Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature

Abstract

Background: There has been a growing interest in the role of the private for-profit sector in health service provision in low-and middle-income countries. The private sector represents an important source of care for all socioeconomic groups, including the poorest and substantial concerns have been raised about the quality of care it provides. Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals. Limited information is available on the extent to which these interventions have successfully expanded access to quality health services for poor and disadvantaged populations. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor.

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

“…[35][36][37] In view of the importance of this sector in many low-income and middle-income countries, these approaches could be worth pursuing, especially when concurrent eff orts are made via accreditation or regulation to ensure that these providers deliver eff ective, effi cient, and equitable health care. 23,64,70 This related stewardship function of the govern ment is crucial, particularly to assuage any concerns about use of the private sector.…”

“…The three reviews [20][21][22] of social marketing emphasised the importance of an integrated package that includes mass media, training of health-care providers, and outreach to patients. Reviews that examined the eff ects of social marketing showed positive eff ects on promotion of awareness and use of insecticide-treated nets 23 and adop tion of recom mended practices for dengue pre vention. 24 However, the studies examined were of low quality.…”

“…36 Evidence for the eff ect of franchising-ie, establishment of a contractual arrangement between a health service provider and a franchise organisation-is weak and shows mixed eff ects in poor and disadvantaged populations. 23 …”

“…Although evidence is mixed in low-income and middleincome countries, regulation seems to be a particularly eff ective strategy to improve the availability of essential drugs, limit the supply of harmful drugs and unregistered products, and control the misuse of drugs. 23,64 Shah and coworkers' review 70 of interventions designed to improve the quality of health services provided by informal private providers (ie, providers who have not received training in allopathic medicine) concluded that market-based approaches that change the incentives or accountability of providers (eg, franchising or regulatory approaches) can improve provider behaviours, but that training alone is less successful. The only evidence for the eff ect of community monitoring strategies (including community scorecards and public reporting of performance data) on improved quality of care is weak and from a high-income setting.…”

“…For example, reviews that considered strategies' eff ects on equity and found promising pro-poor eff ects included those assessing expanded roles for community health workers, 10,11,16 task shifting, 31,32 the expanded use of private service providers, 23,34 strategies to reduce fi nancial barriers to access, 37 and strategies to increase humanresource availability and geographical access. 38,39,43 The other paper in this Series 6 builds on our recommendations and uses data from 15 low-income and middleincome countries to describe how a UNICEF modelling team developed and applied a model that simulates the potential eff ect of implementation of the most promising of these strategies in the context of an equity-based approach to health and nutrition programming.…”