Research Article: Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies

Date Published: April 12, 2011

Publisher: Public Library of Science

Author(s): Sima Berendes, Peter Heywood, Sandy Oliver, Paul Garner, Rachel Jenkins

Abstract: Paul Garner and colleagues conducted a systematic review of 80 studies to compare
the quality of private versus public ambulatory health care in low- and
middle-income countries.

Partial Text: The private sector is the main provider of primary health care for the poor in many
low and middle income countries (LMICs). For example, in South Asia about three
quarters of children from the poorest income quintile with acute respiratory
conditions seeking health care go to a private provider [1], and about 45% of sick
children from the poorest income quintile across 26 African countries go to a formal
or informal private provider rather than a public provider for health care [2]. Private
providers are also increasingly important for providing ambulatory care as
non-communicable diseases (NCDs) increase [3].

Of 8,812 titles and abstracts identified, 80 studies included direct quantitative
comparisons of public and private formal providers (Figure 1, adapted from PRISMA 2009 flow diagram
[29]; Tables S4 and
describe excluded studies). These yielded 133 comparisons, of which we were able to
convert 101 to a 100% scale (Table S6). Most studies were carried out after
1990; they were mainly conducted in sub-Saharan Africa
(n = 39) and in Asia and the Pacific
(n = 23); and most were intended to
compare quality, examining all types of primary service and disease category (Table 2; details in Table S9). Most
studies did not report socio-economic status of public and private service users,
and only five presented data by different wealth groups [30]–[34]. No study compared the same
individual providers working in public and private care settings. For two studies
[35],[36] that reported
results separately for different cadres, we chose public versus private doctors
rather than public versus private nurses or midwives as comparison groups, but it
should be noted that for both groups results pointed in the same direction.



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