Table 3.

Selected health governance and market structure characteristics

Health system’s governance and market characteristics	Praia	Bissau	Maputo
Regulation and regulatory institutions	Developed and formal regulation in place for private sector and ‘special services’. Comparatively strong implementing institutions, from MoH to Hospital management and Medical Council	Absent. Week implementing and governance institutions. At the time of the fieldwork, the SMCH was under administration, and the Medical Council did not have a list of physicians working in Bissau	Patchy regulation, only selectively applied. Some institutions (General government and MCH) stronger than others (Medical Council). Government attempts to ban Special Services were flatly ignored by MCH
Physicians’ opinions about dual practice (DP) regulation	DP should be regulated (89.1%), by the Government (33.3%), by the MoH (70.7%) and by the Medical Council (73.7%)	DP should be regulated (95.8%), by the Government (50.0%), by the MoH (60.4%) and by the Medical Council (78.1%)	DP should be regulated (71.8%), by the Government (12.9%), by the MoH (37.1%) and by the Medical Council (53.2%)
Formal private practice outside public facilities	Developed and regulated, although mostly limited to outpatient visits	Very limited, predominantly low-cost and scarcely regulated	Thriving and high-cost, patchily regulated
Private practice inside public facilities	‘Consultas complementares’ legalized and regulated within ANCH (private practice ‘within’). It is however limited in size, and mostly related to surgical operations and equipment-intensive tests	Unregulated, it is however very common and ‘integrated’ across all the public sector. Informal illegal charges reported to be ubiquitous	Existing as both little-regulated ‘Special Services’ within hospital departments, and more formalized ‘special clinic’ services ‘beside’ MCH public services.
Proportion of specialists among physicians surveyed	Moderate proportion of specialists (65.1%)	Highest number of specialists (75.6%)	Lowest proportion of specialists (56.0%) across the three locations surveyed, possibly linked to existence of local training capacity for basic medical degrees
Physician density in capital city	Highest physicians density of the three locations, comparable with middle- and high-income countries (9.96/10 000)	Lowest physicians density (3.27/10 000)	Average physicians density (6.64/10 000)
Public sector pay	Comparatively high and decompressed (USD903–1802)	Low and compressed (USD315–344)	Low, but decompressed (USD645–989)
Private service prices	Moderate (USD29.22 for outpatient visit)	Comparatively low (USD5.97 for outpatient visit)	High (USD34.99 for outpatient visit)
Demand for public medical services	Moderate, with some waiting list for the central hospital	Moderate, possibly because of burdensome illegal charges	High, although legal moderating fees limiting access to tertiary-care hospitals