The objectives of this Private Sector Assessment (PSA) are to gain a better understanding of the private health care markets in Bangladesh, and to identify areas for increased collaboration between the government, and the private sector. While the study analyzes private health care markets in general, it uses maternal and child health (MCH) as an area of special focus to illustrate general principles, and/or draw lessons for the broader health, nutrition, and population (HNP) sector. MCH was chosen for this emphasis in view of its importance in Bangladesh, and because MCH outcomes constitute a significant part of the Millennium Development Goals (MDG). The PSA analysis confirmed that the private sector dominates the provision of basic care, nursing homes, laboratory and ambulatory diagnostic services
the public sector, however, remains the main provider of inpatient care. The private sector is used for the overwhelming majority of outpatient curative care, while the public sector is used for a larger proportion of hospital deliveries, and preventive care. The higher proportion of institutional deliveries in the public sector, should be understood by the fact that overall, the proportion of institutional deliveries is only 8%. Nonetheless, the dependence on the private sector for curative care is also true for the poor in the country: the poorest 20 percent of children have a higher dependence on the private sector for the management of acute respiratory infections, and diarrhea than the richest quintile. So, while expectedly the richest quintile spends more than the poorest quintile (by a factor of 6) on health care, the proportion of the spending that goes to the private sector, is higher among the poor than among the rich. Yet, financial barriers and lack of basic insurance coverage - public or private - appear to be major constraints for access to care for the poor, and, efforts need to address the financial, physical, and social barriers, especially for the women and the poorer population groups. Key issues stipulate: the public sector is not strategically using the scarce resources that are available in the private sector, aggravated by a low level of public expenditure on health care, conducing to a low level care provision, with the consequent shortages of formally trained staff. In particular, the following three areas appear to deserve priority in government actions: under-consumption of services by the poor and women
service quality and outcomes
and, the knowledge base.