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Project Record

Private versus public strategies for health service provision for improving health outcomes in resource-limited settings.

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 Systematic Reviews Programme
 Research and Evidence Division (Director of Research Office)

 Dr. Dominic Montagu


The objective of this study is to determine what services, and of what quality, are provided to the poor by private for-profit, private non-profit, and public sector providers, and what are the trade-offs between private for-profit, private non-profit, and public sector sources of care for the poor.

While a number of systematic reviews have been conducted or are being conducted on specific areas of working with the private sector, these reviews have been primarily intervention focused. Recently, Patoillard et al, conducted a systematic review of 52 studies on working with the private for-profit providers in low-middle income countries; these studies focus on interventions (such as social marketing, pre-packaging drugs, provision of vouchers, contracting-out services, franchising, regulation and accreditation) to improve utilization of healthcare by poor. While some of the studies showed an increase in the utilization of services and improvement in the quality of care, impacts on equity could not be assessed because of data limitations. Because most of these interventions were not designed as research projects, the review was not able to explain what services are being utilized by the poor and who is providing these services.

Currently, a moderately large body of literature documents the role of the private for-profit and not-for-profit sectors in the provision of health services and commodities for the poor in developing countries. Much of this documentation exists in the form of gray literature: program reviews, program evaluations, and summaries of experience from donor-supported interventions that support non-governmental organizations (NGOs) and/or private-sector delivery of health services. A much smaller collection of peer-reviewed articles exists documenting the scale of private for-profit and not-for-profit provision of healthcare to poor populations in developing countries, and, in rare cases, the quality or affordability of those services.

Outputs will consist of a protocol and a published review.