Child Health

This chapter by Flavia Bustreo looks at the experience of programs and policy initiatives related to child health and tries to understand why these problems occur. In particular, it aims to understand why these programs tend to be implemented without engaging the private sector and what impact this has. Our research indicated that ignoring private provision is undermining program impact in many countries, and our analysis yielded some suggestions about program design and policy changes at the country level.In this chapter, we examine how donor support is developed and implemented and how these processes influence the problems we observe. From this analysis, we suggest changes that donors can make in their development assistance for child health. We indicate where these changes are needed to improve program impact, especially where the context makes it likely that the private health sector will need to be brought into programs to help them achieve their goals.Programs should, as a priority, scrutinize existing health system data from household, provider, and retailer surveys. They should aim to identify the most critical gaps between the populations they target to reach and the best available evidence on where those people are obtaining their services and products. Where private actors are playing a significant role, local consultation is necessary to identify where there is both capacity and willingness to engage in public–private collaborations. Program managers should seek opportunities for collaboration around the manufacture and distribution of products (e.g. fortified foods and oral rehydration salts). Where provider networks are substantially private, officials should consider contracting, either by public or social insurance agencies; “lighter touch” collaboration with private providers to expand coverage of priority interventions should also be considered (e.g. for immunization).To achieve all of this, it is vital that political will and commitment exist at the global, national, and local levels to expand private sector participation, as well as coordination and communication among the multiple stakeholders.