Review of the Private Sector in Health Service Delivery in Karnali Province

A review of private health facilities in the province was conducted by USAID's Strengthening Systems for Better Health Activity to assess the availability and status of private sector health facilities. The review aimed to provide insights into the provision of maternal, newborn, child health, and family planning (MNCH/FP) services through the private health sector in Karnali Province. The review found that higher-level private health facilities, such as hospitals and polyclinics, are concentrated in urban and more populous areas where qualified human resources for health are in greater supply. Conversely, lower-level clinics and pharmacies are predominant in remote areas surveyed. The availability of MNCH/FP services varies across different types of private facilities, with delivery services, newborn care, and immunization being the least available. However, higher-level facilities offer a broader range of MNCH/FP services than lower-level facilities. The review also found that private health facilities show high levels of interest to expand MNCH/FP services and to collaborate with government entities. Respondents across all facility types expressed interest in collaborating with government to conduct awareness campaigns and health camps. Although public sector stakeholders believe that the private sector should focus on curative services, they see private health facilities as potential partners to complement and supplement public sector service delivery. Regarding the quality of care, the review found that 50% or more of private health facilities are aware of MNCH/FP packages and financial incentive programs and guidelines, although few of them have been trained on or are practicing them. The proportion of facilities with at least one staff member trained and oriented on eight MNCH/FP-related service delivery and financial incentive programs was quite low across all types of health facilities. This raises questions regarding the quality of services provided by private facilities. The review highlights the need for improvement in clinics and pharmacies where services are being provided. For example, few facilities have basic amenities and equipment to support MNCH/FP service delivery. The review also notes that private health facilities are not competitors of public health facilities and that there is ample opportunity to expand engagement, partnership, and mutual trust between government health authorities and private facilities and service providers. The review provides evidence to influence and inform the development of a private sector engagement strategy to achieve public health goals by the Ministry of Social Development of Karnali Province. The findings of the review can be used to inform policy and program decisions aimed at improving access to and utilization of quality, essential health services for women, newborns, and children in Karnali Province.