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Thank you Adam for this extremely useful post. Our experience at Oxfam chimes with yours – at conference after conference, and in paper after paper we see and hear the same figures being quoted about the size of the private sector, often coming back to the very same source – the IFC reports. The serious concern is not only that the figures used overstate the size of the private health care sector in developing countries but that they are themselves being used as justification for a greater allocation of public resources to private health care.

Oxfam has also criticised the figures used by the IFC for unhelpfully merging the informal and formal private sector to come up with the false claim in their ‘Business of Health in Africa’ report that ‘A poor woman in Africa today is as likely to take her sick child to a private hospital or clinic as to a public facility.’ Our analysis of the same figures found that 40% of the care labelled as ‘private’ by the IFC was in fact informal and unqualified ( Another distinction which we think is critical but so often ignored, is between profit-making and non-profit private providers. Profit-making brings the inherent risk of market failure which must be acknowledged and responded to. Lumping together church facilities which do often make up a large portion of health care in sub-Saharan Africa for example, with elite profit making facilities designed only for the wealthiest makes little sense for those interested in really understanding the risks, roles and contributions of different types of non-state providers.

Wherever one stands in the spectrum of positions on what role the private sector can and should play in health care systems in developing countries one thing that should unite us is a call for robust and meaningful new data collection on the role and contribution of public and private (profit and non-profit) providers. In the mean time the use of such misleading figures to justify greater investment in profit-making private health care in some of the poorest countries in the world is in our view extremely dangerous.