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Examining the Role of Private Maternity Services in Nepal, India and Tanzania

The maternal and child millennium development goals (MDG) call for a reduction of maternal mortality by three-quarters and child deaths by two-third between 1990 and 2015. It is widely acknowledged that a functioning healthcare system is essential to achieve these aims. To date, Maternal and Newborn Health (MNH) initiatives have primarily focused on improving skills, resources, and referral systems within public sector services. The private maternity care sector has received little attention. However, in many low income countries, there is reportedly a growth in the non-government provision of maternity and obstetric care, and health sector reform strategies are promoting private and public sector "mixes". If the ambitious targets set for reduction in maternal and child health are to be reached, the role played by different elements within the private sector, their limitations and their capacity, and their interface with government services in key areas such as skilled attendance and essential obstetric care, all need to be far better understood. This literature review brings together existing knowledge concerning private (non-government) sector maternity care provision in low-income settings and identifies some key issues for future exploration. It presents a set of tools designed to gather information about private sector provision of maternity care at National or sub-National levels. These tools were simultaneously piloted in three settings, the State of Andhra Pradesh in India, Nepal and Tanzania. Separate reports from each of these pilot studies have been prepared (Ensor & Dey 2003; MacDonagh & Neupane 2003 and Murry & Nyambo 2003). A synthesis report that draws out the key issues arising from this review and across the three settings is also available (MacDonagh, Murray and Ensor 2003). Section 2 explains the scope of and methods used in the review of the literature. Section 3 provides an introduction to some of the terminology and typologies used in discussion of the "private " healthcare sector. Section 4 outlines the findings of the literature review on private sector maternity care in developing countries, and Section Five draws out five key areas where further investigation is required. In section 6 examples of existing initiatives in work with private sector providers of maternity care are outlined. Section 7 introduces a "tool kit" designed to assist local study of private sector provision of maternity care, and the annexes contain the pilot-tested tools.