Towards universal coverage? Understanding the scale of the private sector in maternal health

Merrigold social franchise facilities in Rajastan, India

Women in the waiting room of one of the Merrygold social franchise facilities in Rajastan, India. Photo credit: TRIOs

In a world where those already living below the poverty line are pushed further into poverty as a result of health payments, efforts to achieve universal health coverage demand a focus on equity in both public and private sectors.

To achieve universal coverage, including accessible and adequate quality care, it is imperative that global health policymakers understand the role of the private sector, which MET’s research has shown forms on average 40% of the market for maternal healthcare across 57 LMICs.  Our new analysis of Demographic and Health Surveys across these countries has shown that the private sector not only serves a substantial numbers of women in LMICs, but also favours the richest.

Ashas (social health activists) working in the communities of Rajastan, India

ASHAs working in the communities of Rajastan, India. Photo credit: TRIOs

We also found significant gaps in coverage and high levels of unmet need of up to 61% for family planning and up to 51% for delivery care.  Particularly concerning is that rich-poor gaps (which may link to the affordability of the private sector) are largest for delivery care, which has dire implications for maternal mortality and health equity.

The diversity of the private sector, including the many government and policy environments in which it operates, is the subject of ongoing research by MET.  This diversity, particularly where there is weak governance, highlights the challenge for global health policy (such as SDG 3) to integrate reproductive health into coordinated national strategies and programs in a way that ensures universal access to sexual and reproductive healthcare services worldwide by 2030.

Oona Campbell, Professor of Epidemiology and Reproductive Health at the LSHTM said: “Maternal health research generally neglects the private sector, which our work reveals to be substantial. Much more work is needed to assess quality of services, and to incorporate assessment of private services into routine data.”

This latest research by MET, published as part of a series in the journal Tropical Medicine and International Health, used Demographic and Health Surveys covering 865 547 women aged 15–49 between 2000 and 2013 across 57 low- and middle-income countries, representing a total of 3 billion individuals. The aim was to assess the coverage of maternal health services as well as the role of the private sector in providing those services, in total and by socio-economic position.

An infographic summarising the research is available here.