As countries across the Eastern Mediterranean region (EMR) increasingly rely on private providers to deliver health services, governments face growing pressure to ensure these purchasing arrangements align with Universal Health Coverage (UHC) goals. This article, published in BMJ Global Health and authored by Shehla Zaidi, Aya Thabet, Hassan Salah, Awad Mataria and David Clarke, is based on 19 mixed-methods country case studies commissioned by the World Health Organization. It comprehensively synthesises current purchasing practices, key drivers, and common stewardship challenges in the EMR.
The findings reveal that while political will, domestic financing, and operational experimentation have enabled the expansion of private healthcare purchasing—particularly in middle-income countries—gaps remain in regulatory coherence, contract management, and trust-building with the private sector. Importantly, the study highlights a shared aspiration among countries to strengthen stewardship, improve governance structures, and integrate behavioural incentives to enhance quality and data reporting. The paper provides timely insights for policymakers and development partners on reimagining stewardship approaches to better guide private sector engagement for UHC.