Abstract
BackgroundHealth 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.Methodology/Principal FindingsWe 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/SignificanceThe 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.
Highlights
Most analysts interested in health care in Sub-Saharan Africa (SSA) are familiar with the fact that health care outcomes and health care access remain poor in SSA, and many SSA countries are struggling to meet the Millennium Development Goals (MDG) for health [1]
We focus in more detail on business processes, revenue and expenses, and access to financial markets
Barriers and obstacles to operation The Health Provider Assessment Survey (HPAS) mirrors other, recent enterprise surveys in that it asks firms to identify the element of the business environment that poses the most significant barrier or obstacle to operating their facility
Summary
Most analysts interested in health care in Sub-Saharan Africa (SSA) are familiar with the fact that health care outcomes and health care access remain poor in SSA, and many SSA countries are struggling to meet the Millennium Development Goals (MDG) for health [1]. Some are aware that both public and private providers—we define the ‘‘private sector’’ as including for-profit and not-for-profit providers—play an important role in providing health care to rich and poor populations alike [2] Given these facts, it is unlikely that any pragmatic solution to increase health care access can be achieved without active participation of both the private and public health care sector. To design public policies that effectively improve the private health sector’s contributions to national health systems, policymakers first need to understand the constraints facing the private sector. Increasing such contributions may, but need not, imply the growth of the private health sector in terms of its share of total health care provision, relative to the share of publicly provided care. The literature on constraints private health care providers face is limited
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