Historically, public health agencies have had relatively few formal partnerships with private businesses. Many businesses have either no awareness of public health or a very narrow view of its role. For the others, interactions have usually centred on governmental public health’s regulatory functions such as assuring workplace, product, and consumer safety and establishing environmental standards.
These types of activities can increase business costs, at least over the short term, and can predispose businesses to a negative impression of public health’s authority and responsibilities. However, all businesses and public health agencies share an interest, that is to ensure a healthy population. Hence, businesses should have a financial interest in supporting organised public health efforts, and collaborative efforts can increase the reach and effectiveness of health services.
When we look at this relationship closely, we actually get a reciprocal sense. Businesses have benefitted from many public health activities. In turn, they can contribute greatly to addressing the pressing public health problems for which it bears both direct and indirect costs.
During the Covid pandemic, the time of economic downscaling, job losses, and businesses struggling to survive, many employers asked what they could do to better support public health. Never before has it been clearer that the private sector depends heavily on having a healthy, well-functioning, and productive workforce. Hence, the role of businesses in public health extends beyond simple fiscal contributions.
Although the concept to invest in the healthcare sector is new in Nepal, signs of progress are evident and a considerable amount of private sector activity can be seen in indicators of health outcomes including life expectancy, maternal care, and rates of communicable diseases. While Nepal compares poorly against the standard global benchmarks, the situation is improving.
For example, the country has recorded a consistent success rate of above 90% in tuberculosis treatment since 2009 and this exceeds the 87% global success rate. In addition, maternal mortality during childbirth has fallen to a third of the deaths recorded in 1990. Signs of progress can also be seen in the private sector’s expanding activity in pharmaceuticals, Ayurvedic holistic healing, diagnostic centres and hospitals.
Nearly 3,000 small, medium and large-sized commercial firms operate in these markets, and foreign investments of US$ 18.34 million have been realised since 2009. Healthcare services are delivered by public and private sector entities and account for a total expenditure of over US$ 1 billion each year. This figure amounts to nearly 6% of Nepal’s gross domestic product (GDP) and translates to a per capita expenditure of US$ 40 for the year 2014. This figure, which is lower than the global average, is nevertheless higher than most SAARC countries.
Also, the government of Nepal is supportive of foreign sector investment in the healthcare sector and the most attractive investment opportunities include tertiary hospitals and pharmaceuticals manufacturers. While the healthcare sector has witnessed the growth of private hospitals and diagnostic centres and domestic pharmaceutical manufacturing, there remains a great deal of unmet demand. Most hospital and diagnostic infrastructure have been concentrated in larger cities including Kathmandu, Biratnagar, Butwal, and Pokhara.
Nepal follows a free-market approach to healthcare policy and regulation. The Ministry of Health is responsible for the development of policies and regulations of the sector. A new policy strategy, the Nepal Health Sector Programme (2010-2015) has specifically identified the importance of close collaboration between the public and private sectors in the delivery of healthcare services, and all service providers are expected to deliver quality healthcare in a way that facilitates increased private-sector participation.
Nepal also adheres to a number of international best practices, including guidelines for earthquake-proofing of hospital buildings, mandatory free treatment for 10% of bed capacity, and environmental impact assessment norms for tertiary hospitals. Other benefits, including tax holidays and access to subsidised land for hospitals and pharmaceutical companies operating in underserved regions, would also encourage increased private sector participation and improve healthcare outcomes. As a result of this positive environment, significant foreign investments have been observed since 2013, especially in private tertiary hospitals.
But, is it enough? No. Are there more areas to be improved? Obviously yes!
Building stronger partnerships
Health agencies can provide public recognition to businesses that use partner with them—for example, to commercial food establishments that provide nutritious food options. Likewise, business leaders can participate in all health activities that involve community partnerships. These partnerships will be enhanced by including business leaders and organisations as a priority target audience for health agency reports on disease trends and population health and including specific recommendations for both businesses and governmental policymakers.
Public health departments could develop business-relevant analysis capacities, such as the emerging health impact assessment methodology, to assess the potential health benefits of proposed business-related policies. Such analyses could assist in prioritising policy development efforts and encourage business leaders to adopt policies that are likely to yield the greatest health benefits.
Policymakers could consider creating tax incentives for businesses to invest in public health. This investment could include funding support for health agency initiatives, collaborative work with health departments, or other public health partnerships.
At the national level, a stronger business–public health partnership could translate into more rapid progress on issues of common concern.
Together, public health and business sectors can also be more effective advocates for actions such as tax incentives for employer sponsorship of worksite health promotion programmes, improved nutritional standards for surplus food distribution to schools, and higher standards for clean air and water. Recognition of the value of strong public health agencies could also translate to business support for a dedicated federal funding source to support essential public health services at the provincial and local levels.
Businesses also can join the public health sector to advocate for laws that create healthier physical and social environments. For example, business support of improved nutrition and required physical education in schools, improved mass transit, or prominent nutritional labelling for fast foods can add weight and urgency to these efforts, to reduce the toll of chronic diseases in workers as well as the rest of the population.
Thus, the best way to foster the improvement of public health is to partner with businesses and entrepreneurs. Partnerships between businesses and public health will surely strengthen the process to improve the quality of healthcare services.