Dr. Mostofa Muhammad Lutful assesses one month old baby, Saba, for pneumonia in a hospital in Barisal district, Bangladesh September 2018. Saba's mom, Shanta, holds her baby. Save the Children is helping to train healthcare providers to diagnose and treat pneumonia at the community level.
Introduction
The private sector accounts for an important share of health services available in South Asia. It is not known to what extent socioeconomic and urban–rural inequalities in maternal, newborn and child health (MNCH) interventions are being affected by the presence of private providers.
Methods
Nationally representative surveys carried out from 2009 to 2015 were analysed for seven of the eight countries in South Asia, as data for Sri Lanka were not available. The outcomes studied included antenatal care (four or more visits), institutional delivery, early initiation of breastfeeding, postnatal care for babies, and careseeking for diarrhoea and pneumonia. Results were stratified according to quintiles of household wealth and urban–rural residence.
Results
At regional level, the public sector played a larger role than the private sector in providing antenatal (24.8% vs 15.6% coverage), delivery (51.9% vs 26.8%) and postnatal care (15.7% vs 8.2%), as well as in the early initiation of breast feeding (26.1% vs 11.1%). The reverse was observed in careseeking for diarrhoea (15.0% and 46.2%) and pneumonia (18.2% and 50.5%). In 28 out of 37 possible analyses of coverage by country, socioeconomic inequalities were significantly wider in the private than in the public sector, and in only four cases the reverse pattern was observed. In 20 of the 37 analyses, the public sector was also more likely to be used by the wealthiest women and children.
Conclusion
The private sector plays a substantial role in delivering MNCH interventions in South Asia but is more inequitable than the public sector.