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As COVID-19 leads to a “cash crunch” for the private health sector in developing countries, Mark Hellowell (University of Edinburgh), Andrew Myburgh, Mirja Sjoblom and Srinivas Gurazada (World Bank Group) and Dave Clarke (World Health Organization), consider the opportunities and risks of providing state support to health care businesses. The World Health Organization is calling on countries to adopt a whole-of-government and whole-of-society approach in responding to the COVID-19 pandemic. Among other things, this requires policymakers to include the private health sector in efforts to contain, control and mitigate the health impacts of the outbreak. However, data gathered from a series of interviews with key informants in 12 low- and middle-income countries (LMICs) (Ethiopia, Kenya, Nigeria, Uganda, South Africa, Thailand, India, Sri Lanka, Pakistan, the Philippines, South Korea and Iran) has highlighted a surprising finding. Just as pressure is increasing on countries to ramp up health system capacity, measures designed to “flatten the curve” are reducing the demand for care and creating a “cash crunch” for the private health sector – one that is forcing providers to scale back their businesses and even lay off health workers.

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