Impact of Private Sector Delivery of Quality Care on Maternal, Newborn, and Child Health Outcomes in Low- and Middle-Income Countries: A Systematic Review.

Evidence regarding the impact of the private health sector on healthcare outcomes is often fragmented. Knowledge gaps remain around the impact of private sector care on health outcomes. This systematic review examines the quality of maternal, newborn, and child health (MNCH) care delivery by private sector providers. The review aims to systematically assess the evidence from studies reporting outcome data on morbidity and mortality among mothers, newborns, and children. Searches were conducted in eight electronic databases (Cumulative Index to Nursing and Allied Health, EconLit, Excerpta Medica Database, International Bibliography of the Social Science, Popline, PubMed, ScienceDirect, and Web of Science) and two websites and supplemented with hand-searches and expert recommendations. We conducted the searches and application of inclusion/exclusion criteria using the PRISMA method. For inclusion, studies in low- and middle-income countries must have examined at least one of the following primary outcomes: maternal morbidity, maternal mortality, newborn morbidity, newborn mortality, child morbidity, or child mortality. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 46 studies included, most studies were conducted in India, Bangladesh, Uganda, and Kenya. Thirty-six studies were quantitative, and over one-third implemented a specific intervention that went beyond the broad delivery of quality care in the private sector. Studies indicated that the outcomes of private sector delivery of MNCH care across health systems were mixed. Studies frequently reported on the utilization of health facilities for the treatment of morbidities. Interventions to improve MNCH care included improved coverage and contracting services, community-based training, and public-private partnerships. Studies often did not provide greater contextual detail, including the complexities and realities of people seeking care across provider types. Future research should disaggregate data on quality of care, as well as describe the methods and specific facility details in their sample.