Health Care on the Frontlines: Survey Evidence on Public and Private Providers in Uganda

Abstract:     
This report presents findings from a baseline survey of 155 primary health care facilities (dispensaries, with and without maternity units) that was carried out in Uganda in the latter part of 2000. By collecting data both from the dispensaries and from local governments, it was possible to validate the collected data and check for discrepancies in reporting. Data from client exit polls provided a qualitative measure of performance. The analysis compares service delivery performance in three ownership categories: government, private for-profit, and private nonprofit. Among the topics it explores at the facility level are staffing, availability of drugs and other inputs, remuneration, outputs, and financing.

The evidence suggests a close link between the three types of providers through the labor market for health workers. Government dispensaries, for example, pay higher salaries than private facilities, and for-profit facilities appear to pay more than nonprofits for qualified health staff. These salary differences affect the movement of staff between provider organizations.

Several other dimensions of service delivery - mix of services, pricing, quality, use of drugs, and cost-efficiency - also vary among ownership categories. The findings are highly relevant for public policy in Uganda and in other countries in Africa that are undertaking civil service reform and promoting privatepublic partnerships in health care.

Number of Pages in PDF File: 64

working papers series