CHORUS Paper: The Role of the Private Sector in the COVID-19 Pandemic: Experiences From Four Health Systems

Much of the initial impact of COVID-19 was on urban populations; the United Nations estimated that perhaps 95% of cases occurred in urban areas (1). The livelihoods of the urban poor, particularly migrant workers and those working in the informal sector who are reliant on a daily-wages, were severely undermined by stringent lockdowns (2). In urban settings, the population depend on the private sector for both health-care and their livelihoods. Evidence from Low and Middle Income Countries (LMICs) consistently shows private providers are more likely to be used by urban citizens, particularly women, than their rural counterparts (34). This is particularly true for poor households in urban areas who lack accessible public health-care and so are dependent on informal drug shops and pharmacies (46). Any disruption to the sector will have a substantial effect that is likely to be amplified for poorer communities.

The COVID-19 response has highlighted the need to understand the role of private actors outside the health sector and created a demand for innovative strategies and partnerships between the public and private sector (14). At the same time, the pandemic has drawn attention to weaknesses in government’s ability to plan and regulate private sector activity (15). Given the disproportionate vulnerability of urban populations to COVID-19 and its social and economic impacts, understanding how to strengthen urban governance to deliver an effective response is vital.