title: Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.
abstract: BACKGROUND
  Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited.
  
  
  RESULTS
  We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities.
  
  
  CONCLUSIONS
  The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility.
authors.affiliation: RAND Corporation, Arlington, Virginia, United States of America. nburger@rand.org
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Burger
authors.forename: Daniel
authors.initials: D
authors.lastname: Kopf
authors.forename: Connor P
authors.initials: CP
authors.lastname: Spreng
authors.forename: Joanne
authors.initials: J
authors.lastname: Yoong
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sood
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D005869:Ghana; D017048:Health Care Costs; D006268:Health Facilities / Q000191:economics*; D006282:Health Personnel / Q000706:statistics & numerical data; D006290:Health Planning Technical Assistance; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D007630:Kenya; D010594:Pharmacies / Q000706:statistics & numerical data; D017149:Private Sector; D017150:Public Sector