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Public-private partnerships and health system strengthening in global health « Back to Blogs

HIV continues to be a major threat to patient and population health around the world. It will only be controlled by effective programmes that enable the prompt diagnosis and management of patients with this infection. In view of this, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set ambitious targets for the diagnosis and management of patients with HIV infection. The target expects “90% of people living with HIV infection to know their status; 90% of those who know their status to receive antiretroviral therapy (ART); and 90% of those on ART to achieve viral suppression”. (1)

These targets are most difficult to achieve in resource-poor countries, and the challenge is greatest in sub-Saharan Africa. The targets will not be possible if drugs are not available, and so access to affordable drug treatments rightly gets a great deal of attention in the medical literature. But the targets are also dependent on adequate laboratory infrastructure to enable to initial diagnosis and ongoing assessment of patients with HIV infection. The burden of disease in countries in sub-Saharan Africa means that public health laboratories will struggle to cope with the demands placed upon them.

Part of the solution might be in public-private partnerships that enable health system strengthening in the health laboratory domain. However, there is not a great deal of evidence of the effectiveness of this approach. In light of this, Shrivastava and colleagues reviewed the role of public-private partnerships in enabling laboratories to scale up the provision of testing for HIV infection. (1) The researchers came up with some interesting results. The found that public-private partnerships were effective in enabling scale-up, in improving quality and efficiency, and sometimes in saving costs. Their review included national and international public-private partnerships – suggesting that both can play a role in laboratory system strengthening. The main limitation of the review is that there are relatively few published studies in this domain. This may reflect the fact that public-private partnerships are still largely a novel strategy in enabling laboratory system strengthening. Certainly, there is no question but that to tackle the HIV epidemic in resource-poor countries, it will need to scale up. In doing so, it may also enable health system strengthening in laboratory testing in other infectious diseases – such as Ebola and influenza. The ideal system would be one that caters to whatever infectious diseases are threatening the health of patients and populations in the countries in question.



  1. Shrivastava R, Fonjungo PN, Kebede Y, Bhimaraj R, Zavahir S, Mwangi C, Gadde R, Alexander H, Riley PL, Kim A, Nkengasong JN. Role of public-private partnerships in achieving UNAIDS HIV treatment targets. BMC Health Serv Res. 2019 Jan 18;19(1):46. 

Competing interests


KW works for BMJ which produces a range of resources in infectious and non-infectious diseases.




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