Impact of Private Sector Delivery of Quality Care on Maternal, Newborn, and Child Health Outcomes in Low- and Middle-Income Countries: A Systematic Review

Samantha R. Lattof; Joe Strong; Blerta Maliqi; Nuhu Yaqub

doi:10.5334/aogh.4596

Figures & Tables

Table 1

PICOTS criteria used in the systematic review.

PICOTS
Populations	Pregnant women, mothers, and newborns
Interventions	Delivery of quality maternal and newborn health services by the private sector
Control	Not necessary
Outcomes	Quantitative, qualitative, or mixed‑methods data on: maternal morbidity maternal mortality newborn morbidity newborn mortality child morbidity child mortality service utilization experience of care, including respectful care components of quality care (i.e. safety, effectiveness, timeliness, efficiency, equity, people‑centered care) secondary outcome: infant and/or child growth
Timeframe	January 1, 1995 to June 30, 2019
Setting	Low‑ and middle‑income countries

Table 2

Search terms and their combinations.

1. PRIVATE SECTOR	2. QUALITY OF CARE	3. MNCH
private sector	quality	matern*
for‑profit		pregnan*
for profit		mother*
public–private		newborn*
private enterprise*		infant*
NGO		child*
non‑government*		pediatric*
		paediatric*
		neonat*

Table 3

Outcomes of included studies.

REPORTED STUDY OUTCOMES	NUMBER OF STUDIES IN THE FINAL INVENTORY THAT REPORT THE OUTCOME
Maternal morbidity	15
Maternal mortality	6
Newborn morbidity	6
Newborn mortality	16
Child morbidity	14
Child mortality	10
Quality of care	110
Experience of care	45
Service utilization	7
Infant/child growth*	9

[i] *Secondary outcome.

Table 4

Included studies by region and country.

REGION/COUNTRY	NUMBER OF STUDIES INCLUDED IN FINAL INVENTORY (%)	NUMBER OF STUDIES EXAMINING MORBIDITY AND/OR MORTALITY AMONG MOTHERS, NEWBORNS, AND CHILDREN (%)	REGION/COUNTRY	NUMBER OF STUDIES INCLUDED IN FINAL INVENTORY (%)	NUMBER OF STUDIES EXAMINING MORBIDITY AND/OR MORTALITY AMONG MOTHERS, NEWBORNS, AND CHILDREN (%)
Africa	49 (35.3%)	18 (35.3%)	Asia¹	67 (48.2%)	27 (52.9%)
Angola	1 (0.7%)	—	Afghanistan	2 (1.4%)	—
Côte D’Ivoire	1 (0.7%)	—	Bangladesh	11 (7.9%)	8 (15.7%)
Ghana	1 (0.7%)	1 (2.0%)	China	2 (1.4%)	1 (2.0%)
Ethiopia	2 (1.4%)	2 (3.9%)	Georgia	1 (0.7%)	1 (2.0%)
Kenya	11 (7.9%)	4 (7.8%)	India	30 (21.6%)	11 (21.6%)
Lesotho	1 (0.7%)	1 (2.0%)	Indonesia	2 (1.4%)	1 (2.0%)
Malawi	3 (2.1%)	2 (3.9%)	Iran	2 (1.4%)	2 (3.9%)
Niger	1 (0.7%)	—	Jordan	1 (0.7%)	—
Nigeria	3 (2.2%)	1 (2.0%)	Nepal	4 (2.9%)	2 (3.9%)
Tanzania	3 (2.2%)	1 (2.0%)	Pakistan	6 (4.3%)	1 (2.0%)
The Gambia	1 (0.7%)	—	Philippines	2 (1.4%)	—
Uganda	15 (10.8%)	4 (7.8%)	Sri Lanka	2 (1.4%)	—
Zambia	2 (1.4%)	1 (2.0%)	Turkey	2 (1.4%)	—
Multiple countries	4 (2.9%)	1 (2.0%)
Latin America & Caribbean	14 (10.1%)	4 (7.8%)	Oceania¹	1 (0.7%)	—
Brazil	5 (3.6%)	1 (2.0%)	Papua New Guinea	1 (0.7%)	—
Guatemala	2 (1.4%)	1 (2.0%)
Haiti	2 (1.4%)	—	Cross‑regional studies	8 (5.8%)	2 (3.9%)
Mexico	4 (2.9%)	1 (2.0%)
Multiple countries	1 (0.7%)	1 (2.0%)	Total	139 (100%)	51 (100%)

[i] ¹Asia and Oceania include countries that belong to the following World Bank group classifications: East Asia and the Pacific, Europe and Central Asia, the Middle East, and South Asia.

Table 5

Characteristics of included studies.

CHARACTERISTICS	NUMBER OF STUDIES INCLUDED IN FINAL INVENTORY (%)	NUMBER OF STUDIES EXAMINING MORBIDITY AND/OR MORTALITY AMONG MOTHERS, NEWBORNS, AND CHILDREN (%)
Methodology
Randomized controlled trial	2 (1.4%)	1 (2.0%)
Randomized controlled trial	1 (0.7%)	—
Controlled clinical trial	1 (0.7%)	—
Cohort analytic	10 (7.2%)	4 (7.8%)
Case‑control	2 (1.4%)	2 (3.9%)
Cohort (before & after)	7 (5.0%)	2 (3.9%)
Interrupted time series	1 (0.7%)	1 (2.0%)
Qualitative	8 (5.8%)	2 (3.9%)
Mixed methods	21 (15.1%)	9 (17.6%)
Regression	55 (39.6%)	23 (45.1%)
Other	31 (22.3%)	7 (13.7%)
Unclear/not specified	2 (1.4%)	—
Country income group
Low	33 (23.7%)	11 (21.6%)
Lower‑middle	75 (54.0%)	29 (56.9%)
Upper‑middle	19 (13.7%)	7 (13.7%)
Multiple	12 (8.6%)	4 (7.8%)
Geographical level
National	34 (24.5%)	7 (13.7%)
Sub‑national (e.g. state, city)	73 (52.5%)	30 (58.8%)
Local (e.g. village)	7 (5.0%)	1 (2.05)
Health facility	18 (12.9%)	9 (17.6%)
Other	5 (3.6%)	2 (3.9%)
Unclear/not specified	2 (1.4%)	2 (3.8%)
Study population
Pregnant women	11 (7.9%)	4 7.8%)
Women during childbirth	2 (1.4%)	1 (2.0%)
Mothers postpartum	12 (8.6%)	1 (2.0%)
Newborns	13 (9.4%)	3 (5.9%)
Children	9 (6.5%)	5 (9.8%)
Healthcare providers	41 (29.5%)	10 (19.6%)
Parents/child caretakers	4 (2.9%)	3 (5.9%)
Multiple answers from list	26 (18.7%)	11 (21.6%)
Other (e.g., urban poor, married women)	20 (14.4%)	13 (25.5%)
Unclear/unspecified	1 (0.7%)	—
Publication type
Peer‑reviewed journal article	103 (74.1%)	33 (64.7%)
Report	27 (19.4%)	13 (25.5%)
Book or book chapter	1 (0.7%)	1 (2.0%)
Other (e.g., conference paper, abstract)	8 (5.8%)	4 (7.8%)
Implemented a specific intervention beyond the delivery of quality care?
Yes	58 (41.7%)	21 (41.2%)
No	81 (58.3%)	30 (58.8%)
Type of data
Quantitative	104 (74.8%)	40 (78.4%)
Qualitative	8 (5.8%)	2 (3.9%)
Both	27 (19.4%)	9 (17.6%)
Longitudinal data?
Yes	45 (32.4%)	19 (37.3%)
No	90 (64.7%)	30 (58.8%)
Unclear/not specified	4 (2.9%)	2 (3.9%)

LMICs	low‑ and middle‑income countries
MNCH	maternal, newborn, and child health
QOC	quality of care
WHO	World Health Organization