The role of private providers in maternal health.

Every day, nearly 800 women die from complications of pregnancy and childbirth. A great many of these deaths are preventable; however, there is no single, straightforward solution. Because identifi cation of every woman who will have a life-threatening complication during pregnancy or childbirth is impossible, saving of women's lives during pregnancy and childbirth needs a systems approach with on-call structures in place that can respond immediately and eff ectively to these complications, around the clock. This challenge is daunting for most of the countries where the burden of maternal mortality is highest, but should not paralyse action. To accelerate progress to reach Millennium Development Goal 5, health systems should bring solutions to the women who need them most, and make these solutions sustainable at adequate scale. Private health care is one of the fastest growing segments of the health-care system, and private providers (ie, all non-public-sector providers) and businesses (ie, pharmacies) are an important source of health care for families in the lower wealth quintiles in low-income and middle-income countries. 1 In countries such as Nigeria and Uganda, more than 50% of the population in the lowest income bracket seek health services from private health workers (eg, licensed and unlicensed providers, midwives, pharmacists, and traditional healers). 2 Although these locally based providers are often the fi rst line of response for families in need of health care, little is known about the services they provide, the quality of their care, or the fees they charge. Private providers attend deliveries both at homes and in medical facilities, constituting a substantial proportion of delivery services in some low-income and middle-income countries. 3 Additionally, for many years the private sector has played a substantial part in provision of services for family planning, one of the most eff ective ways to reduce maternal mortality. 3–6 Recent evidence from social franchising suggests that this model of clinical service delivery by private providers is positively associated with client volume, client satisfaction, and in some instances increased use of services and positive health eff ects. 7 However, questions about equity and cost-eff ectiveness need further research. 7 Whether the private sector can have a key role in prevention of maternal mortality is an essential question. So far, the development and donor community has largely focused its eff orts on strengthening of the public health sector, despite the potentially substantial part the private sector could play to address …