An awkward threesome—donors, governments and non-state providers of health in low income countries

Bilateral and multilateral donors make frequent reference to collaboration with non-state providers (NSPs) in the health sector, and the desirability of so-called public private partnerships. Governments of many low-income countries are also increasingly committed to this goal in their policy statements. This article presents a range of cases from six countries of how governments, donors and NSPs interact. It describes examples of what type of engagement is taking place between governments and NSPs, highlights some common themes and reflects on common motivations for collaboration and constraints to it. Examples are examined under the original study design headings of dialogue, regulation, facilitation and contracting. These categories were not easy to sustain. Much government support to NSPs was characterised by donor involvement, fostering a 'pilot project' style of approach. In other cases, it was not so much a case of governments pursuing a specific intervention to support or regulate NSPs, as NGOs taking an initiative to fill a gap in government provision. The article highlights the main gap in interaction with NSPs as a comprehensive framework for regulating services provided by small scale, for profit NSPs. This is a serious shortcoming given that they deliver the bulk of basic health care in most of the countries examined. Copyright (c) 2006 John Wiley & Sons, Ltd.