Strategies for engaging the private sector in sexual and reproductive health: How effective are they?

David Peters, Gita G. Mirchandani, Peter M. Hansen

Research output: Contribution to journalArticle

Abstract

The private health sector provides a significant portion of sexual and reproductive health (SRH) services in developing countries. Yet little is known about which strategies for intervening with private providers can improve quality or coverage of services. We conducted a systematic review of the literature through PubMed from 1980 to 2003 to assess the effectiveness of private sector strategies for SRH services in developing countries. The strategies examined were regulating, contracting, financing, franchising, social marketing, training and collaborating. Over 700 studies were examined, though most were descriptive papers, with only 71 meeting our inclusion criteria of having a private sector strategy for one or more SRH services and the measurement of an outcome in the provider or the beneficiary. Nearly all studies (96%) had at least one positive association between SRH and the private sector strategy. About three-quarters of the studies involved training private providers, though combinations of strategies tended to give better results. Maternity services were most commonly addressed (55% of studies), followed by prevention and treatment of sexually transmitted diseases (32%). Using study design to rate the strength of evidence, we found that the evidence about effectiveness of private sector strategies on SRH services is weak. Most studies did not use comparison groups, or they relied on cross-sectional designs. Nearly all studies examined short-term effects, largely measuring changes in providers rather than changes in health status or other effects on beneficiaries. Five studies with more robust designs (randomized controlled trials) demonstrated that contraceptive use could be increased through supporting private providers, and showed cases where the knowledge and practices of private providers could be improved through training, regulation and incentives. Although tools to work with the private sector offer considerable promise, without stronger research designs, key questions regarding their feasibility and impact remain unanswered.

Original languageEnglish (US)
JournalHealth Policy and Planning
Volume19
Issue numberSUPPL. 1
DOIs
StatePublished - 2004

Fingerprint

Private Sector
Reproductive Health
Reproductive Health Services
private sector
health
health service
Developing Countries
Social Marketing
developing country
franchising
Private Practice
social marketing
Sexually Transmitted Diseases
Contraceptive Agents
PubMed
sexually transmitted disease
Health Status
Motivation
contraceptive
Research Design

Keywords

  • Private providers
  • Private sector
  • Reproductive health
  • Sexual health

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Health(social science)
  • Health Professions(all)
  • Public Health, Environmental and Occupational Health

Cite this

Strategies for engaging the private sector in sexual and reproductive health : How effective are they? / Peters, David; Mirchandani, Gita G.; Hansen, Peter M.

In: Health Policy and Planning, Vol. 19, No. SUPPL. 1, 2004.

Research output: Contribution to journalArticle

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