RT Journal Article
SR Electronic
T1 Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001495
DO 10.1136/bmjgh-2019-001495
VO 4
IS 4
A1 Sufang Guo
A1 Liliana Carvajal-Aguirre
A1 Cesar G Victora
A1 Aluisio J D Barros
A1 Fernando C Wehrmeister
A1 Luis Paulo Vidaletti
A1 Gagan Gupta
A1 Md Ziaul Matin
A1 Paul Rutter
YR 2019
UL http://gh.bmj.com/content/4/4/e001495.abstract
AB 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.