It was , however , evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people .
Background There has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries .
The private sector represents an important source of care for all socioeconomic groups , including the poorest and substantial concerns have been raised about the quality of care it provides .
Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals .
Limited information is available on the extent to which these interventions have successfully exp and ed access to quality health services for poor and disadvantaged population s. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor .
Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study.
BACKGROUND The objective of this study was to evaluate a competitive voucher program intended to make sexual and reproductive health care ( SRHC ) accessible to adolescents from disadvantaged areas of Managua . METHODS A quasi-experimental intervention study was performed in which 28,711 vouchers that gave free access to SRHC in 20 health centers , were distributed to adolescents . To evaluate the impact , community sampling took place in markets , neighborhoods , and outside schools where self-administered question naires were distributed . The study comprised a r and om sample of 3,009 female adolescents , ages 12 to 20 years old , 904 voucher receivers and 2,105 nonreceivers . Their use of SRHC , and knowledge and use of contraceptives and condoms were measured . RESULTS Voucher receivers had a significantly higher use of SRHC compared with nonreceivers , 34 % versus 19 % ( adjusted odds ratio , 3.1 ; 95 % confidence interval , 2.5 - 3.8 ) . The highest influence was seen among respondents at schools , where use was 24 % relative to 6 % in nonreceivers ( adjusted odds ratio , 5.9 ; 95 % confidence interval , 3.7 - 9.5 ) . Voucher receivers answered significantly more questions correctly that were related to knowledge of contraceptives and sexually transmitted infections than nonreceivers . At schools , sexually active voucher receivers had a significantly higher use of modern contraceptives than nonreceivers , 48 % versus 33 % ( adjusted odds ratio , 2.3 ; 95 % confidence interval , 1.2 - 4.4 ) ; and in neighborhoods , condom use during last sexual contact was significantly greater among voucher receivers than nonreceivers ( adjusted odds ratio , 2.5 ; 95 % confidence interval , 1.4 - 4.5 ) . CONCLUSION The voucher program succeeded in increasing access to SRHC for poor and underserved girls . The needs of adolescents were met with a relatively simple intervention through existing health facilities . Many adolescents appeared willing to protect themselves against the risks of sexual intercourse . This suggest that access to SRHC can play an important role in changing youth behavior and increase the use of contraceptives and condoms
It was , however , evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people .
Background There has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries .
The private sector represents an important source of care for all socioeconomic groups , including the poorest and substantial concerns have been raised about the quality of care it provides .
Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals .
Limited information is available on the extent to which these interventions have successfully exp and ed access to quality health services for poor and disadvantaged population s. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor .