Abstract
BackgroundDespite the growing interest in the private health sector in low- and middle-income countries, little is known about physicians working outside the public sector. The present work adopts a mixed-methods approach to explore characteristics, working patterns, choices, and motivations of the physicians working exclusively for the private sector in the capital cities of Cape Verde, Guinea Bissau, and Mozambique. The paper’s objective is to contribute to the understanding of such physicians, ultimately informing the policies regulating the medical profession in low- and middle-income countries.MethodsThe qualitative part of the study involved 48 interviews with physicians and health policy-makers and aimed at understanding the practice in the three locations. The quantitative study included a survey of 329 physicians, and multivariate analysis was conducted to analyse characteristics, time allocation, earnings, and motivations of those physicians working only for the private sector, in comparison to their public sector-only and dual practice peers.ResultsOur findings showed that only a limited proportion of physicians in the three locations work exclusively for the private sector (11.2%), with members of this group being older than those practicing only in the public or in both sectors. They were found to work fewer hours per week (49 hours) than their public (56 hours) and dual practice peers (62 hours) (P <0.001 and P = 0.011, respectively). Their median earnings were USD 4,405 per month, with substantial variations across the three locations. Statistically significant differences were found with the earnings of public-only physicians (P <0.001), but not with those of the dual practice group (P = 0.340). The qualitative data from the interviews showed private-only physicians’ preference for an independent and more flexible work modality, and this was quoted as a determining factor for their choice of sector. This group appears to include those working in the more informal sector, and those who decided to leave the civil service following a disagreement with the public employer.ConclusionsThe study shows the importance of understanding the relation between health professionals’ characteristics, motivations, and their engagement with the private sector to develop effective policies to regulate the profession. This may ultimately contribute to achieving universal access to medical services in low- and middle-income countries.Electronic supplementary materialThe online version of this article (doi:10.1186/1478-4491-12-51) contains supplementary material, which is available to authorized users.
Highlights
Despite the growing interest in the private health sector in low- and middle-income countries, little is known about physicians working outside the public sector
The literature on qualified private sector physicians (PSP) in low- and middle-income countries (LMICs) mainly focuses on the description and quality of their practice [7,8] and it rarely distinguishes between those who work exclusively for the private and those engaging simultaneously with private and public sector activities, the so-called dual practitioners
Characteristics of private sector physicians (PSPs) PSPs were found to be a minority in the three locations
Summary
Despite the growing interest in the private health sector in low- and middle-income countries, little is known about physicians working outside the public sector. The private sector in low- and middle-income countries (LMICs) is attracting growing interest as a valid instrument to reach the poor [1,2]. The literature on qualified private sector physicians (PSP) in LMICs mainly focuses on the description and quality of their practice [7,8] and it rarely distinguishes between those who work exclusively for the private and those engaging simultaneously with private and public sector activities, the so-called dual practitioners. Topping up the public salary to meet the cost of living and supporting the extended family are found to be main reasons for engaging with the private sector in Portuguese-speaking African countries [14]. Russo et al [15] argue that physicians’ involvement in the private sector in LMICs is more common than generally assumed, as multiple forms of private practice can be found even within public facilities
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