Journal of Education and Health Promotion

Abstract Private hospital services (PHS) with the undeniable effects on the Universal Health Coverage (UHC)
goals have a considerable contribution to the health system of developing countries. The purpose of
this systematic scoping review (ScR) was to identify and map the available evidence regarding the
developing countries to scrutinize the nature of the PHS toward UHC through providing graphical/
tabular information of the records trends and types, sources of the records, frequent settings, drivers
of the PHS growth, range of the PHS, behaviors of the PHS, and opportunities for policy actions.
This study was performed following the 2017 published methodological guidance of the Joanna
Briggs Institute for the conduct of ScR. Furthermore, a narrative‑thematic synthesis integrated with
the systematic analysis applying approach to health system strengthening (HSS) through systems
thinking was employed. Thirty‑two included records in English that met the inclusion criteria were
found between 2011 and July 2020. There has been a sharp increase in the generation of the records
with a 90.6% growth rate between 2015 and 2020. The most frequent records types were review
article, and the lancet was the most specialized journal. India was the most frequent country. Near
half of the growth drivers of PHS have been originated from the governance. Besides, the range of
PHS was identified only about Mongolia, and the significant frequency of codes of the PHS behaviors
(32.6%) was related to integrated people‑centered health service delivery. 47.8% of the identified HSS
interventions were recommended about governance. Governance plays a decisive role in the nature
of the PHS in UHC. Concerning the dynamic architectures of interactions between health system
functions, probably the countries themselves have realized the importance of the governance role in
the HSS than other functions. Given the all of the recommended interventions were a combination of
foundational and institutional, sustainable participation of PHS in the health system seems far and
requires a solid will of the governments. Future research is needed about the range of PHS and its
behaviors in terms of consumables, revenue‑raising, and pooling of funds.

Abstract There is a lack of conceptual clarity about the role of delivering private hospital services
(DPHS) accompanied by major gaps in evidence. The purpose of this systematic scoping
review was to identify and map the available evidence regarding the developing countries
to scrutinize the participation of DPHS exclusively in the universal health coverage (UHC)
through providing graphical/tabular classifications of the bibliometric information, sources
of the records, frequent location, contribution of the private hospital services in the health
system, and roles of DPHS in UHC. This study was performed following the published
methodological guidance of the Joanna Briggs Institute for the conduct of scoping review,
applying some major databases and search engines. In addition, a narrative-thematic
synthesis integrated with the systematic analysis using the policy framework of the World
Health Organization was employed. The 28 included records in English which met the
inclusion criteria were found between 2014 and January 2020. The chronological trend of
records was progressive until 2019. India was the most frequent location (12%). China and
Sri Lanka on the one end of the spectrum and Somalia along with South Korea from the
other end were, respectively, the least and the most contributed countries in terms of DPHS.
Overall, 90% of the roles were concerned with UHC goals. Although evidence has revealed
inconsistency in the identified roles, a continuous chain of positive or negative effects in the
UHC objectives and goals was observed. Some knowledge gaps about the roles, causes of
the increasing and decreasing DPHS contribution, and its behaviors around the privatization
types and circumstances of the delivery were recommended as prioritized research agendas
for evidence-based policymaking in future.