In developing countries, the private sector provides a substantial
proportion of primary health care to low income groups for communicable
and non-communicable diseases. These providers are therefore central to
improving health outcomes. We need to know how their services compare to
those of the public sector to inform policy options.
Methods and Findings
We summarised reliable research comparing the quality of formal private
versus public ambulatory health care in low and middle income countries.
We selected studies against inclusion criteria following a comprehensive
search, yielding 80 studies. We compared quality under standard
categories, converted values to a linear 100% scale, calculated
differences between providers within studies, and summarised median
values of the differences across studies. As the results for for-profit
and not-for-profit providers were similar, we combined them. Overall,
median values indicated that many services, irrespective of whether
public or private, scored low on infrastructure, clinical competence,
and practice. Overall, the private sector performed better in relation
to drug supply, responsiveness, and effort. No difference between
provider groups was detected for patient satisfaction or competence.
Synthesis of qualitative components indicates the private sector is more
Although data are limited, quality in both provider groups seems poor,
with the private sector performing better in drug availability and
aspects of delivery of care, including responsiveness and effort, and
possibly being more client orientated. Strategies seeking to influence
quality in both groups are needed to improve care delivery and outcomes
for the poor, including managing the increasing burden of
PLoS Med 8 (4): e1000433 [doi:10.1371/journal.pmed.1000433]
Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies.