Private Sector Engagement in Sexual and Reproductive Health and Maternal and Neonatal Health: A Review of the Evidence

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Most poor people in most poor countries get most of their healthcare from private rather than public sources. This paper reviews current evidence about the way in which the private sector delivers Sexual and Reproductive Health (SRH) and Maternal and Neonatal Health (MNH) services. The paper focuses on three particular issues – equity, quality and cost-effectiveness.

The private sector covers all health providers who are not directly managed and paid by the state. It includes for-profit and not-for-profit providers in the formal sector (who are generally trained, and licensed to practice or sell medicines), as well as the mass of informal providers, and shop-keepers who sell medicines.

The review draws mainly on evidence published in peer-reviewed journals, and grades the strength of the evidence using WHO’s scale of 1-5. ‘Grey’ literature is included where it meets a minimum standard. A range of sources were searched, and about 50 papers on SRH and 100 papers on MNH were included in the final review.

Although there is some published literature on private healthcare in developing countries, most of it is about market interventions in the way providers organise their work, the majority of them donor-funded. These have been divided into two categories – ‘service delivery’ such as training or franchising, and ‘financing’ such as vouchers.