Strategies for Private Sector Participation in Child Healthcare: A Meta Analysis of Empirical Findings

A large number of households in developing countries seeks child health care services from the private sector. Despite this, policy makers have largely ignored it while developing health policies. Without an effective stewardship of government, the technical quality of child healthcare services provided by the private sector has generally remained poor. In this context, there is a growing consensus that a better match between the role of public and private sectors and their respective capabilities needs to be established. In such a redefined role, the public sector would largely perform a stewardship function and create an environment in which the private sector can help the state achieve its goals in the health sector. This raises a number of policy issues: how governments can fulfill their stewardship function in the context of child health, how they can work with the existing private sector to improve the effectiveness of child health services, and how they can encourage further private sector participation in the delivery of child health care services. Policy makers and analysts usually possess little knowledge or understanding of the private sector. In addition, the strategies and instruments to "harness" and "grow" the private sector for the achievement of child health objectives are not widely studied, or understood. This paper provides an overview of reform strategies and instruments being utilized in developing countries to enhance the contribution of the private sector to child health care. 1.1 Objectives The paper uses an analytical framework to gather and analyze information about public-private partnership programs, the effectiveness of these programs, and to identify the areas for future work on public-private issues in child health care. The paper is based on a review of 130 relevant studies, both published and unpublished. 1.2 Analytical Framework The paper uses an analytical framework to help health policy makers and planners identify policies to: Work with the private sector to ensure that the services it provides meet health sector goals (harnessing the private sector); Create an environment that supports private sector growth consistent with child health goals (growing the private sector). Certain principles of public finance and institutional economics guide the public-private division of labor. These principles also set out the stewardship role of the public sector in guiding (the often much larger) private sector in financing and provision of child health services. These principles help clarify the rationale for effective mix of public and private sectors in health care goods and services and marking out their specific domains. According to these principles, a desirable division of labor between public and private sectors in health depends on whether markets can work properly (contestability), so that the private sector will produce positive results, and whether information is sufficiently available (measurability) to permit assessment of the effectiveness of services. When markets and information fail, governments must play a corrective role. When markets and information succeed, government can open space for private response to consumer demand. As these conditions differ from time to time and place to place, the relative roles and relations of private and public sectors must evolve as well (For detailed description of the framework and the associated principles see, Chakraborty and Harding, 2001 pp.5-8).