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Comparative performance of public and private sector delivery of BCG vaccination: Evidence from Sub-Saharan Africa

机译：公共和私营部门提供的卡介苗接种的比较表现：来自撒哈拉以南非洲的证据

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Background: The private sector is an important source of health care in the developing world. However, there is limited evidence on how private providers compare to public providers, particularly for preventive services such as immunizations. We used data from Sub-Saharan Africa (SSA) to assess public-private differences in Bacillus Calmette-Guerin (BCG) vaccine delivery. Methods and findings: We used demographic and health surveys from 102,629 children aged 0-59 months from 29 countries across SSA to measure differences in BCG status for children born at private versus public health facilities (BCG is recommended at birth). We used a probit model to estimate public-private differences in BCG delivery, while controlling for key confounders. Next, we estimated how differences in BCG status evolved over time for children born at private versus public facilities. Finally, we estimated heterogeneity in public-private differences based on wealth and rural-urban residency. We found that children born at a private facility were 7.1 percentage points less likely to receive BCG vaccine in the same month as birth than children born at a public facility (95% CI 63-8.0; p < 0.001). Most of this difference was driven by for-profit private providers (as opposed to NGOs) where the BCG provision rate was 10.0 percentage points less than public providers (95% CI 9.0-11.2; p < 0.001) compared to only 2.4 percentage points for NGOs (95% CI 1.0-3. 8; p < 0.01). Moreover, children born at private for-profit facilities remained less likely to be vaccinated up to 59 months after birth. Finally, public-private differences were more pronounced for poorer children and children in rural areas. Conclusions: The for-profit private sector performed substantially worse than the public sector in providing BCG vaccine to newborns, resulting in a longer duration of vulnerability to tuberculosis. This disparity was greater for poorer children and children in rural areas
机译：背景：私营部门是发展中国家医疗保健的重要来源。但是，关于私人服务提供者与公共服务提供者相比的证据有限，特别是在预防服务（如免疫接种）方面。我们使用了来自撒哈拉以南非洲地区（SSA）的数据来评估卡介苗芽孢杆菌（BCG）疫苗接种中的公私差异。方法和调查结果：我们对来自SSA的29个国家/地区的102,629名0-59个月大的儿童进行了人口统计和健康调查，以衡量私人和公共卫生机构出生的儿童的BCG状况差异（建议在出生时推荐BCG）。我们使用概率模型来估计BCG交付中的公私差异，同时控制关键混杂因素。接下来，我们估计了私人和公共场所出生的孩子的BCG状况如何随时间变化。最后，我们根据财富和城乡居民身份估算了公私部门差异的异质性。我们发现，与在公共场所出生的孩子相比，在私人场所出生的孩子在出生当月接受BCG疫苗的可能性降低了7.1个百分点（95％CI 63-8.0; p <0.001）。这种差异的大部分是由营利性私人提供者（与非政府组织相对）驱动的，其中，BCG的提供率比公共提供者（95％CI 9.0-11.2; p <0.001）低10.0个百分点，而对于公共提供者，仅为2.4个百分点非政府组织（95％CI 1.0-3。8; p <0.01）。此外，在私人营利性机构出生的孩子出生后59个月内仍不太可能接种疫苗。最后，贫困儿童和农村地区儿童的公私差异更为明显。结论：营利性私营部门在向新生儿提供BCG疫苗方面的表现大大逊于公共部门，导致结核病易感性持续时间更长。对于贫困儿童和农村地区的儿童来说，这种差距更大

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