Public-private partnership as a success factor for health systems

With few exceptions, social sectors in South Asia suffer from insufficient allocation of public resources, the prime example being the health sector. As a consequence, private facilities and services have steadily emerged to dominate the health sector, a process which took place largely in a policy vacuum with little serious attempt to evolve public-private partnerships. Equally lacking have been explicit social development goals to underpin the development of private sector participation as an essential ingredient in health reform. For example, despite supplying >80% of healthcare in Pakistan, the private sector remains mostly absent at the policy table, even while becoming indispensable in the provision of accessible, affordable and equitable services. Rationalising the private sector's role is therefore increasingly critical to health care reform. While public-private partnerships [PPP] have been legitimized at global level by the World Health Organization, and successful models have emerged in some nations, in many countries there is an urgent need to find ways to encourage genuine partnerships based on mutual recognition and trust so as to extend essential health services to meet the needs of under-served populations. This requires complementary development of a regulatory role for the public sector. We examine these issues from a South Asian perspective, with Pakistan as our primary case study. We also highlight community participation as an important dimension of PPP in health

Coverage and factors associated with tetanus toxoid vaccination status among females of reproductive age in Peshawar

To estimate the coverage and determine the factors associated with tetanus toxoid vaccination status among females of reproductive age. Cross-sectional study. District Peshawar, NWFP, from July to September 2002. A total of 646 females of reproductive age [15-49] years were selected from both urban and rural areas of Peshawar through stratified cluster sampling. A pre-tested structured questionnaire was administered to females. Two logistic regression models were built, one for all females and one for married females only. Overall 65.0% females were vaccinated [95% confidence interval [CI] [61.3%, 68.6%]. For all females, the variables that were significantly associated with vaccination status were marital status [OR= 8.5, 95% CI [4.7, 15.6]], source of information regarding tetanus toxoid [TT] vaccination, knowledge regarding TT vaccination, visits of lady health worker [LHW] to a household [OR = 2.3, 95% CI [1.4, 3.9] and restriction on TT vaccination [OR = 28.7, 95% CI [3.5, 237.9]]. For the married females, the variables that were significantly associated with vaccination status were source of information; visits of LHW to a household [OR = 2.8, 95% CI [1.5 to 5.2]] and an interaction between knowledge regarding TT vaccination and antenatal care visits. These findings are of public health concern as a majority of females is not vaccinated according to WHO recommendations. It is recommended that maternal and neonatal tetanus [MNT] vaccination campaigns should include lady health workers at implementation stage