Who Cares for Women and Their Newborns in Low- and Middle-Income Countries? The Role of the Private Sector in Provision of Family Planning, Antenatal, and Delivery Care

Session: What is the Local Private Health Sector and Can it Offer Quality Maternal Health Care?

Presenter: Lenka Benova, London School of Hygiene and Tropical Medicine

Background: The private sector is an important, but under-studied, healthcare provider in many low- and middle-income countries (LMICs). We used the Demographic and Health Surveys (DHS) for 57 countries (2000-2013) to describe family planning, antenatal (ANC), and delivery-care provision, focusing on the roles of the public and private sectors, in total and by socioeconomic position.

Methodology: We defined “met and unmet need for services” and “use of appropriate service types” clearly, and made explicit how source and sector of provision and wealth quintiles were classified, and how missing data were handled. Regional estimates (for Sub-Saharan Africa, Middle East/Europe, Asia, and Latin America) averaged country-level estimates, weighted by their total populations.

Results: Across the regions, unmet need ranged from 28-61% for family planning, 8-22% for ANC, and 21-51% for delivery care. Overall, the public sector provided the majority of all three healthcare services. The private-sector share among users of family planning services was 37-39% across regions (overall mean: 37%), with a median across countries of 41%. The private-sector market share among users of ANC was 13-61% across regions (overall mean: 44%), with a median across countries of 15%. The private-sector share among women who delivered in appropriate, classifiable locations was 9-56% across regions (overall mean: 40%), with a median across countries of 14%. For all three healthcare services, women in the richest wealth quintile used private services more than the poorest. Rich-poor gaps in met need for services were generally smallest for family planning and largest for delivery-care.

Conclusion: In LMICs, the private sector served a substantial proportion of women, particularly among the richest. To achieve universal health coverage, including its component of adequate quality, it is imperative to understand this sector, starting with improved data collection on source of care provision. The study was conducted with funding provided by Merck Sharp & Dohme Corp.