This brief outlines an operational definition of the private sector in health service delivery, developed in collaboration with the WHO's Technical Advisory Group on the Governance of the Private Sector for Universal Health Coverage. The absence of a common definition was recognized as a challenge, potentially leading to an underestimation of the private health sector's impact on health systems. The private sector encompasses various subcomponents, including direct provision of health care, management of health care institutions, manufacturing of health care goods, and financing of health care. The focus of this definition is on private sector entities involved in service delivery.

The purpose of this workbook is to assist ministries of health, health managers and practitioners in engaging with the private sector on delivery of quality maternal, newborn and child health (MNCH) services in lower- and middle-income countries. Private health care is one of the fastest growing segments of the health-care system in lower- and middle-income countries, and private providers are an important source of health care. To accelerate progress to reach the Sustainable Development Goals for ending preventable maternal, newborn and child deaths, it is critical that whole health system organizations invest not only in increasing coverage of interventions, but also in quality. The audience for the workbook is those who are involved with organizing and implementing processes for engaging the private sector in delivery of quality MNCH services.

This document introduces a collaboratively developed study protocol to identify what data and information is currently being collected by governments and how this is used for governance of the private sector in health. As part of inclusive health policy, ‘situational awareness’ and the generation of intelligence is needed by governments on the private sector in health. To perform specific governance functions, such as contracting, more explicit information on the private sector is required. This study responds to recommendations from the private sector landscaping undertaken as part of the WHO strategy report “Engaging the private health service delivery sector through governance in mixed health systems”.

Dual practice, the combination of public and private practice in the same or different sites, is ubiquitous in most national health systems. Within the literature, there has been more focus on the dual practice of physicians and specialists, although nurses, midwives and other health workers also engage in the practice. The adverse consequences of dual practice for universal health care vary by context, and evidence is largely descriptive and fails to quantify and analyse its effects. Governance response also remains inherently contextual and varies by level of implementation intensity and capacity. Overall, the effects of different governance tools in response to dual practice remain unexplored in the literature. Studies do not elicit much insight into the process of policy reform in response to dual practice.

"This volume examines the public/private sector mix in a number of national healthcare systems and their interface with the goals of health equity and quality of healthcare. Moreover, there is a consideration of public accountability. The unique significance of this collection of national studies involving the public/private sector mix of healthcare services and/or finances is that it provides insights into the factors that enhance the public/private sector mix in fulfilling the goals of health equity and the quality of healthcare services as well as an understanding of the circumstances in which elements of the public/private sector mix may be harmful for the achievement of such goals in a variety of national settings. The contributions to this volume provide a variety of perspectives in dealing with these objectives"--