In most low and middle income countries the private health
sector has grown to become a substantial, and in some cases the
major source of health services.
In these countries, out of pocket payments to private health care
providers make up most of the total amount spent on health - from
over 50% in much of sub-Saharan Africa to over 80% in some Asian
countries.
What do people spend on private sector health care?
Poor households may spend disproportionately more of their
household income on health than richer ones. Much of this
expenditure is on pharmaceuticals and private for profit providers,
both qualified doctors, nurses, and pharmacists, and unqualified
providers such as shopkeepers or traditional practitioners. A
smaller amount of private spending is spent on buying hospital
care. This is usually financed through borrowing, often at
extortionate rates, which can drive middle-income families into
poverty, and the poor into even deeper poverty.
What do we know about private health providers?
Private providers are sometimes the only means for the poor to
access modern health care, as they are often closer than government
facilities and, once costs such as lost working time, travel and
unofficial user fees are taken into account, they are often cheaper
than the public sector. Evidence shows that quality of care is
highly variable and the poor may not be getting value for
money.
We understand the private sector as covering both
for profit
and
not for profit providers. These providers can be working
directly for consumers who pay either out of pocket or via an
insurance scheme; they can be working on contracts with either
governments or development agencies; or in other public private
partnerships, again either with governments or development
agencies.
How can poor people get value for money?
HLSP is keen to better understand and to work with both demand and
supply sides to help poor people get value for their expenditure.
This can be done through supply side schemes such as social
marketing and franchising, and provider contracting, training and
regulation. On the demand side, insurance and other collective
purchasing schemes, voucher programmes and consumer education are
all being explored.
Our work
We have examined how working with the private sector could improve
access to good quality, affordable and appropriate health services
in a resource,
Private sector participation in health which
describes and assesses a range of approaches to strengthening
public-private sector engagement.
We have also developed a review of national strategies for
public-private sector engagement in malaria treatment and
prevention, for WHO in 2006. The report is available on the WHO
website at
http://www.who.int/tdr/publications/publications/partner_malaria.htm›