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Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia
  1. Sufang Guo1,
  2. Liliana Carvajal-Aguirre2,
  3. Cesar G Victora3,4,
  4. Aluisio J D Barros3,4,
  5. Fernando C Wehrmeister3,4,
  6. Luis Paulo Vidaletti3,
  7. Gagan Gupta5,
  8. Md Ziaul Matin6,
  9. Paul Rutter1
  1. 1UNICEF Regional Office for South Asia, Kathmandu, Nepal
  2. 2UNICEF, New York, New York, USA
  3. 3International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
  4. 4Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
  5. 5UNICEF India, United Nations Childrens Fund, New Delhi, India
  6. 6UNICEF Bangladesh, Dhaka, Bangladesh
  1. Correspondence to Dr Cesar G Victora; cvictora{at}gmail.com

Abstract

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.

  • health equity
  • maternal–child health services
  • socioeconomic factors
  • health status disparities
  • Asia

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2019-001495

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    Footnotes

    • Handling editor Sanni Yaya

    • Contributors SG, LC-A, CGV, PR and AJDB conceived the idea of manuscript. CGV, AJDB, FCW and LPV carried out data analysis with inputs from other researchers involved. CGV, FCW, GG, MZM, SG and LC-A drafted the first version of the manuscript. All authors provided inputs to the interpretation of findings and approved the final version of manuscript.

    • Funding The analyses were funded by the UNICEF Regional Office for South Asia. UNICEF staff members are included among the authors of the manuscript.

    • Disclaimer The results presented here are descriptive and do not reflect the results of any program or initiative being implemented by UNICEF.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.