This paper summarizes findings from over 130 studies of private services provided to improve child health. These studies demonstrate that public-private interactions in favor of better child health have been moderately successful in some cases. Much better results are possible. The key to success is more effective public guidance, or what the latest World Health Report 2000 refers to as stewardship. This paper distils lessons of experience with private sector child health services and links them to a framework of public-private relations that can form a strengthened basis for child health improvements in developing countries.

This paper supports the work of an inter-agency working group directed at improving child health. It forms part of a larger toolkit to be made available to health practitioners and policy makers seeking to apply lessons of experience to challenges in the many different country settings in which these specialists are working. The toolkit will answer this key question: "What approaches can induce private sector providers of child health services to do a better and more cost-effective job of improving child health?" The positive answer will focus on a framework of public stewardship that harmonizes private actions to yield better health outcomes than currently prevail.

The paper concludes that to succeed with limited resources, governments must limit and focus their own activities and spending on making the private sector as effective as possible. On a continuing basis, public health managers need to reassess emerging issues, redefine the public sector role in stewardship of the private sector, and adjust its strategies to promote child health care. A key step for effective public action has been to recognize that public health requires actions by both public and private providers.

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