Dennis Mardieh L, Benova Lenka, Owolabi Onikepe O, Campbell Oona M R
Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Guttmacher Institute, 125 Maiden Lane 7th Floor, New York, NY, 10038, USA.
BMC Health Serv Res. 2018 Sep 10;18(1):699. doi: 10.1186/s12913-018-3514-y.
Ensuring universal access to maternal and reproductive health services is critical to the success of global efforts to reduce poverty and inequality. Engaging private providers has been proposed as a strategy for increasing access to healthcare in low- and middle-income countries; however, little consensus exists on how to estimate the extent of private sector use. Using research from sub-Saharan Africa, this study systematically compares and critiques quantitative measures of private sector family planning and childbirth service use and synthesizes evidence on the role of the private sector in the region.
We conducted a systematic review of the Medline, Global Health, and Popline databases. All studies that estimated use of private sector of family planning or childbirth services in one or more sub-Saharan African countries were included in this review. For each study, we extracted data on the key study outcomes and information on the methods used to estimate private sector use.
Fifty-three papers met our inclusion criteria; 31 provided outcomes on family planning, and 26 provided childbirth service outcomes. We found substantial methodological variation between studies; for instance, while some reported on service use from any private sector source, others distinguished private sector providers either by their profit orientation or position within or outside the formal medical sector. Additionally, studies measured the use of private sector services differently, with some estimating the proportion of need met by the private sector and others examining the sector's share among the market of service users. Overall, the estimates suggest that the private sector makes up a considerable portion (> 20%) of the market for family planning and childbirth care, but its role in meeting women's need for these services is fairly low (< 10%).
Many studies have examined the extent of private sector family planning and childbirth service provision; however, inconsistent methodologies make it difficult to compare results across studies and contexts. Policymakers should consider the implications of both private market share and coverage estimates, and be cautious in interpreting data on the scale of private sector health service provision without a clear understanding of the methodology.
确保普遍获得孕产妇和生殖健康服务对于全球减贫和减少不平等努力的成功至关重要。在低收入和中等收入国家，吸引私营医疗服务提供者被提议作为增加医疗服务可及性的一项策略；然而，关于如何估计私营部门服务的使用程度，目前几乎没有达成共识。本研究利用撒哈拉以南非洲地区的研究，系统地比较和批评了私营部门计划生育和分娩服务使用情况的定量测量方法，并综合了关于该地区私营部门作用的证据。
我们对Medline、Global Health和Popline数据库进行了系统综述。所有估计一个或多个撒哈拉以南非洲国家私营部门计划生育或分娩服务使用情况的研究均纳入本综述。对于每项研究，我们提取了关键研究结果的数据以及用于估计私营部门使用情况的方法的信息。
53篇论文符合我们的纳入标准；31篇提供了计划生育方面的结果，26篇提供了分娩服务方面的结果。我们发现不同研究之间存在很大的方法学差异；例如，一些研究报告了来自任何私营部门来源的服务使用情况，而另一些研究则根据其盈利导向或在正规医疗部门内外的地位来区分私营部门提供者。此外，不同研究测量私营部门服务使用情况的方式也不同，一些研究估计私营部门满足需求的比例，另一些研究则考察该部门在服务使用者市场中的份额。总体而言，估计表明私营部门在计划生育和分娩护理市场中占相当大的比例（>20%），但其在满足妇女对这些服务的需求方面的作用相当低（<10%）。
许多研究都考察了私营部门计划生育和分娩服务的提供程度；然而，方法不一致使得难以在不同研究和背景下比较结果。政策制定者应考虑私营市场份额和覆盖范围估计的影响，在未清楚了解方法的情况下，谨慎解读关于私营部门卫生服务提供规模的数据。
