Role of non-state actors in health delivery

Non-state actors play an important role in the delivery of health services in developing counties (Bennet et al., 2005). When they have a health problem, most people in the third world first visit private healthcare providers – private-not-for-profit (PNFP) and private health practitioners (PHP), including traditional healers – because they are seen to be more convenient, working for longer hours and more considerate than public health care facilities.
More so, private service providers are often the first choice for women seeking birth control methods (Rosen and Conly 1999; Bennet et al. 2005). Generally private health care providers are more accessible, convenient, and are perceived to be of better quality. Private providers were trusted for being very friendly and approachable, extremely thorough and careful, and easy to contact.
Villagers trusted public providers for their skills and abilities (Ozawa.S, Walker.D.G, 2011). Progressively, more decision makers in developing countries are cognizant of the role of the private health sector in service delivery. In fact governments acknowledge the hurdles they face to meet the basic health needs of their populations and so they contract out to non-government organisations (NGOs) and private sector companies, to meet the needs of underserved populations.
The private health sector differs in terms of its legal status, training, facility base, nature and complexity of product or service provided and proportion of time spent in private practice (Patouillard, et al. 2007). In Uganda, the private sector facilities are known to have an uncoordinated network and weak regulation though some initiatives such as the Accredited Drug Dispensing Outlets (ADDO) have come up to organise private sector groups such as the drug shop networks .
The private health sector contributes about half of the health outputs in Uganda; of the present number of health staff (doctors, nurses, midwives) in the country, including the PNFP sector, almost 40% working for the private sector; 45 per cent of women of reproductive health age in 2011 received their family planning services in a private facility (HSSIP 2011/12-2015/16). The facility based PNFPs comprise 41% of the hospitals and 22% of lower level health facilities complementing the public health care system especially in rural areas. It is estimated that PHPs contribute 46% of the health care providers in Uganda (MoH, 2011).
Three quarters of PHPs provide family planning services, 90% offer malaria and STD treatment, 40% provide maternity, post abortion care and adolescent sexual health services. Difficulties in accessing capital and other incentives have limited the development of certain aspects of service delivery in the private sector. The private sector is the preferred first line point of care, largely an attribute to simplicity in access to care which includes close proximity to clients and beneficiaries. Through enhanced partnerships, the role of the private sector in Uganda is of immense importance in ensuring that a larger proportion of Ugandans get access to quality health services. One of the objectives of the National Development Plan (2010) is to build and utilise the full potential of the public and private partnerships in Uganda’s national health development.



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