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Developing countries have been increasingly adopting the Private Sector Participation (PSP) model in the delivery of electricity, telecom and water services. The results from individual studies on the impact of PSP has been mixed. This systematic review synthesizes the evidence on access and quality of services as a result of PSP. Though count of evidence approach shows that PSP is associated with positive impact on outcomes, not all of that can be attributed to PSP. The strength of positive evidence also varies between sectors and outcomes and is strongest for those outcomes where there could be a strong corresponding benefit to the private sector. Narrative synthesis indicated that (i) there are potential trade-offs between different outcomes; (ii) PSP should be accompanied by appropriate regulation, sector reform, and organizational changes to achieve the desired outcomes; (iii) In the absence of specific measures, access to rural and poor areas are adversely affected; and (iv) Unless properly designed, short term focus could dominate long term investment for network expansion and improvement.