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Submitted by Connor on

Dear Adam -- Thanks for the interesting blog post. It is good to see that the 'Healthy Partnerships' Report on Africa you refer to (of which I was the lead author) continues to spark debates about the evidence regarding public- and private health care provision. As you remind us in your post, and as also April's comments emphasize, the question of what the public-private mix is for an entire region is not an easy one to answer. In order to help tackle this challenge in developing the Report, we assembled an advisory panel that included experts from across the World Bank Group, think tanks, academia, and the WHO to think through the (dis)advantages of the available indicator sets, including DHS and WHS. The decision to go with DHS was supported by the panel for a number of reasons, but the higher country coverage of DHS was a particular factor. Even with the higher country coverage, as you point out correctly and importantly (this can get lost when communicating the 'headline' only), the DHS data represent only a partial view; especially the regional average. Of course, this is true for the WHS data also, which is available for 18 countries in the region. It excludes for example, Nigeria, where 18% of the region’s population resides and where the private health sector dominates. For a population-weighted average, this is not trivial. -- But aside from the pros and cons about such averages, which you and April have articulated in detail, I'd like to recall the context in which the cited 50/50 average appears in the 'Healthy Partnerships' Report. The section is titled "The private health sector in Africa is too large to be ignored, though it is only partly and often poorly integrated in the health system". I trust we can agree that this statement holds true, even as the debate on the precise public-private split continues, as it should. The private health sector is something governments should pay attention to and be strategic about. It is important to be reminded, as you did here, that regional averages should be enjoyed with appropriate caution, whether DHS or WHS, especially for a region as diverse and dynamic as Africa. The repeated scrutiny of such numbers is most welcome, and it points to the need for improved research and analysis of the role of private sector in health. [I might add, it would certainly be a most fruitful conversation here in Indonesia.] -- Connor