Guo Sufang, Carvajal-Aguirre Liliana, Victora Cesar G, Barros Aluisio J D, Wehrmeister Fernando C, Vidaletti Luis Paulo, Gupta Gagan, Matin Md Ziaul, Rutter Paul
UNICEF Regional Office for South Asia, Kathmandu, Nepal.
UNICEF, New York, New York, USA.
BMJ Glob Health. 2019 Aug 21;4(4):e001495. doi: 10.1136/bmjgh-2019-001495. eCollection 2019.
The private sector accounts for an important share of health services available in South Asia. It is not known to what extent socioeconomic and urban-rural inequalities in maternal, newborn and child health (MNCH) interventions are being affected by the presence of private providers.
Nationally representative surveys carried out from 2009 to 2015 were analysed for seven of the eight countries in South Asia, as data for Sri Lanka were not available. The outcomes studied included antenatal care (four or more visits), institutional delivery, early initiation of breast feeding, postnatal care for babies, and careseeking for diarrhoea and pneumonia. Results were stratified according to quintiles of household wealth and urban-rural residence.
At regional level, the public sector played a larger role than the private sector in providing antenatal (24.8% vs 15.6% coverage), delivery (51.9% vs 26.8%) and postnatal care (15.7% vs 8.2%), as well as in the early initiation of breast feeding (26.1% vs 11.1%). The reverse was observed in careseeking for diarrhoea (15.0% and 46.2%) and pneumonia (18.2% and 50.5%). In 28 out of 37 possible analyses of coverage by country, socioeconomic inequalities were significantly wider in the private than in the public sector, and in only four cases the reverse pattern was observed. In 20 of the 37 analyses, the public sector was also more likely to be used by the wealthiest women and children.
The private sector plays a substantial role in delivering MNCH interventions in South Asia but is more inequitable than the public sector.
在南亚，私营部门在可获得的卫生服务中占重要份额。目前尚不清楚孕产妇、新生儿和儿童健康（MNCH）干预措施中的社会经济及城乡不平等在多大程度上受到私营医疗服务提供者的影响。
对2009年至2015年期间在南亚八国中的七个国家开展的具有全国代表性的调查进行了分析，因为斯里兰卡的数据不可用。所研究的结果包括产前护理（四次或更多次就诊）、机构分娩、母乳喂养的早期开始、婴儿产后护理以及腹泻和肺炎的就医情况。结果根据家庭财富五分位数和城乡居住地进行分层。
在区域层面，公共部门在提供产前护理（覆盖率24.8%对15.6%）、分娩服务（51.9%对26.8%）和产后护理（15.7%对8.2%）以及母乳喂养的早期开始方面（26.1%对11.1%）比私营部门发挥了更大的作用。而在腹泻（15.0%和46.2%）和肺炎（18.2%和50.5%）的就医方面则观察到相反的情况。在按国家进行的37项可能的覆盖率分析中，有28项显示私营部门的社会经济不平等比公共部门显著更大，只有4项观察到相反的模式。在37项分析中的20项中，最富裕的妇女和儿童也更有可能使用公共部门的服务。
私营部门在南亚提供孕产妇、新生儿和儿童健康干预措施方面发挥着重要作用，但比公共部门更不公平。
