From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <span dir="ltr"><<a href="mailto:ruglucia@paho.org">ruglucia@paho.org</a>></span><br><div class="gmail_quote">crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br>

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<p class="MsoNormal" style="margin-left:.5in"><b><font color="maroon" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:maroon;font-weight:bold" lang="EN">Comparative Performance of Private and Public Healthcare

Systems in Low- and Middle-Income Countries: <br>

A Systematic Review<br>

<br>

<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in"><i><font face="Arial" size="1"><span style="font-size:9.0pt;font-family:Arial;font-style:italic" lang="EN">“…reevaluates

the evidence relating to comparative performance of public versus private

sector healthcare delivery in low- and middle-income countries….”<u></u><u></u></span></font></i></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN"><br>

Sanjay Basu </span></font><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial" lang="EN">1,2,3*,</span></font><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN"> Jason

Andrews <font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial" lang="EN">4<font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">, Sandeep Kishore <font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial" lang="EN">5<font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">,

Rajesh Panjabi </span></font><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial" lang="EN">6</span></font><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">, David

Stuckler </span></font><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial" lang="EN">3,7<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial" lang="EN"><br>

1 Department of Medicine, University of California, San Francisco, California,

United States of America, 2 Division of General Internal Medicine, San

Francisco General Hospital, San Francisco, California, United States of

America, 3 Department of Public Health and Policy, London School of Hygiene

& Tropical Medicine, London, United Kingdom, 4 Division of Infectious

Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States

of America, 5 Tri-Institutional MD-PhD Program, Weill Cornell Medical

College/Rockefeller University/Sloan-Kettering Institute, New York, New York,

United States of America, 6 Division of Global Health Equity, Brigham and

Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

of America, 7 Department of Sociology, Cambridge University, Cambridge, United

Kingdom<br>

Academic Editor: <font color="#303030"><span style="color:#303030">Rachel

Jenkins, King's College London,

 <u></u>United Kingdom<u></u><u></u><u></u><u></u></span></font></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font color="#303030" face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial;color:#303030" lang="EN"><br>

</span></font><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">PLoS Medicine – 19 June 2012 - Volume

9 -| Issue 6 - e1001244<br>

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</span></font></b><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold" lang="EN"><u></u><u></u></span></font></b></p>

<p style="text-indent:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Available online at: </span></font><font face="Arial"><span style="font-size:10.0pt;font-family:Arial"><a href="http://t.co/CM3o6H3h" title="http://bit.ly/N6hOQM" target="_blank"><font color="black"><span style="color:windowtext">http://bit.ly/N6hOQM</span></font></a><br>

            </span></font><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN"><u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">“……Private

sector healthcare delivery in low- and middle-income countries is sometimes

argued to be more efficient, accountable, and sustainable than public sector

delivery. Conversely, the public sector is often regarded as providing more

equitable and evidence-based care. We performed a systematic review of research

studies investigating the performance of private and public sector delivery in

low- and middle-income countries.<br>

<br>

<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><i><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-style:italic" lang="EN">Methods

and Findings<br>

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<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Peer-reviewed studies

including case studies, meta-analyses, reviews, and case-control analyses, as

well as reports published by non-governmental organizations and international

agencies, were systematically collected through large database searches,

filtered through methodological inclusion criteria, and organized into six

World Health Organization health system themes: <br>

accessibility and responsiveness; quality; outcomes; accountability,

transparency, and regulation; fairness and equity; and efficiency. <br>

<br>

Of 1,178 potentially relevant unique citations, data were obtained from 102

articles describing studies conducted in low- and middle-income countries. <br>

<br>

<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Comparative cohort and

cross-sectional studies suggested that providers in the private sector more

frequently violated medical standards of practice and had poorer patient

outcomes, but had greater reported timeliness and hospitality to patients.

Reported efficiency tended to be lower in the private than in the public

sector, resulting in part from perverse incentives for unnecessary testing and

treatment. Public sector services experienced more limited availability of

equipment, medications, and trained healthcare workers. <br>

<br>

<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">When the definition of

“<i><span style="font-style:italic">private sector</span></i>”

included unlicensed and uncertified providers such as drug shop owners, most

patients appeared to access care in the private sector; however, when

unlicensed healthcare providers were excluded from the analysis, the majority

of people accessed public sector care. <br>

<i><span style="font-style:italic">“Competitive dynamics</span></i>”

for funding appeared between the two sectors, such that public funds and personnel

were redirected to private sector development, followed by reductions in public

sector service budgets and staff.<br>

<br>

<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Conclusions<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial" lang="EN">Studies evaluated in this

systematic review do not support the claim that the private sector is usually

more efficient, accountable, or medically effective than the public sector;

however, the public sector appears frequently to lack timeliness and

hospitality towards patients….”<br>

<br>

<u></u><u></u></span></font></p><br></div></div></div><br>