Do private health providers help achieve Universal Health Coverage? A scoping review of the evidence from low-income countries

Coveney, Laura; Musoke, David; Russo, Giuliano

doi:10.1093/heapol/czad075

Cited by 3 publications

References 67 publications

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Leveraging the social networks of informal healthcare providers for universal health coverage: insights from the Indian Sundarbans

Brahmachari,

Mishra,

Gotsadze

et al. 2024

Health Policy and Planning

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India’s healthcare landscape is characterized by a multitude of public and private healthcare providers, yet its health systems remain weak in many areas. Informal healthcare providers (IHPs) bridge this gap, particularly in rural India, and are deeply embedded within local communities. While their importance is widely recognized, there is a knowledge gap regarding the specifics of their social networks with actors in health systems. The aim of this study was to map the social networks of IHPs to elucidate the type and nature of their relationships, in order to explore opportunities for intersectoral collaboration to achieve universal health coverage (UHC). We have adopted the social network analysis (SNA) approach using qualitative ego-network methodology to evaluate the types and strengths of ties in the Indian Sundarbans. A total of 34 IHPs participated in the study. Qualitative data were analysed using NVivo10 and Kumu.io was used to visualize the social networks. Results show that the 34 IHPs had a total of 1362 ties with diverse actors, spanning the government, private sector and community. The majority of the ties were strong, with various motivating factors underpinning the relationships. Most of these ties were active and have continued for over a decade. The robust presence of IHPs in the Indian Sundarbans is attributable to the numerous, strong and often mutually beneficial ties. The findings suggest a need to reconsider the engagement of IHPs within formal health systems. Rather than isolation, a nuanced approach is required based on intersectoral collaboration capitalizing on these social ties with other actors to achieve UHC in impoverished and underserved regions globally.

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Leveraging the social networks of informal healthcare providers for universal health coverage: insights from the Indian Sundarbans

Brahmachari,

Mishra,

Gotsadze

et al. 2024

Health Policy and Planning

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Approaches, enablers and barriers to govern the private sector in health in low- and middle-income countries: a scoping review

Goodman,

Witter,

Hellowell

et al. 2024

BMJ Glob Health

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IntroductionThe private sector plays a substantial role in delivering and financing healthcare in low- and middle-income countries (LMICs). Supporting governments to govern the private sector effectively, and so improve outcomes across the health system, requires an understanding of the evidence base on private health sector governance. This paper reports on a scoping review, which synthesised evidence on the approaches used to govern private sector delivery and financing of healthcare in LMICs, the effectiveness of these approaches and the key enablers and barriers to strengthening governance.MethodsWe undertook a systematic search of databases of published articles and grey literature to identify eligible papers published since 2010, drawing on WHO’s governance definition. Data were extracted into a pretested matrix and analysed using narrative synthesis, structured by WHO’s six governance behaviours and an additional cross-cutting theme on capacities.Results107 studies were selected as relevant, covering 101 LMICs. Qualitative methods and document/literature review were predominant. The findings demonstrate the relevance of the WHO governance behaviours, but the lack of robust evidence for approaches to implementing them. Valuable insights from the literature include the need for a clear vision around governance aims; the importance of ensuring that policy dialogue processes are inclusive and transparent, avoiding interest group capture; the benefits of exploiting synergies between governance mechanisms; and the need to develop capacity to enact governance among both public and private actors.ConclusionGovernance choices shape not just the current health system, but also its future development. Common barriers to effective governance must be addressed in policy design, stakeholder engagement, public and private sector accountability, monitoring and capacity. Achieving this will require in-depth explorations of governance mechanisms and more rigorous documentation of implementation and outcomes in diverse contexts.

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Brazil’s experiment to expand its medical workforce through private and public schools. Impacts and consequences of the balance of regulatory and market forces in resource- scarce settings

Scheffer,

Mosquera,

Cassenote

et al. 2024

Preprint

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Background. There is a global shortage of doctors, and governments worldwide are concerned with expanding national medical workforces to improve services. Since 2013 the Government of Brazil has introduced legislation to liberalise the medical education market and implement quotas to improve its supply of physicians – the Mais Médicos (More Doctors) Legislation (MML). Such experience provides an insight for the global debate on the role of the private sector in medical education. Methods. We draw from the analysis of unique medical demography datasets to assess the impact of those policies on number and distribution of doctors and medical students, composition of the workforce, and quality of training. To analyze the increasing trend of students and physicians, interrupted time-series analysis was conducted using segmented linear regression, comparing two time periods considering the MML as the start of the intervention. Findings. Within the context of Brazil’s population and economic growth over the last decades, we find that since 2003 Brazil has almost doubled its medical workforce to 2.77 per 1,000 population, with the largest increase recorded after the 2013 legislation. Our analysis shows such growth has benefited poorer, remote states, although the bulk of new doctors and students are still located in the country’s richer regions. The diversity of medical students increased significantly since the More Doctors Legislation, with more female (61.4% in 2023 as opposed to 55.5% in 2013), and mixed-race enrolments (25.5% and 19.4%). However, medical students are still predominantly white (68.7% and 71.6%), and from fee-paying secondary schools (68.1% and 75.8%). Conclusions. We conclude that Brazil’s policy approach has delivered a substantial overhaul of its medical workforce through a combination of public and private sector policies and discuss the implications for similar countries. Private schools can be critical for expansion; but the data from Brazil suggest the private sector does little to address inequalities and cast doubt on the quality of the training offered.

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Do private health providers help achieve Universal Health Coverage? A scoping review of the evidence from low-income countries

Cited by 3 publications

References 67 publications

Leveraging the social networks of informal healthcare providers for universal health coverage: insights from the Indian Sundarbans

Leveraging the social networks of informal healthcare providers for universal health coverage: insights from the Indian Sundarbans

Approaches, enablers and barriers to govern the private sector in health in low- and middle-income countries: a scoping review

Brazil’s experiment to expand its medical workforce through private and public schools. Impacts and consequences of the balance of regulatory and market forces in resource- scarce settings

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