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By Anne Mills, Sara Bennett, Steven Russell, Nimal Attanayake, Charles Hongoro, V. R. Muraleedharan, Paul Smithson (auth.)

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A more dif®cult to classify arrangement between public and private sectors is where essentially the same body of doctors work in both sectors. In Zimbabwe, Sri Lanka, Thailand and some states in India this was legally allowed; in Ghana only locums were permitted, but in countries and states where it is not legally allowed it is usually none the less common. While this does not change the formal pattern of ®nancing and ownership, it substantially affects the interaction of the two sectors and means that sectors which are formally quite separate, in practice interact.

In order to ensure comparability across country case-studies and at the same time focus the studies in a manageable way, four `tracer' reforms were selected for study in each country. The tracer reforms selected were: . . bureaucratic commercialisation; user fees; contracting out services to the private sector; enabling and regulating the private sector. In health care, the relative roles of public and private sectors are commonly analysed according to the part they play in ®nancing health care and in provision of health care (Bennett 1991).

During the past 5±10 years, there has been substantial interest in developing systems of performance indicators to track the effects of health policy development and implementation within countries and to allow international comparisons of performance (Knowles 1997, McPake and Kutzin 1997). The approach used here draws from these sources. 1 System level results Quality It is common to break down an assessment of quality of care into input, process and outcome indicators. While data on inputs were quite readily available, hard evidence on both process and outcome aspects of quality was much more patchy.

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