The Role of Non-State Actors in Strengthening Health Systems

In a majority of low- and middle-income countries, governments are responsible for providing health care to their citizens even when they are not the sole providers. Outside of government, other groups provide coverage, but there are challenges. This project will identify the policy and regulatory factors that have helped or hindered efforts to allow non-state providers to contribute to strengthening health systems. The role of non-state health providers Beyond the public sector, there is a large number of non-state health actors. They include commercial companies, NGOs, religious institutions, individual care providers, and shopkeepers. The services they provide vary immensely in complexity and national importance. A movement toward universal health care Currently, there is considerable global momentum for achieving universal health coverage in the form of quality health services that are accessible without the risk of financial hardship. In this context, many low- and middle-income governments are seeking to better understand and harness what non-state actors can contribute to health care. Although their situations vary, the outcomes can be particularly detrimental when their services are low quality or very expensive. These challenges can exacerbate health and income inequities. Governance strategies for optimizing the contributions of non-state health actors include: -targeted interventions, such as public-private partnerships; and -changes in policy and regulatory environments. Existing reviews of the impact of these governance strategies on the quality and equity of services provided by non-state actors are limited. They have also been largely inconclusive. Research to address the challenge IDRC, the Rockefeller Foundation, and the Alliance for Health Systems and Policy Research will jointly support approximately 10 research projects that respond to the question, "How can non-state providers contribute to improved health coverage, and how can governments facilitate this?" Researchers from low- and middle-income countries will undertake observational research examining existing and relevant country cases. The research will focus exclusively on low- and middle-income country contexts. A two-stage competitive selection process will be used to identify and select the research projects. The researchers will compare and contrast various low- and middle-income countries' experiences. As a result, this portfolio of projects will contribute to a body of evidence urgently needed in those countries. The research will inform policymakers in low- and middle-income countries, along with others seeking to optimize the contribution of non-state actors to universal health coverage. Findings will be published and shared in a book, special journal issue, policy briefs, videos, dissemination workshops, and social media.

Project ID


Project status



60 months

IDRC Officer

Marie-Gloriose Ingabire

Total funding

CA$ 1,090,000


Maternal and Child Health

Project Leader

Abdul Ghaffar


World Health Organization/Organisation mondiale de la santé/Organización Mundial de la Salud

Institution Country


Institution Website