Public Sector

South Africa has a dual health system, namely, the public health sector that includes government health institutions, serving mostly the lower income population and the private health sector that serves those who can afford care from their own income. The public sector is responsible for 82 percent of the population and only accounts for 40 percent of the government health expenditure. The purpose of this study was to evaluate job satisfaction levels among nursing staff within a public hospital in Southern Gauteng. [adapted from abstract]

This study endeavored to identify the gap in knowledge regarding the diagnosis and management of tuberculosis between public and private doctors and the factors affecting these knowledge scores in urban Pakistan. [adapted from abstract]

The primary objective of this study was to solicit and identify perspectives on vertical aid among key Mozambican public sector health managers who must coordinate, implement, and manage the myriad projects, agencies, and resource flows that the increase in vertical funding has produced amid continued severe workforce staffing shortages. [from author]

This article reports on a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. [adpated from abstract]

The objective of this study was to determine the type and number of different types of health care providers, and the quality, cost and utilization of care delivered by those providers in rural Uganda. [from abstract]

This review is focused on comparing health outcomes in private versus public care settings. It seeks to summarize what is known regarding the relative morbidity or mortality outcomes that result from treatment by public or private providers in low- and middle-income countries. [from abstract]

This book presents the principal findings of a study on contractual arrangements between faith-based hospitals and public health authorities in four sub-Saharan African countries.

This article discusses health workers’ preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. [from abstract]

This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients’ satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates.

The objectives of this study include documenting the role of the private for-profit sector in voluntary counseling and testing (VCT) service delivery; establishing whether there are significant differences in the quality of VCT services, particularly in counseling and referral practices, between public, private for-profit, NGO, and mission providers; measuring key VCT service statistics at facilities within each sector; and identify best practices from each sector. [adapted from introduction]

This document details the results of a study to determine whether a quality improvement package designed to enable small-scale commercial reproductive health service providers to improve the quality of services provided through self-assessment, action-planning, and supervisors’ support is effective in improving service quality. [adapted from sbatract]

This article describes issues raised by the deployment of civil servants through the public-private partnership for health to work in private-not-for-profit health facilities in Kibaale region of Uganda. [adapted from abstract]

This study evaluated the skills and competency levels of hospital managers in South Africa to determine whether there are any significant differences between managers in the public and private sectors. The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training. [adapted from abstract]

In responding to the goal of rapidly increasing access to antiretroviral treatment (ART), the government of Botswana undertook a major review of its health systems options to increase access to human resources, one of the major bottlenecks preventing people from receiving treatment. In mid-2004, a team of government and World Health Organization (WHO) staff reviewed the situation and identified a number of public sector scale up options. The team also reviewed the capacity of private practitioners to participate in the provision of ART. Subsequently, the government created a mechanism to include private practitioners in rolling out ART.

Since the late 1990s, Malawi’s public health services have appeared to be heading for collapse due to declining staffing levels. The government launched the Essential Health Package in 2004 to help improve the health of the population, which includes scaling-up HIV and AIDS-related services. The biggest challenge facing the initiative is improving human resource levels. [adapted from author]

This study explored the distribution of public sector health workers [in Zimbabwe] to show how its pattern impacts on equity objectives in health care delivery. [from executive summary]

This paper offers a conceptual framework for considering the many layers of influences upon health worker motivation. It suggests that worker motivation is influenced not only by specific incentive schemes targeted at workers, but also by the whole range of health sector reforms which potentially affect organizational culture, reporting structures, channels of accountability, etc.

Nigeria has one of the largest stocks of human resources for health (HRH) in Africa. However, great disparities in health status and access to health care exist among the six geo-political zones, and between rural and urban areas. This assessment measures the size, skills mix, distribution, and growth rate of HRH in the public health sector in Nigeria. The assessment also quantifies the increase in HRH requirements in the public health sector necessary for reaching key PEPFAR targets and the health Millennium Development Goals. The findings are based on a survey conducted in April-May 2006 in 290 public health facilities representing all levels of care (primary, secondary, and tertiary).

Government and donor funds fail to meet growing demands for reproductive health care in the public sector. Strategies to support uch services include: convince governments to invest more in family planning; use market segmentation to direct subsidies to the poor and to direct clients who can afford to pay to the private sector; encourage public-private partnerships to increase use of the private sector; increase the efficiency of service provision in the public sector; plan for the phase-out of donor-provided contraceptives. [author’s description]

The objective of this document is to implement and evaluate a public–private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. [author’s description]

This paper evaluates structural quality of hospital care in the context of an evaluation of contracting out district hospital services in South Africa. Three contractor hospitals, run by a private company and paid by public purchasers to provide district hospital care to a rural catchment population, were matched with three adjacent public hospitals and three private hospitals serving largely insured patients. A structured instrument was used to provide a quantitative measure of structural quality. Private hospitals scored highest overall, followed by public and then contractor hospitals.

This article considers some of the effects of health sector reform on human resources for health (HRH) in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. [adapted from abstract]

The Human Resource Management (HRM) Assessment Tool offers a method for assessing what an organization’s Human Resource Management system consists of and how well it functions. The HRM Assessment Tool helps users to develop strategies to improve the human resource system and make it as effective as possible. It can also serve as a basis for focusing discussions, brainstorming, and strategic planning. It is designed to be used in public and private-sector health organizations.

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce.

We develop a principal-agent model to analyze how the behavior of a physician in the
public sector is affected by his activities in the private sector. We show that the physician will have incentives to over-provide medical services when he uses his public activity as a way of increasing his prestige as a private doctor. The health authority only benefits from the physician’s dual practice when it is interested in ensuring a very accurate treatment for the patient. Our analysis provides a theoretical framework in which some actual policies implemented to regulate physicians’ dual practice can be addressed.

We report on income generation and work mix among 100 civil servants who manage public health services in developing countries. Their salary puts these managers among the better-off in their countries. However, 87% of the respondents complement their salaries with other income-generating activities.

The report presents findings from a baseline survey of 155 primary health care facilities (dispensaries, with and without maternity units) that was carried out in Uganda in the latter part of 2000. The analysis compares service delivery performance in three ownership categories: government, private for-profit, and private nonprofit. Among the topics it explores at the facility level are staffing, availability of drugs and other inputs, remuneration, outputs, and financing. The findings are highly relevant for public policy in Uganda and in other countries in Africa that are undertaking civil service reform and promoting private-public partnerships in health care.