Many low- and middle-income countries (LMICs) face a persistent gap between population health needs and the fiscal and operational capacity of public systems to finance, purchase, and govern quality services. Limited public budgets, inefficiencies, and uneven private-sector investment contribute to differential pricing and inequalities in access to and health outcomes.

At the same time, private providers and insurers, technology firms, and other investor-led initiatives are already shaping health markets, often operating alongside or outside of publicly financed systems. These commercial actors, including those pursuing both financial returns and social impact, influence service delivery models, pricing structures, and investment flows. While these dynamics can accelerate innovation and capacity, they may also reinforce inequities if not aligned with national Universal Health Coverage (UHC) goals.

Positioned within Subtheme 3 (Path Forward: Shaping Markets and Strengthening Governance for Equitable Health), which charts the path forward for shaping markets and strengthening governance for equitable health in the context of the Commercial Determinants of Health (CDOH), Parallel Session (PS) 3.2 moves beyond a traditional focus on health financing design. It recognizes the influence of commercial dynamics and asks: How can public purchasers and development partners better understand the decision drivers and constraints of commercial actors already shaping and increasingly shaping LMIC health markets, and strategically engage with, influence, and align these dynamics toward UHC, equity, and quality outcomes?

The session will therefore examine both:

• The perspectives, decision logics (i.e., how health market opportunities and risks are assessed), and constraints of commercial actors and impact-oriented investors already operating in health markets; and

• The impact investment and impact measurement and management (IMM) approaches are available to public actors and development partners to shape these dynamics.

It will focus on practical financing strategies, such as strategic purchasing, blended finance, and other instruments, that can reshape private-sector incentives, influence investment patterns, and strengthen alignment with public health goals. International Financial Institutions (IFIs) and Public Development Banks (PDBs) are framed not as parallel actors, but as catalysts that can de-risk investments, co-finance system enablers, and support governance reforms.

In many LMIC contexts, promising innovations and service delivery models stall after demonstration due to unresolved scale‑up risks, misaligned incentives, or lack of integration with public financing and purchasing systems. Strategically structured capital, combined with targeted technical assistance and risk‑sharing, can help address these barriers by aligning private investment with government priorities and absorptive capacity. When deliberately aligned with MDB‑supported reforms and sovereign financing operations, such approaches can accelerate the scale-up of proven solutions in national health systems: strengthening equity, sustainability, and value for money rather than creating parallel delivery channels.