For-profit sector immunization service provision: does low provision create a barrier to take-up?

Achievement of the health-related Millennium Development Goals is dependent on increasing take-up of preventive public health services (PHSs) in developing countries. Poor country governments often lack the resources to provide optimal access to preventive services and a great deal of attention is being directed towards the private sector to fill this void. In many developing countries, the private sector already plays a large role in health care. However, the for-profit private sector has little incentive to provide PHSs. The lack of provision of services by the for-profit sector may create a barrier to take-up of these services. In this study, we use data from a census of health facilities combined with data from community and provider surveys from Kenya to analyse whether the private for-profit sector has lower provision rates of child immunization services, and subsequently whether this creates a barrier that results in lower immunization take-up. We show that only 34% of for-profit facilities provide immunizations and that in areas with a larger share of for-profit providers, children are more likely to have no immunization coverage. Our model predicts that the odds of a child receiving no immunization coverage are 4.8 times higher in areas where all health facilities are for-profit compared to areas with no for-profit facilities. This indicates that a policy of engagement with the private for-profit sector aimed at increasing provision of immunization services may be an effective strategy for increasing take-up.