SUPPORT summaries

Private for-profit sector - Can working with private for-profit providers improve utilization and quality of health services for the poor?

Concern regarding the technical failures of care provided by the private for-profit sector (i.e. private commercial providers) has led to the development of interventions aimed at addressing these limitations. The interventions implemented within the private for-profit sector and reviewed by the paper include social marketing, the use of vouchers, the prepackaging of drugs, franchising, training, regulation, accreditation and contracting-out.Social marketing is the application of the tools and concepts of commercial marketing to social and health problems.
A voucher is a form of demand-side subsidy that the recipient can use as payment for a product or service from identified providers. Pre-packaging involves packaging drugs in pre-defined doses adequate for the targeted population and treatment length. A franchise is a contractual arrangement between a health service provider and a franchise organisation. Accreditation is a strategy to improve and control service quality at organisational or facility level through oversight by an independent quality control evaluation body. Training interventions can include formal training sessions, vendor-to-vendor education and the distribution of guidelines. Regulatory interventions aim to set up and ensure adequate technical quality of the services provided through binding regulations. Contracting-out is a purchasing mechanism used to acquire specified services of a defined quality at an agreed price from a specific private provider and for a specific period of time.

Key messages

- Only low quality evidence is available on the effectiveness of interventions for working with the private for profit sector to improve the utilization and quality of health services for the poor.
- This evidence shows that many interventions involving the private for-profit sector can be implemented successfully in poor communities.
- Positive equity impacts can be inferred from interventions involving providers who are predominantly used by poor people.
- However, stronger evidence of the equity impacts of interventions for working with the private for-profit sector is needed for more robust conclusions to be drawn.