Recent Trends in Working with the Private Sector to Improve Basic Healthcare – A Review of Evidence and Interventions

Building on the framework from Chapter 5, Montagu and Goodman, along with Peter Berman, Amy Penn, and Adam Visconti, use this chapter, “Recent Trends in Working with the Private Sector to Improve Basic Healthcare,” to look at the evidence and practice that exists for a set of key private-sector engagement interventions.A number of interventions in LMICs have, for many years, applied different models of subsidy, support, and engagement to address social and efficiency failures in private healthcare markets. This chapter reports on a review of these models and the evidence in supporting them to better understand what interventions are currently common, and to what extent practice is based on evidence. Using the typology from Chapter 5, we examined five models of intervention with private markets for care: commodity social marketing, social franchising, contracting, accreditation, and vouchers.To bring together the evidence for this evaluation, we conducted a systematic review of both published and gray literature, identifying programs large enough to be cited in publications and studies of the listed intervention types. A total of 343 studies were included in the review, including both published and gray literature. We identified 380 programs, the earliest having begun operation in 1955. Commodity social marketing programs were the most common intervention type, with 110 documented programs operating for condoms alone at the highest period. Existing evidence shows that these models can improve access, utilization, and, possibly, quality; however, for all program types, the overall evidence base remains weak, with practice in private sector engagement consistently moving in advance of evidence. Future research should address key questions concerning the impact of interventions on the market as a whole, the distribution of benefits by socioeconomic status, the potential for scale-up and sustainability, cost-effectiveness compared to relevant alternatives, and the risk of unintended consequences. Alongside better data, a stronger conceptual basis linking program design and outcomes to context is needed.