Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

Mohanan, Manoj; Giardili, Soledad; Das, Veena; Rabin, Tracy L.; Raj, Sunil Saksena; Schwartz, Jeremy I.; Seth, Aparna; Goldhaber-Fiebert, Jeremy D.; Miller, Grant; Vera‐Hernández, Marcos

doi:10.2471/blt.16.179556

Cited by 30 publications

(24 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A similar strategy was used to assess whether a social franchising and telemedicine intervention improved the quality of childhood illness management in Bihar, India. The study found zero improvements in the clinical management of childhood illnesses using SPs 31…”

Section: Research Examples With the Sp Methodsmentioning

confidence: 89%

Use of standardised patients for healthcare quality research in low- and middle-income countries

et al. 2019

Self Cite

View full text Add to dashboard Cite

The use of standardised patients (SPs)—people recruited from the local community to present the same case to multiple providers in a blinded fashion—is increasingly used to measure the quality of care in low-income and middle-income countries. Encouraged by the growing interest in the SP method, and based on our experience of conducting SP studies, we present a conceptual framework for research designs and surveys that use this methodology. We accompany the conceptual framework with specific examples, drawn from our experience with SP studies in low-income and middle-income contexts, including China, India, Kenya and South Africa, to highlight the versatility of the method and illustrate the ongoing challenges. A toolkit and manual for implementing SP studies is included as a companion piece in the online supplement.

show abstract

Section: Research Examples With the Sp Methodsmentioning

confidence: 89%

Use of standardised patients for healthcare quality research in low- and middle-income countries

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…We analyse data from provider quality assessments undertaken as part of baseline surveys conducted for the Bihar Evaluation of Social Franchising and Telemedicine (BEST) project—an evaluation of a large telemedicine programme funded by the Bill and Melinda Gates Foundation in Bihar. 15 …”

Section: Methodsmentioning

confidence: 99%

Providers' knowledge of diagnosis and treatment of tuberculosis using vignettes: evidence from rural Bihar, India

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundAlmost 25% of all new cases of tuberculosis (TB) worldwide are in India, where drug resistance and low quality of care remain key challenges.MethodsWe conducted an observational, cross-sectional study of healthcare providers' knowledge of diagnosis and treatment of TB in rural Bihar, India, from June to September 2012. Using data from vignette-based interviews with 395 most commonly visited healthcare providers in study areas, we scored providers' knowledge and used multivariable regression models to examine their relationship to providers' characteristics.Findings80% of 395 providers had no formal medical qualifications. Overall, providers demonstrated low levels of knowledge: 64.9% (95% CI 59.8% to 69.8%) diagnosed correctly, and 21.7% (CI 16.8% to 27.1%) recommended correct treatment. Providers seldom asked diagnostic questions such as fever (31.4%, CI 26.8% to 36.2%) and bloody sputum (11.1%, CI 8.2% to 14.7%), or results from sputum microscopy (20.0%, CI: 16.2% to 24.3%). After controlling for whether providers treat TB, MBBS providers were not significantly different, from unqualified providers or those with alternative medical qualifications, on knowledge score or offering correct treatment. MBBS providers were, however, more likely to recommend referrals relative to complementary medicine and unqualified providers (23.2 and 37.7 percentage points, respectively).InterpretationHealthcare providers in rural areas in Bihar, India, have low levels of knowledge regarding TB diagnosis and treatment. Our findings highlight the need for policies to improve training, incentives, task shifting and regulation to improve knowledge and performance of existing providers. Further, more research is needed on the incentives providers face and the role of information on quality to help patients select providers who offer higher quality care.

show abstract

“…Our study evaluates a social franchising system, which is currently popular among global health actors despite the lack of sound empirical evidence on its role or effects. 41 It incorporates an account of components that would improve the regulation of drug shops and retail health markets and forge formal linkages to government health services, which is missing in previous studies. 5 38 40 Lastly, it evaluates the iCCM of childhood febrile illnesses rather than just malaria tests.…”

Section: Introductionmentioning

confidence: 99%

Health system effects of implementing integrated community case management (iCCM) intervention in private retail drug shops in South Western Uganda: a qualitative study

et al. 2017

View full text Add to dashboard Cite

BackgroundIntervening in private drug shops to improve quality of care and enhance regulatory oversight may have health system effects that need to be understood before scaling up any such interventions. We examine the processes through which a drug shop intervention culminated in positive unintended effects and other dynamic interactions within the underlying health system.MethodsA multifaceted intervention consisting of drug seller training, supply of diagnostics and subsidised medicines, use of treatment algorithms, monthly supervision and community sensitisation was implemented in drug shops in South Western Uganda, to improve paediatric fever management. Focus group discussions and in-depth interviews were conducted with stakeholders (drug sellers, government officials and community health workers) at baseline, midpoint and end-line between September 2013 and September 2015. Using a health market and systems lens, transcripts from the interviews were analysed to identify health system effects associated with the apparent success of the intervention.FindingsStakeholders initially expressed caution and fears about the intervention’s implications for quality, equity and interface with the regulatory framework. Over time, these stakeholders embraced the intervention. Most respondents noted that the intervention had improved drug shop standards, enabled drug shops to embrace patient record keeping, parasite-based treatment of malaria and appropriate medicine use. There was also improved supportive supervision, and better compliance to licensing and other regulatory requirements. Drug seller legitimacy was enhanced from the community and client perspective, leading to improved trust in drug shops.ConclusionThe study showed how effectively using health technologies and the perceived efficacy of medicines contributed to improved legitimacy and trust in drug shops among stakeholders. The study also demonstrated that using a combination of appropriate incentives and consumer empowerment strategies can help harmonise common practices with medicine regulations and safeguard public health, especially in mixed health market contexts.

show abstract

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

Cited by 30 publications

References 35 publications

Use of standardised patients for healthcare quality research in low- and middle-income countries

Use of standardised patients for healthcare quality research in low- and middle-income countries

Providers' knowledge of diagnosis and treatment of tuberculosis using vignettes: evidence from rural Bihar, India

Health system effects of implementing integrated community case management (iCCM) intervention in private retail drug shops in South Western Uganda: a qualitative study

Contact Info

Product

Resources

About