title: Firm-level perspectives on public sector engagement with private healthcare providers: survey evidence from Ghana and Kenya.
abstract: BACKGROUND
  Health systems in Sub-Saharan Africa (SSA) are in urgent need of improvement. The private health sector is a major provider of care in the region and it will remain a significant actor in the future. Any efforts by SSA governments to improve health systems performance therefore has to account for the private health sector. Regional and international actors increasingly recognize importance of effectively engaging with the private health sector, and initiatives to improve engagement are underway in several countries. However, there is little systematic analysis of private health providers' view and experience with engagement.
  
  
  RESULTS
  In this study we surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is "command-and-control" type regulations to improve the quality of care. There is little attention paid to building the capacity of health care businesses through either technical or financial assistance. The vast majority of these facilities also receive no government assistance in meeting public health and social goals. Finally, government engagement with private pharmacies is often neglected and clinics receive a disproportionate share of government assistance.
  
  
  CONCLUSIONS
  Overall, our findings suggest that there may be considerable untapped potential for greater engagement with private health facilities--particularly pharmacies. Improving engagement will likely help governments with limited resources to better take advantage of the private sector capacity to meet access and equity objectives and to accelerate the achievement of the Millennium Development Goals.
authors: University of Southern California, Los Angeles, California, United States of America. nsood@sppd.usc.edu
authors: Neeraj
authors: N
authors: Sood
authors: Nicholas
authors: N
authors: Burger
authors: Joanne
authors: J
authors: Yoong
authors: Dan
authors: D
authors: Kopf
authors: Connor
authors: C
authors: Spreng
mesh_terms: D005869:Ghana / Q000453:epidemiology; D019538:Health Care Surveys / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000191:economics / Q000331:legislation & jurisprudence; D006282:Health Personnel / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006290:Health Planning Technical Assistance; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D017149:Private Sector / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011634:Public Health / Q000592:standards; D017150:Public Sector / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*