What can be done about the private health sector in low-income countries? – ScienceOpen
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      What can be done about the private health sector in low-income countries? Translated title: Secteur sanitaire privé dans les pays à faible revenu: que peut-on faire ? Translated title: Qué hacer con el sector sanitario privado en los países de bajos ingresos?

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          Abstract

          A very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives? Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments.

          Translated abstract

          Il existe dans les pays à faible revenu un secteur sanitaire privé très important regroupant un large éventail de prestataires et utilisé par toutes les couches de la population. On peut toutefois s'inquiéter de la qualité des soins donnés, surtout dans la partie la plus informelle de ce système. Cela est particulièrement vrai en ce qui concerne les maladies d'importance majeure en santé publique comme la tuberculose, le paludisme et les infections sexuellement transmissibles. Comment peut-on influencer les activités du secteur privé dans ces pays de façon qu'elles contribuent à la réalisation des objectifs sanitaires nationaux ? Bien qu'on ne dispose guère de données satisfaisantes, il existe des informations sur les types d'intervention les plus à même d'influencer directement le comportement des prestataires et sur les conditions requises pour parvenir à des résultats. On connaît moins bien, en revanche, les approches efficaces en ce qui concerne les interventions au niveau de la demande de soins et les politiques consistant à renforcer le rôle des pouvoirs publics en matière d'achat et de réglementation.

          Translated abstract

          En los países de bajos ingresos existe un sector sanitario privado de grandes dimensiones. Se trata de una gran variedad de proveedores a los que recurren amplios segmentos de la población. El tema de la calidad de la atención prestada, sobre todo en el el extremo más informal de la gama de provedores, suscita una considerable preocupación. Así ocurre sobre todo con las enfermedades más importantes en el campo de la salud pública, como la tuberculosis, el paludismo y las infecciones de transmisión sexual. ¿Cómo se puede influir en las actividades del sector privado en esos países para que contribuyan al logro de los objetivos de salud nacionales? Aunque la evidencia disponible no es satisfactoria, se dispone de bastante información sobre los tipos de intervención más eficaces para influir directamente en la actitud de los proveedores, así como sobre las que podrían ser las condiciones necesarias para asegurar el éxito de esas iniciativas. La evidencia es mucho menor, sin embargo, en cuanto a la manera de enfocar eficazmente las intervenciones orientadas al lado de la demanda y las políticas que entrañan el fortalecimiento de las funciones adquisitiva y reguladora de los gobiernos.

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          Most cited references72

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          The world health report 2000 - Health systems: improving performance

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            Treatment seeking for malaria: a review of recent research.

            A review of literature on treatment seeking for malaria was undertaken to identify patterns of care seeking, and to assess what is known about the adequacy of the treatments used. There is considerable variation in treatment seeking patterns, with use of the official sector ranging from 10-99% and self-purchase of drugs ranging from 4-87%. The majority of malaria cases receive some type of treatment, and multiple treatments are common. The response to most episodes begins with self-treatment, and close to half of cases rely exclusively on self-treatment, usually with antimalarials. A little more than half use the official health sector or village health workers at some point, with delays averaging three or more days. Exclusive reliance on traditional methods is extremely rare, although traditional remedies are often combined with modern medicines. Although use of antimalarials is widespread, underdosing is extremely common. Further research is needed to answer the question of what proportion of true malaria cases get appropriate treatment with effective antimalarial drugs, and to identify the best strategies to improve the situation. Interventions for the private and public sector need to be developed and evaluated. More information is needed on the specific drugs used, considering resistance patterns in a particular area. In order to guide future policy development, future studies should define the nature of self-treatment, record multiple treatments and attempt to identify the proportions of all cases who begin treatment with antimalarials at standardized time intervals. Hypothetical questions were found to be of limited usefulness in estimating rates of actual treatments. Whenever possible, studies should focus on actual episodes of illness and consider supplementing retrospective surveys with prospective diary-type methods. In addition, it is important to determine the specificity of local illness terms in identifying true malaria cases and the extent to which local perceptions of severity are consistent with clinical criteria for severity and symptoms of complicated malaria.
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              Ten recommendations to improve use of medicines in developing countries.

              R. Laing (2001)
              Inappropriate prescribing reduces the quality of medical care and leads to a waste of resources. To address these problems, a variety of educational and administrative approaches to improve prescribing have been tried. This article reviews the experiences of the last decade in order to identify which interventions have proven effective in developing countries, and suggests a range of policy options for health planners and managers. Considering the magnitude of resources that are wasted on inappropriately used drugs, many promising interventions are relatively inexpensive. Simple methods are available to monitor drug use in a standardized way and to identify inefficiencies. Intervention approaches that have proved effective in some settings are: standard treatment guidelines; essential drugs lists; pharmacy and therapeutics committees; problem-based basic professional training; and targeted in-service training of health workers. Some other interventions, such as training of drug sellers, education based on group processes and public education, need further testing, but should be supported. Several simplistic approaches have proven ineffective, such as disseminating prescribing information or clinical guidelines in written form only. Two issues that will require a long-term strategic approach are improving prescribing in the private sector and monitoring the impacts of health sector reform. Sufficient evidence is now available to persuade policy-makers that it is possible to promote rational drug use. If such effective strategies are followed, the quality of health care can be improved and drug expenditures reduced.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra )
                0042-9686
                2002
                : 80
                : 4
                : 325-330
                Article
                S0042-96862002000400012
                537f2297-3159-4ecc-9810-bfe35c2a5a7c

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0042-9686&lng=en
                Categories
                Health Policy & Services

                Public health
                Services santé,Secteur privé,Marketing services santé,Qualité soins,Legislation,Health,Défense consommateur,Pays en développement,Health services,Private sector,Marketing of health services,Quality of health care,Consumer advocacy,Developing countries,Servicios de salud,Sector privado,Comercialización de los servicios de salud,Calidad de la atención de salud,Legislación sanitaria,Defensa del consumidor,Países en desarrollo

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