PRIVATE PRACTITIONERS IN THE SLUMS OF KARACHI - WHAT QUALITY OF CARE DO THEY OFFER

Private health services have expanded in many developing countries ove r the last 10 yr. Qualified private practitioners provide basic health care for poorer groups in urban areas, although health care planners frequently criticize them for providing poor quality of care, charging high fees and failing to provide preventive health advice. In Karachi , a large city with more than 400 slums, private practitioners are imp ortant providers of care to the poor. This study assessed the nature a nd quality of care provided by 201 practitioners selected from four di stricts df the city. Vignettes of specific medical problems were used to assess their knowledge and their practice was measured by observing 658 doctor-patient contacts. The results show that knowledge was clos er to accepted medical management than was their actual prescribing pr actice. On the other hand, their manners and interpersonal behaviour w ere good. Thus poor prescribing practice, which might equally stem Fro m market influences as lack of knowledge, is the cause of low standard s or care. In these circumstances, didactic in-service training to imp rove prescribing practice is unlikely to be successful. (C) 1998 Elsev ier Science Ltd. All rights reserved.