Public and Private Sector Health Facilities: Who Possesses National Health Guidelines?

Abstract

Background: Health guidelines help in ensuring uniformity in quality of care for clients, yet little attention has been giving to understanding if health facilities in the public or private sector are more likely to possess national health guidelines. We hypothesize that government health facilities in low and middle income countries are more likely to possess national guidelines as they are required to comply with public regulations, and are closer to organizations that communicate these guidelines. Methods: We use cross-sectional data from the DHS-SPA surveys to understand the relationship between the managing authority of a health facility (public versus private) and if the facility reports the presence of national health guidelines for maternal and child health (MNCH), communicable, and non-communicable diseases. We restrict our sample to several African and South Asian countries. Findings: We find that health facilities managed by a public authority are more likely to possess guidelines for MNCH, and communicable diseases, as compared to privately managed health facilities. In terms of MNCH healthcare guidelines, the odds of reporting the presence of national guidelines for family planning, IMPAC, CEmOC, and PMTCT, are 57%, 42.4%, 72.2%, and 60.2% higher respectively among public health facilities. For communicable disease guidelines, the odds of reporting the presence of national guidelines for malaria, tuberculosis, and STIs are 103%, 121%, and 81% higher respectively among public health facilities. Interpretation: Our findings suggest that inspite of criticisms, public health facilities have comparative strength in possessing guidelines. Our findings imply a need to improve health system regulation. Funding Statement: The authors stated that they did not receive funding for this work. Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: The study uses publicly available, secondary data and so an IRB application was not filed.