Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia
Introduction 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.Met...
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/4/e001495.full |
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| author | Aluísio J D Barros Cesar G Victora Sufang Guo Paul Rutter Fernando C Wehrmeister Luis Paulo Vidaletti Liliana Carvajal-Aguirre Gagan Gupta Md Ziaul Matin |
| author_facet | Aluísio J D Barros Cesar G Victora Sufang Guo Paul Rutter Fernando C Wehrmeister Luis Paulo Vidaletti Liliana Carvajal-Aguirre Gagan Gupta Md Ziaul Matin |
| author_sort | Aluísio J D Barros |
| collection | DOAJ |
| description | Introduction 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.Methods 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.Results 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.Conclusion The private sector plays a substantial role in delivering MNCH interventions in South Asia but is more inequitable than the public sector. |
| format | Article |
| id | doaj-art-05d79b415ccd483988dfede835dea307 |
| institution | DOAJ |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-05d79b415ccd483988dfede835dea3072025-08-20T02:39:14ZengBMJ Publishing GroupBMJ Global Health2059-79082019-07-014410.1136/bmjgh-2019-001495Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South AsiaAluísio J D Barros0Cesar G Victora1Sufang Guo2Paul Rutter3Fernando C Wehrmeister4Luis Paulo Vidaletti5Liliana Carvajal-Aguirre6Gagan Gupta7Md Ziaul Matin810 Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, BrazilInternational Center for Equity in Health, Federal University of Pelotas, Pelotas, BrazilUNICEF Regional Office for South Asia, Kathmandu, NepalPharmacy Practice, School of Biomedical Sciences, University of Portsmouth, Portsmouth, UKPostgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, BrazilInternational Center for Equity in Health, Federal University of Pelotas, Pelotas, BrazilData and Analytics Section, UNICEF, New York, New York, USAUNICEF India, United Nations Childrens Fund, New Delhi, IndiaUNICEF Bangladesh, Dhaka, BangladeshIntroduction 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.Methods 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.Results 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.Conclusion The private sector plays a substantial role in delivering MNCH interventions in South Asia but is more inequitable than the public sector.https://gh.bmj.com/content/4/4/e001495.full |
| spellingShingle | Aluísio J D Barros Cesar G Victora Sufang Guo Paul Rutter Fernando C Wehrmeister Luis Paulo Vidaletti Liliana Carvajal-Aguirre Gagan Gupta Md Ziaul Matin Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia BMJ Global Health |
| title | Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia |
| title_full | Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia |
| title_fullStr | Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia |
| title_full_unstemmed | Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia |
| title_short | Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia |
| title_sort | equitable coverage the roles of the private and public sectors in providing maternal newborn and child health interventions in south asia |
| url | https://gh.bmj.com/content/4/4/e001495.full |
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