For the public good? Regulation, management, and the performance of private healthcare providers in Tanzania

Not only does the health sector account for a significant proportion of the economy in most countries, it helps to build human capital by preventing death and disability. In many low- and middle-income countries (LMIC), the private healthcare sector comprises a major and growing source of treatment.

Their rapid growth reflects a confluence of factors including inadequate public provision, especially in the face of rapid urbanisation, together with economic growth which has increased disposable incomes. However, the appropriate role of the private sector is much contested. There are widespread concerns about provider incentives and over-provision of care, and the equity implications of working with providers who may mainly serve the relatively well-off.

The key aim of this project is to investigate potential drivers of better performance of private healthcare providers in Tanzania. The study will focus on two key drivers:

1. Internal management of the organisation: While there is a large literature documenting the role of management practices in determining firm performance, and emerging evidence in the hospital sector of high-income countries, little is known about the management-performance relationship in the health sector of LMICs. The study will address data constraints that have limited previous work by combining “gold-standard” measures of quality of care and management practices.
2. Government regulation and oversight: Regulations in LMICs are often under-developed and poorly enforced. For example, only 6 out of 45 countries in Africa have a comprehensive registry of private facilities. Inspections are rare, and revocation of licences almost unheard of. However, the Government of Tanzania is engaging with the private sector in novel ways. This raises the question of whether greater government oversight of private health providers can improve patient care.

The study will draw on novel data collected as part of an ongoing project examining the impact of a quality improvement intervention (known as SafeCare) in Tanzania. This project, conducted in collaboration with the Ifakara Health Institute in the context of a randomised controlled trial, gathered detailed information on the quality of care and business performance of 240 private health facilities across the country, using standardised (covert) patients, observations of clinical interactions, and patient exit interviews.