge partnerships. | |
| Is the private sector organised for public sector engagement? | A. No private sector organisation |
| B. Limited private sector organisation (eg, parts of the private sector) | |
| C. Moderate private sector organisation (wider membership) | |
| D. Organised private sector (wide and active membership) | |
| E. Do not know | |
| Is the public sector organised and resourced for private sector engagement? | A. No public sector organisation (for PSE) |
| B. Limited public sector organisation for PSE (eg, limited resources, role and reach) | |
| C. Moderate public sector organisation (eg, investment in resources, roles and reach) | |
| D. Public sector organisation for PSE (eg, established/adequate resources, roles and reach) | |
| E. Do not know | |
| Are there public–private coordination platforms? | A. No coordination platform |
| B. Coordination platform(s) available but not formalised/used | |
| C. Coordination platforms formalised and used on an ad hoc basis | |
| D. Coordination platform(s) formalised and consistently used | |
| E. Do not know | |
| Enable stakeholders. Government ensure that tools exist for implementing health policy to authorise and incentivise health system stakeholders and, where necessary, impose sanctions to align their activities and further leverage their capacities, towards national health goals. | |
| What regulations are in place for the private sector? (eg, licensure, accreditation) | A. No regulations in place |
| B. Limited regulations in place | |
| C. Regulations in place but some gaps | |
| D. Comprehensive regulatory framework | |
| E. Do not know | |
| Do public financing arrangements include the private sector? (eg, grants, in-kind, contracting) | A. No public financing of the private sector |
| B. Limited public financing options (eg, training, access to commodities) | |
| C. Wider availability of public financing instruments but not widely used (eg, grants or contracts to specific entities only) | |
| D. Public financing instruments available and cover a range of private sector entities | |
| E. Do not know | |
| Is there adequate public sector capacity to ensure compliance with regulations and rules? | A. No capacity to monitor or enforce |
| B. Limited capacity to monitor/enforce (eg, ad hoc, selective) | |
| C. Moderate capacity to monitor/enforce (eg, procedures in place but not fully implemented) | |
| D. Monitoring and compliance systems fully implemented | |
| E. Do not know | |
| Nurture trust. Government leads the establishment of transparent, accountable and inclusive institutions at all levels to build trust ensuring that all health system actors, public and private, are accountable for their actions to a country’s population. | |
| How central are patient/civic interests to private sector engagement? | A. Patient/civic interests not mentioned as part of PSE |
| B. Patient/civic interests mentioned broadly as part of PSE | |
| C. Patient/civic interests with some specificity as part of PSE (eg, some analysis of gaps) | |
| D. Patient/civic interests specified as part of PSE (eg, analysis considers gender, diversity, equity) | |
| E. Do not know | |
| Do measures exist to manage competing and conflictive sectoral interests? | A. No measures in place |
| B. Measures in place but not used for mitigation | |
| C. Measures in place but require pressure to prompt mitigation (eg, via media or civic intervention) | |
| D. Measures in place and used to mitigate and manage interests | |
| E. Do not know | |
| What is the role of brokers/champions in sectoral engagement? | A. No broker/champion |
| B. Broker/champion used on an ad hoc basis with limited effect | |
| C. Brokers/champions used more routinely to facilitate engagement | |
| D. Brokers/champions consistently engaged to facilitate engagement and build trust across sectoral entities | |
| E. Do not know | |
| Is there any sharing of resources, capacities, skills for establishing trust between sectors? | A. No sharing of resources, capacities, skills |
| B. Ad hoc sharing of resources, capacities, skills | |
| C. Externally driven sharing of resources, capacities and skills | |
| D. Cooperative models of sharing of resources, capacities and skills | |
| E. Do not know | |