The differences in how the private sector operates have a direct impact on how to interpret the impact of a growing private sector provision of delivery on maternal health outcomes.
One of the milestones of the newly launched Every Newborn Action Plan is coordinated support and effort amongst private sector providers of delivery services and newborn care (14).
The sector of the delivery facility was ascertained from mothers, but the availability of obstetric services was not measured.
A recent study based on nationally representative data from 34 sub-Saharan African countries found that increased private sector provision of deliveries is associated with favourable outcomes in terms of service access and equity (Yoong et al. 2010).
Using MacKeith et al.'s [ 14] estimates for public sector coverage of deliveries (87.5%) and the UTH and clinic figures for the period (19,691 deliveries), we estimate that there were approximately 22,000 births in Lusaka during the 6-month period July-December 1999, and 365 hospital admissions for postpartum morbidity were positively identified for the same period.
In Mumbai slums with a high uptake of institutional births and a 60/40 split in favour of the public sector for delivery care, we found no difference in caesarean section rates between the two sectors, which is somewhat surprising given the high rates of caesareans observed in the private sector in nine other states of India (excluding Maharashtra).
The distinction between private and public sector in terms of delivery of public services is increasingly blurred, but the structures and frameworks in which they operate are no less complex.
Given the dominance of the private sector in delivery of maternal health services and emerging importance of m-health in creation of demand for services, this research is very timely as it will provide empiric evidence of the feasibility of these ideas in a conservative, remote rural population beset with militant activity.
Within the health sector, the delivery of a basic package of health services (BPHS) with the aim of universal access, has been achieved by competitive contracting-out to non-governmental organisations (NGOs).
Despite increasing prominence of the private sector as a provider of delivery and newborn care, there is a dearth of data on newborn care practices in these facilities.
