Enabling and regulating private sector provision of malaria services in three districts of Western Cameroon

This study aims to examine the existing enabling and regulatory interventions in Cameroon, and to explore their impact on the performance of private providers of malaria services. It makes recommendations to decision-makers on the best strategies for influencing the performance of private providers of public health services in low income countries. The study’s framework involves the Ministry of Health as a principal who authorises the private sector as an agent to provide malaria services to populations, in exchange for mutually agreed rewards and in the context of specified rules. Data were collected using both qualitative and quantitative research methods. This study found that the private sector provides a substantial portion of malaria services in Cameroon. There is evidence that enabling and regulatory interventions can enhance the private sector's quantity and quality of inputs which are used for expanding coverage, improving quality of care and affordability of malaria services. These interventions can approximate the objectives of multiple stakeholders including the Ministry of Health, Medical Council, managers, clinical staff and patients, thereby addressing the principal- agent problems in the health sector. Areas of private sector activity that are particularly difficult, but critical to influence are those of overcharging, unnecessary self-referral and issues of informal providers. Enabling interventions neither compete with nor negate traditional regulations in the health sector but seek to complement regulatory mechanisms by adding value from the perspective of influencing private sector providers’ behaviour. Government needs to invest in its ability - improving capacities and governance, providing resources and logistics - to oversee the ongoing development, implementation, monitoring and revision of enabling and regulatory interventions for the private health sector. The performance of private providers appears to be more positively influenced by enabling interventions than by regulatory mechanisms. In the absence of enabling interventions it may be inappropriate to try to influence the performance of private providers through regulatory mechanisms alone. While the resources needed for enforcement of regulations are limited, enabling and regulatory interventions can be integrated in such a way that it is in the interests of the private sector to comply with regulation of health service delivery. This can reduce the level of resources needed for effective enforcement of regulation amongst private providers. This study concludes that the integration of enabling and regulatory interventions appear to be a strategic policy option for influencing the performance of private providers of malaria services in low income countries.

Grantor dc:publisher.institution

Department of Public Health and Family Medicine

Year dc:date.issued

2007

Author dc:creator

• Njoumemi, Zakariaou

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/11427/7442

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/7442