VIEWPOINT - PUBLIC VERSUS PRIVATE HEALTH-CARE-DELIVERY - BEYOND THE SLOGANS

In most settings, a 'public' health service refers to a service which belongs to the state. The term 'private' is used when health care is d elivered by individuals and/or institutions not administered by the st ate. In this paper it is argued that such a distinction, which is base d on the institutional or administrative identity of the health care p rovider, is not adequate because it takes for granted that the nature of this identity automatically determines the nature of the service de livered to the population. A different frame of classification between public and private health services is proposed: one which is based on the purpose the health service pursues and on the outputs it yields. A set of five operational criteria to distinguish between health servi ces guided by a public or private purpose is presented. This alternati ve classification is discussed in relation to a variety of existing si tuations in sub-Saharan Africa (Mall, Uganda, Zimbabwe). It is hoped t hat it carl be used as a tool in the hands of the health planner in or der to bring more rationality in the current altercation between the p ublic and the private health care sector.