RAND Corporation, Arlington, Virginia, United States of America.
PLoS One. 2012;7(2):e27885. doi: 10.1371/journal.pone.0027885. Epub 2012 Feb 24.
Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited.
METHODOLOGY/PRINCIPAL FINDINGS: We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities.
CONCLUSIONS/SIGNIFICANCE: The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility.
发展中国家的健康状况持续落后于发达国家，许多国家也未能实现千年发展目标。在许多发展中国家，私营卫生部门提供了大部分医疗服务（例如，撒哈拉以南非洲地区约为 50%），但私营提供者通常与卫生系统融合程度较差。改善卫生系统绩效的努力将需要包括私营部门，并增加其对国家卫生目标的贡献。然而，关于私营医疗保健提供者所面临的限制的文献有限。
方法/主要发现：我们分析了肯尼亚和加纳私立医疗机构调查的数据，以评估私立提供者面临的增长限制。相当一部分医疗机构（加纳：62%；肯尼亚：40%）报告称，获得资金的机会有限是他们面临的最大障碍；只有少数医疗机构报告使用正规信贷机构为日常运营提供资金（加纳：6%；肯尼亚：11%）。其他重要的障碍包括腐败、犯罪、对商品和服务的需求有限以及公共基础设施差。大多数医疗机构都使用纸质而非电子系统来记录患者信息（加纳：30%；肯尼亚：22%）、记账（加纳：45%；肯尼亚：27%）和库存控制（加纳：41%；肯尼亚：24%）。两国的大多数诊所都报告称，正在开展活动来提高提供者的技能，并监测他们提供的护理水平和质量。然而，只有少数药房报告开展此类活动。
结论/意义：结果表明，改善获得资金的机会和改善业务流程（特别是在药房）将支持私立卫生设施做出更多贡献。如果提供者在具备成功运营业务和医疗机构所需的业务流程的情况下，能够更好地利用获得资金的机会，那么这些策略可能是互补的。
