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WP13 - Engaging the private sector in maternal and neonatal health in low and middle income countries

Future Health Systems

We reviewed existing literature on private sector initiatives that have shown effectiveness in improving maternal and neonatal health. The private sector constitutes a significant proportion of delivery services for women in developing countries and it also plays a key role in family planning, abortion, nutrition, and antenatal care. We primarily address maternal health outcomes and include interventions that improve neonatal health outcomes where they are included in the study design or interventional strategy alongside maternal outcomes. We do not review evidence that addresses neonatal outcomes alone, as this would go beyond the scope of this paper.

Our paper reviews family planning and safe abortion initiatives as well as the literature on efforts to train private sector health workers in maternal health. Community based misoprostol programs play a special role in altering the traditional limitations of training. To a lesser extent the evidence on clean delivery kits has shown that they can be an important means of working with the private sector on maternal health.

In addition to interventions, the paper reviews strategies to accommodate private sector incentives. Demand side strategies have used conditional cash transfers and vouchers to encourage women to seek antenatal care. Supply side strategies use microfinance to allow private sector midwives and other women‘s health care providers to improve their practices. One innovative program in India is known as the Chiranjeevi Scheme and is a form of contracting out to increase supply of delivery services and to ensure access for poor women. Social franchising and social marketing are also discussed.

The paper concludes by discussing key principles for donors to consider in engaging with the private sector to improve the safety and quality of private sector maternal and neonatal health care in low and middle income countries.