Mallick Lindsay M, Bellows Nicole, Husband Rebecca, Weinberger Michelle
Avenir Health, Glastonbury, Connecticut, United States of America.
Department of Family Science, School of Public Health, University of Maryland, Maternal and Child Health Program, College Park, Maryland, United States of America.
PLOS Glob Public Health. 2025 May 7;5(5):e0004418. doi: 10.1371/journal.pgph.0004418. eCollection 2025.
Governments in low- and middle-income countries increasingly recognize their role as stewards of mixed health systems comprising both public and private actors, but policy often lacks a nuanced understanding of how individuals switch between these two sectors for their healthcare needs, especially for family planning (FP) and maternal, newborn and child health (MNCH). In this cross-sectional study, we used data collected by The Demographic and Health Surveys Program between 2014-2021 from eight countries (Afghanistan, India, Indonesia, Kenya, Malawi, Nigeria, Pakistan, and Uganda) to describe service and sector use among women with a recent birth, a need for FP, and a child under five years old experiencing an illness (N = 53,014). We applied multivariable logistic regressions in each country to test the associations first between sector for birth and missed opportunities for contraceptives or sick child care, and next, between sector use dynamics between birth and contraceptive use (sector fidelity, sector switching, or nonuse of services) and nonuse of sick child care. Sector at facility for birth and sector switching between services was common, but neither were generally associated with missed opportunities for care for sick children. However, private sector use at birth predicted nonuse of contraceptives in four countries, though the directionality varied. Consistently, women who did not access care at birth and contraception had significantly greater odds of missing care for sick children. Notably, in Malawi, the adjusted odds ratio of missed sick child care among those with nonuse of care for birth or contraceptives was 2.5 times that of those with sector fidelity (95% Confidence Interval: 1.43-4.22). These findings underscore the need for health system stewards to closely consider both the public and private sectors in health governance. Greater cross-sectoral cooperation and continuity of care is paramount to improving health outcomes.
低收入和中等收入国家的政府越来越认识到自己作为混合卫生系统管理者的角色，该系统由公共和私营部门行为体共同构成，但政策往往对个人如何根据自身医疗需求在这两个部门之间转换缺乏细致入微的理解，尤其是在计划生育（FP）以及孕产妇、新生儿和儿童健康（MNCH）方面。在这项横断面研究中，我们使用了人口与健康调查项目在2014年至2021年间从八个国家（阿富汗、印度、印度尼西亚、肯尼亚、马拉维、尼日利亚、巴基斯坦和乌干达）收集的数据，来描述近期生育过、有计划生育需求以及家中有五岁以下患病儿童的妇女的服务使用情况和部门选择情况（N = 53,014）。我们在每个国家应用多变量逻辑回归，首先检验分娩部门与避孕或患病儿童护理错失机会之间的关联，其次检验分娩与避孕使用之间的部门使用动态（部门忠诚度、部门转换或不使用服务）与不使用患病儿童护理之间的关联。分娩机构的部门以及服务之间的部门转换很常见，但两者通常都与患病儿童护理错失机会无关。然而，分娩时使用私营部门服务在四个国家预测了避孕措施的不使用情况，尽管方向有所不同。一直以来，在分娩和避孕时未获得护理的妇女错过患病儿童护理的几率显著更高。值得注意的是，在马拉维，分娩或避孕未获得护理的人群中，错过患病儿童护理的调整优势比是部门忠诚度人群的2.5倍（95%置信区间：1.43 - 4.22）。这些发现强调了卫生系统管理者在卫生治理中密切考虑公共和私营部门的必要性。加强跨部门合作和护理连续性对于改善健康结果至关重要。
