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 pre-packaging 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.