In recent years, there has been substantial growth of
the private health sector in developing countries.
Since many governments have been unable to maintain
health expenditures at past levels, they have deliberately
promoted the involvement of the private sector
in health care (Kumaranayake et al., 2000). However,
regulations regarding the operation of private health
providers have not kept pace with the expansion of
this sector. This has led to concerns about the inability
of outdated government regulations to address
potential opportunistic behavior by private providers,
leading to variations in the price and quality of services
(Hongoro and Kumaranayake, 2000). For example,
low-quality treatment of tuberculosis and sexually
transmitted infections (STIs) by private-sector
providers may have contributed to antibiotic resistance
in developing countries (Brugha and Zwi, 1999;
Mills et al., 2002).
Nevertheless, much of the existing regulation of
health-sector quality and price in developing countries
occurs through legislation, even though its effectiveness
in regulating the quality of services offered by
the private sector remains unknown (Kumaranayake
et al., 2000). An alternative approach to improving
the quality of services offered by private providers is
to create incentives for changing their practices and
to train providers in improving quality of care and
marketing services to clients (Agha et al., 1997;
Foreit, 1998). Better marketing of higher-quality
services can be expected to lead to greater utilization
of reproductive health services. Franchising is one
mechanism for changing provider behavior that may
lead to increased utilization of better-quality privatesector
services (Montagu, 2002).
This study examined the performance of a nurse and
paramedic network that was established to increase the
quality and utilization of reproductive health care
services in a district in Nepal. We assessed the extent to
which there were improvements in client perceptions of
the quality of care and an increase in the utilization of
reproductive health services offered by network clinics.