R. Brugha et A. Zwi, IMPROVING THE QUALITY OF PRIVATE-SECTOR DELIVERY OF PUBLIC-HEALTH SERVICES - CHALLENGES AND STRATEGIES, Health policy and planning (Print), 13(2), 1998, pp. 107-120
Citations number
75
Categorie Soggetti
Heath Policy & Services","Health Care Sciences & Services
Despite significant successes in controlling a number of communicable
diseases in low and middle income countries, important challenges rema
in, one being that a large proportion of patients with conditions of p
ublic health significance, such as tuberculosis, malaria, or sexually
transmitted diseases, seek care in the largely unregulated 'for profit
' private sector. Private providers (PPs) often offer services which a
re perceived by users to be more attractive. However, the available ev
idence suggests that serious deficiencies in technical quality are oft
en present. Evaluations of interventions to promote evidence-based car
e in high income countries have shown that multi-faceted strategies wh
ich increase provider knowledge have had some success in improving ser
vice quality. A wider range of factors needs to be considered in low a
nd middle income countries (LMICs), especially factors which contribut
e to discrepancies between provider knowledge and practice. Studies ha
ve shown that PPs, especially, perceive or experience patient and comm
unity pressures to provide inappropriate treatments. LMIC governments
also lack the capacity to enforce regulatory controls. Context-specifi
c multi-faceted strategies are needed, including the local adaptation
and dissemination to providers of relevant evidence, the education of
patients and communities to adopt effective treatment-seeking and trea
tment-taking behaviour, and feasible mechanisms for ensuring and monit
oring service quality, which may include a role for self-regulation by
provider organizations or provider accreditation. Developing, impleme
nting and evaluating strategies to improve the quality of service prov
ision will depend on the involvement of the key stakeholders, includin
g policy makers and PPs, Focusing on studies from Asia, Africa and Lat
in America, this paper develops a model for identifying the influences
on PPs, mainly private medical practitioners, in their management of
conditions of public health significance. Based on this, multi-faceted
strategies for improving the quality of treatment provision are sugge
sted. Interventions need to be inexpensive, practical, efficient, effe
ctive and sustainable over the medium to long term. Achieving this is
a significant challenge.