Public-private partnerships in sexual and reproductive healthcare provision: establishing a gender analysis

Jasmine Gideon,Susan F Murray,Benjamin M Hunter

doi:10.1080/21699763.2017.1329157

Jasmine Gideon, Susan F Murray + Show 1 more

Open Access

https://doi.org/10.1080/21699763.2017.1329157

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Abstract

AbstractThe past few decades have seen the growing popularity of public-private partnerships (PPPs) across the health sector – a catch all term used to encompass diverse activities involving both public and private sector entities in areas of global and domestic health. In the article we consider the factors that have led to this proliferation of PPPs in the healthcare delivery field and consider the link to the process of ‘scientization’ of healthcare. With a focus on sexual and reproductive health the article also considers two commonly used mechanisms employed in SRH service delivery that have been used in PPPs – social franchise and health voucher schemes. We then reprise key points from the existing critical literature on gendered health systems and go on to consider their application to such service provision-oriented PPPs, using an exploratory analysis of a case study of the use of maternal health vouchers in India.

Highlights

Public-private partnerships (PPPs) is a term that is used across the health sector to encompass diverse activities involving both public and private sector entities in areas of global and domestic health
The rationale for PPPs stems from claimed inefficiencies of public bureaucracies and purported superior efficiency of private sector actors operating in healthcare markets (World Bank, 1993), and a wider penetration of neoliberalism’s market fundamentalism into public policy since the 1980s (Harvey, 2005)
The interrogation of a case study of a PPP in Sexual and reproductive health (SRH) presented here suggests that despite the rhetoric around ‘innovative approaches’ that generally accompanies PPPs, it did little to confront gender norms and values that are often deeply embedded within health systems as well as the households that interact with them

Summary

Introduction

Public-private partnerships (PPPs) is a term that is used across the health sector to encompass diverse activities involving both public and private sector entities in areas of global and domestic health. The marketisation discourse that promoted voucher schemes from the early 2000s emphasised that they were to be a means of improving the desirable use of services among poor communities ‘by placing purchasing power’, and ‘choice of provider’ in the hands of the recipients (Gupta et al, 2010) This offers a clear example of the way in which poor women are disciplined to become ‘rational economic women’ (Rankin, 2001), reinforcing the ‘smart economics’ approach to gender equality. Given the inherent problems in contracting private providers to deliver public SRH services and likely implications for women’s health and position in society, it is important that evaluations of PPPs go beyond short-term assessments of service use and predictable analyses of programme ‘challenges’ if policy-makers and practitioners are to learn any meaningful lessons where interventions are replicated on a large scale. The pragmatic response of the community workers was encouraged by the precarious nature of their employment at the front line of service delivery and reveals ways in which the gendered nature of health systems reflects and reinforces power relations in communities

Discussion

Notes on contributors