What opportunities exist for the governance of private sector engagement in mixed health systems in the African Region?

Given the significant role of private actors in health across the African Region, there is a need to interrogate how private sector engagement (PSE) is governed. We identify three key opportunities for strengthening the governance of PSE in mixed health systems in the African Region. This work draws on a programme of activities conducted by the World Health Organization Regional Office for Africa, including a multi-country stakeholder survey, a regional meeting with participants from the public and private sectors, and a descriptive case study of the governance environment. We draw on a governance framework focused on three governance inputs - participation, consensus orientation, and strategic vision and policy design - to present opportunities. First, participation can be strengthened by formalising mechanisms for dialogue and consultation, creating partnerships, and defining roles and responsibilities. Second, better consensus orientation can be sought through aligning sectoral goals, such as through deploying champions and improving understandings of health equity. Third, strategic vision and policy design can be advanced by better integrating the private sector into mixed health systems. Integration can improve both data sharing in national health information systems and oversight. Moving forward, addressing how health equity can be re-centred and improving collaboration across sectors are essential.