The overall poor quality of outpatient healthcare in both the formal private and public sector in low and middle income countries is worrying—especially given the increasing volume of chronic conditions, such as diabetes and heart disease, which require relatively sophisticated, long-term outpatient medical care.
This conclusion, from a review by Paul Garner from the Liverpool School of Tropical Medicine, Liverpool, UK and colleagues and published in this week's PLoS Medicine, stresses the pressing need for national governments to find and implement effective strategies to improve the quality of healthcare provided in both sectors in order to improve health outcomes in low and middle income countries.
In their review, the authors systematically identified, summarized, and scored the results of studies that directly compared the quality of outpatient care in low and middle income countries offered by public providers with the care offered by ''formal'' private providers (recognized by law) and ''informal'' private providers (providers that are not legally recognized, such as shopkeepers).
The authors found that overall many services, irrespective of whether public or private, scored low (less than 50%) on infrastructure, clinical competence, and practice. Generally, the formal private sector performed better in relation to drug supply, responsiveness, and effort, but there was no detectable difference between health provider groups for patient satisfaction.
The authors put their findings in context: "Many efforts to improve the quality of ambulatory care are restricted to the public sector on the grounds that public funds should be reserved for the public sector because that is where the poor turn for their health care. But concentrating on the public sector misses a large proportion, the majority in some cases, of the providers used by the poor."
They continue: "Raising the quality of care delivered by private, as well as public, providers would, in fact, be a pro-poor intervention as it would improve the effectiveness of the money the poor spend on health care."
In an accompanying Perspective article, Jishnu Das (uninvolved in the research) from the World Bank and the Centre for Policy Research, New Delhi, India says: "The review reflects a logical initial focus in the literature on individual providers rather than the interactions between providers; going forward, broadening the discussion on quality to health care markets can generate valuable insights for policy."
He continues: "Such market-level analysis can help answer policy questions ranging from regulatory issues to the trade-off between access and quality."
Funding: This research was funded by the UK Department for International Development for the benefit of the poor in developing countries (http://www.research4development.info/SearchResearchDatabase.asp?ProjectID=50118). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Berendes S, Heywood P, Oliver S, Garner P (2011) Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies. PLoS Med 8(4): e1000433. doi:10.1371/journal.pmed.1000433
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: Garner and colleagues:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000433
CONTACT:
Prof. Paul Garner
Liverpool School of Tropical Medicine
International Health Research Group
Pembroke Place
Liverpool, L3 5QA
United Kingdom
+44 (0)151 705 3201
+44 (0)151 705 3364 (fax)
pgarner@liv.ac.uk
Perspective by Jishnu Das
Competing Interests: The author has declared that no competing interests exist.
Citation: Das J (2011) The Quality of Medical Care in Low-Income Countries: From Providers to Markets. PLoS Med 8(4): e1000432. doi:10.1371/journal.pmed.1000432
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: Garner and colleagues:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000432
CONTACT:
Jishnu Das
The World Bank and Centre for Policy Research
Development Economics Research Group
MSN MC3-311
1818 H Street, NW
Washington, DC 20433
United States of America
+1 202-472-2781
jdas1@worldbank.org
FROM THE PLoS MEDICINE MAGAZINE SECTION
Are malaria nets widely used?
In this week's PLoS Medicine Thomas Eisele from Tulane University School of Public Health and Tropical Medicine in New Orleans, USA and colleagues dispute reports in media and elsewhere that insecticide-treated nets are not widely used, or are misused. They argue that such misconceptions are not evidence-based and are damaging to malaria control efforts. "We identified only one peer-reviewed study that reported misuse of ITNs," say the authors, and this study was "non-generalizable." The authors recommend that "inaccurate news stories of widespread ITN misuse should be rebuked directly through the dissemination of empirical data contradicting anecdotal reports and in rebuttal editorials in newspapers and journals."
Funding: No specific funding was received to write this Essay.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Eisele TP, Thwing J, Keating J (2011) Claims about the Misuse of Insecticide-Treated Mosquito Nets: Are These Evidence-Based? PLoS Med 8(4): e1001019. doi:10.1371/journal.pmed.1001019
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.10001019
CONTACT:
Dr. Thomas Eisele
Tulane University School of Public Health and Tropical Medicine
Department of International Heath and Development
1440 Canal St
Suite 2200
New Orleans
Louisiana
70112
+1 504-715-2002
teisele@tulane.edu
Journal
PLoS Medicine