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Assessment of the private health sector in the Republic of Congo
This country assessment is part of a set of studies planned in order to provide a better understanding of how to improve the business environment in which the private sector operates in Congo and other African countries. The assessment was conducted in order to establish a baseline of information, to help with political decision-making and provide market information. The private health sector assessment in the Republic of Congo provides a diagnosis of the nature and the effectiveness of the interface between the public and private sectors, establishes a dialogue on policy with stakeholders, and makes recommendations for reform that would bolster public and private involvement. The methodology is based on a supply and demand approach to identify market, policy and institutional barriers, and options for reducing these barriers by changing policies and initiatives. The information pertaining to demand reveals how users perceive private providers and their potential. The information pertaining to supply gives a better understanding of the role that private providers play and the challenges they encounter. The institutional information shows how Congo's institutions have facilitated or hampered the private participation. The study methodology includes the following aspects: (i) presentation of the general context of the private health sector in Congo, (ii) multidimensional analysis of demand, (iii) multidimensional analysis of supply, and (iv) analysis of institutional context. Options for action presented in this report include (i) policy and governance initiatives, (ii) regulatory initiatives, (iii) incentive initiatives, and (iv) concrete measures for public-private partnerships (PPP) in the health sector-- Source other than Library of Congress.
Book
Qualitative research exploring the complexities of exercise promotion in prostate cancer survivorship
This study aimed to explore the contextual and multilevel challenges to promoting exercise engagement among prostate cancer survivors in a low-resource setting, with a focus on integrating exercise-based rehabilitation into routine care and survivorship care planning, using a qualitative approach grounded in interpretative description.
Sixteen prostate cancer survivors (aged 53-77 years) were purposively sampled from public and private healthcare facilities in Cape Town, South Africa. Semi-structured telephonic interviews were conducted using a topic guide informed by prior research. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.
Four major themes were identified. Findings highlighted stark contrasts in exercise engagement between men treated in private versus public healthcare settings. Exercise was essential to private patients, whereas most public patients showed limited interest. Factors influencing engagement included knowledge gaps, treatment complications, fear of worsening symptoms, and age-related comorbidities. Socio-environmental barriers-such as neighbourhood safety and poor work-life balance-reduced exercise opportunities. Facility-level issues included inconsistent messaging from providers, lack of exercise oncology pathways, and absent referral systems.
Our study identified key multilevel influences surrounding exercise promotion and integration in routine care for prostate cancer survivors receiving treatment in private and public healthcare settings. While highlighting the opportunities/challenges surrounding integrating exercise programs in routine management, our findings offer program planners valuable insights for planning and developing interventions in resource-constrained settings.
Journal Article
A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries
Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.
Journal Article
Primary Health Care in Canada: Systems in Motion
Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. Methods: This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Findings: Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Conclusions: Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert.
Journal Article
Impact of Service Quality on In-Patients’ Satisfaction, Perceived Value, and Customer Loyalty: A Mixed-Methods Study from a Developing Country
Recent literature on healthcare quality demands more contextualized and patient-perspective research, as models from developed countries are not suitable for developing countries. Moreover, research on private healthcare services in Vietnam has long been underestimated by academia, but it has significant economic and commercial value. Hence, this study explores the dimensions of service quality in private healthcare and how they impact in-patient satisfaction, perceived value, and customer loyalty in Vietnam.
This mixed-method study had a sample size of five inpatients for the qualitative phase and 368 inpatients for the quantitative phase from hospitals in Vietnam. The qualitative analysis explores service quality dimensions in private healthcare and incorporates them with the literature to develop a conceptual model. The quantitative phase tests the relationship between each construct in the conceptual model via structural equation modeling.
The four dimensions of service quality were emotion, function, social influence, and trust. Most of these dimensions have a significant impact on customer perceived value and satisfaction. However, emotion does not significantly influence customer perceived value, and function does not considerably impact customer satisfaction. In addition, social influence is an underrepresented variable in the service quality literature, but it has the most substantial impact on customer perceived value and customer satisfaction. The quantitative results also confirm that customer satisfaction and customer perceived value significantly impact customer loyalty (word-of-mouth and revisit intention); however, customer perceived value does not significantly impact customer satisfaction.
The study suggests that private healthcare providers and the government in Vietnam should allocate resources to improve service quality. Practitioners should invest in social branding and e-services to reach out to their customers. Future research should focus on a cost-benefit analysis and compare the effectiveness of service quality dimensions on customer behavioral intention.
Journal Article
Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India
Background
Multimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings.
Methods
We undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits.
Result
The overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1–1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1–2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1–2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0–2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6–4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1–3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13–2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01–3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals.
Conclusion
Our findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers.
Journal Article
Specialists’ Dual Practice within Public Hospital Setting: Evidence from Malaysia
In line with the commitment of the Malaysian government and Ministry of Health to prevent the brain drain of specialists from public hospitals, they have been permitted to perform dual practice within the public hospital setting (DPH) since 2007. DPH allowed them to hold jobs in both public and private practices within the same public hospitals that they are affiliated to, permitting these specialists to treat public and private patients. Nevertheless, the information regarding DPH in Southeast Asia region is still limited. This narrative review provides insight into the implementation of DPH in Malaysia. It highlights that DPH has been well-governed and regulated by the MOH while serving as a means to retain specialists in the public healthcare system by providing them with opportunities to obtain additional income. Such a policy has also reduced the financial burden of the government in subsidizing healthcare. However, as in other countries with similar policies, multiple challenges have arisen from the implementation of DPH in Malaysia despite its positive achievements and potentials. This paper concludes that proactive governance, monitoring, and regulation are key to ensure the success of DPH.
Journal Article
How Could Private Healthcare Better Contribute to Healthcare Coverage in Vietnam?
Private healthcare services in Vietnam are seen as a major part of the solution to the rapid increase in need and demand for healthcare services. Formally recognized over 20 years ago, the private health services coexist with public services and are available all over the country. However, the scale and size of private sector is still small compared to the public sector and public acceptance and reputation still limited. There are substantial concerns with the quality of services and the adequacy of regulation. Human resource for health is currently inadequate to support growth in both public and private sectors. The role of the private sector in achieving Vietnam's population health objectives is not clear. In this emerging economy, there is significant potential for increased dependency on private healthcare to increase health access inequities. This paper discusses how private healthcare could better contribute to healthcare coverage in Vietnam.
Journal Article