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Safe in Their Hands? Engaging Private Providers in the Quest for Public Health Goals

In many low-income countries, private providers have long been a significant source of health care. Private providers include individual practitioners, both formal and "informal", working alone and in groups; national and international nongovernmental organizations; and private companies providing health care for employees and their dependents. In some countries, private (or more accurately non-state) practitioners provide over 50% of ambulatory care in rural and urban areas. Despite their importance in delivering services to vulnerable populations, they received only limited attention from policy-makers and researchers until the late 1980s. This neglect — particularly of informal providers — was often reinforced by active opposition from formal professionals. There is growing recognition of their importance, however, and signs of a shift in attitude. While concerns remain about quality, effectiveness and cost, there is also interest in their untapped potential to help meet public health goals.