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Private Sector Participation and Health System Performance in Sub-Saharan Africa

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  • Joanne Yoong
  • Nicholas Burger
  • Connor Spreng
  • Neeraj Sood

Abstract

Background: The role of the private health sector in developing countries remains a much-debated and contentious issue. Critics argue that the high prices charged in the private sector limits the use of health care among the poorest, consequently reducing access and equity in the use of health care. Supporters argue that increased private sector participation might improve access and equity by bringing in much needed resources for health care and by allowing governments to increase focus on underserved populations. However, little empirical exists for or against either side of this debate. Methodology/Principal Findings: We examine the association between private sector participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. We also examine the correlation between private sector participation and key background factors (socioeconomic development, business environment and governance) and use multivariate regression to control for potential confounders. Private sector participation is positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations. The positive association between private sector participation and improved health system performance is robust to controlling for confounders including per capita income and maternal education. Private sector participation is positively correlated with measures of socio-economic development and favorable business environment. Conclusions/Significance: Greater participation is associated with favorable intermediate outcomes in terms of access and equity. While these results do not establish a causal link between private sector participation and health system performance, they suggest that there is no deleterious link between private sector participation and health system performance in SSA.

Suggested Citation

  • Joanne Yoong & Nicholas Burger & Connor Spreng & Neeraj Sood, 2010. "Private Sector Participation and Health System Performance in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-9, October.
    • Handle: RePEc:plo:pone00:0013243
    DOI: 10.1371/journal.pone.0013243
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    References listed on IDEAS

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    1. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    2. Chakraborty, Sarbani & Frick, Kevin, 2002. "Factors influencing private health providers' technical quality of care for acute respiratory infections among under-five children in rural West Bengal, India," Social Science & Medicine, Elsevier, vol. 55(9), pages 1579-1587, November.
    3. Berman, Peter A., 1998. "Rethinking health care systems: Private health care provision in India," World Development, Elsevier, vol. 26(8), pages 1463-1479, August.
    4. April Harding & Alexander S. Preker, 2003. "Private Participation in Health Services," World Bank Publications - Books, The World Bank Group, number 15147, December.
    5. Kamat, Vinay R., 2001. "Private practitioners and their role in the resurgence of malaria in Mumbai (Bombay) and Navi Mumbai (New Bombay), India: serving the affected or aiding an epidemic?," Social Science & Medicine, Elsevier, vol. 52(6), pages 885-909, March.
    6. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
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    1. Idrissa Beogo & Chieh-Yu Liu & Yiing-Jenq Chou & Chuan-Yu Chen & Nicole Huang, 2014. "Health-Care-Seeking Patterns in the Emerging Private Sector in Burkina Faso: A Population-Based Study of Urban Adult Residents in Ouagadougou," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-11, May.
    2. Ole Magnus Theisen & Håvard Strand & Gudrun Østby, 2020. "Ethno-political favouritism in maternal health care service delivery: Micro-level evidence from sub-Saharan Africa, 1981–2014," International Area Studies Review, Center for International Area Studies, Hankuk University of Foreign Studies, vol. 23(1), pages 3-27, March.
    3. Idrissa Beogo & Amadou Darboe & Oluwafunmilade A Adesanya & Bomar Mendez Rojas, 2018. "Choosing between nurse-led and medical doctor-led from private for-profit versus non-for-profit health facilities: A household survey in urban Burkina Faso," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-15, July.
    4. Nicholas E Burger & Daniel Kopf & Connor P Spreng & Joanne Yoong & Neeraj Sood, 2012. "Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya," PLOS ONE, Public Library of Science, vol. 7(2), pages 1-9, February.
    5. Neeraj Sood & Nicholas Burger & Joanne Yoong & Dan Kopf & Connor Spreng, 2011. "Firm-Level Perspectives on Public Sector Engagement with Private Healthcare Providers: Survey Evidence from Ghana and Kenya," PLOS ONE, Public Library of Science, vol. 6(11), pages 1-12, November.

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