Health ministries are the largest single buyer of healthcare in most countries, and the majority of private sector players have the same approach: a product, a disease area, and a pitch. That approach fails more often than the industry admits, and the reason is structural rather than tactical. Governments do not experience healthcare the way manufacturers do. For a minister, treatment is the last chapter of a story that begins with the determinants of health like clean water supply, pollution, and prevention, and the daily job is managing crises rather than planning systems. Rolf Hoenger, who is co-founder and vice-chair of the Movement Health Foundation, argues that the companies and organizations that understand this inversion are the ones that get into the room, and the ones that do not spend years sending proposals that never reach a decision maker.
Start Where The Minister Starts
The first discipline Hoenger describes is uncomfortable for commercial teams, because it requires accepting a lower position in the hierarchy of government concerns. “You have to put yourself in the shoes of the government and understand how they see health care,” he says, “and health care, at the end, is for them the end of the story and not the beginning.” A health system, in his framing, begins with the social determinants of health: the environment, safe water, pollution, and the conditions in which people live. Prevention comes next. Only then does the conversation arrive at what most of the industry considers its core business. “For many health ministers, health care means sick care. It’s the end of the curve.”
That reframing matters because it explains why so much private sector outreach lands badly. A proposal built entirely around a treatment arrives at the narrowest point of a minister’s agenda, and it arrives during a week consumed by something else. Hoenger is blunt about what fills a minister’s calendar: “The daily bread of health ministers is emergencies. Anything can go wrong: shortages, patients not treated, issues with hospitals, a disease outbreak somewhere, and issues with the unions, nurses, or doctors.” Breaking out of that churn requires lifting the conversation to a strategic level, because strategy is the only place that common ground exists. Better outcomes from the same money. A success story the ministry can communicate. Without something in it for the ministry, there is no co-creation, only correspondence.
The Pitch That Never Reaches The Priority List
The most common failure, in Hoenger’s reading, is a narrow one. Industry arrives thinking only about its own disease area and its own access question, and hardly does the harder work of positioning that issue inside a wider national health agenda. Governments hold hundreds of competing priorities. The question is not whether an issue is important, but why it should rank. “What might be a priority for us might not be a priority in the holistic sense of a health system,” he says. Defining a genuine win-win is the price of entry, and salespeople who cannot do it rarely get a second meeting.
Calibration to context matters just as much. The same proposition does not travel. Where basic needs go uncovered, Hoenger notes, an innovation that extends life by three months is a difficult opening argument, while in a mature system that same three months can anchor the entire discussion. He is equally skeptical of the comparative shaming that some teams fall back on. Telling a government that a neighboring country has already done this and that they are behind, “I honestly have not seen that work very well in most circumstances.” The alternative he proposes is a change of role rather than a change of script: “It’s more about being a consultant with system-level insights and capacity-building capabilities than just being a salesperson.”
Build For The Handover, Not The Pilot
Sustainability is where most partnerships quietly collapse, and Hoenger identifies two failure modes. The first is bringing a ready-made solution. The Movement Health Foundation, which he describes as genuinely cross-industry and so not read as an industry lobby, works the other way round: listen to the needs, let the government define the challenge, then look at what can be offered against the priorities they set. “If a government wants to discuss primary health care for children and you come with a program about cancer care, you’re never going to get a sustainable solution.” The second failure mode is personnel. Governments change, and so do the people inside them. “You can never develop anything if you depend on one person only. You need to build a network approach so that you have a system engagement and not a one-person engagement.”
What holds the arrangement together afterwards is practical governance: joint steering committees, clear key performance indicators, formal structures, regular progress reporting, and a written agreement about what the project actually is. Ownership is the point. The teams on the government side need skin in the game, because the measure of success is not the pilot but whether the state takes the program over and scales it. “If you are coming as a consultant to help them, but then it has to be taken over by them. If we fail on this one, then it’s not sustainable.” Hoenger expects the pressure on that handover to intensify. Aging populations and the shift toward non-communicable diseases, such as cancer, diabetes, obesity, and cardiovascular disease, will force governments to rethink priorities everywhere, and economic growth will not cover the cost. That puts efficiency, digital health infrastructure, data sharing, and socioeconomic argumentation at the center of access discussions. Both sides, he notes, will need a different skill set to have that conversation at all.
Follow Rolf Hoenger on LinkedIn for more insights on health system transformation, government partnerships, and patient access.
