Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: Implications for the HRH problem

Ahmed, Syed Masud; Hossain, Awlad

doi:10.1016/j.healthpol.2007.05.011

Cited by 67 publications

(80 citation statements)

References 25 publications

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“…20 Unqualified practitioner do not charge visiting fees, and they are abundant in rural communities, minimizing transportation costs and wage loss. [21][22][23] However, since they often run their own drug shops, they may prescribe a greater quantity of drugs compared with qualified health-care practitioners, [24][25][26] increasing overall cost per episode of illness, suggested by analysis of medicine costs in this study.…”

Section: Discussionmentioning

confidence: 82%

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Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh

Halder

Luby

Akhter

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. Understanding illness costs associated with diarrhea and acute respiratory infections (ARI) could guide prevention and treatment strategies. This study aimed to determine incidence of childhood diarrhea and ARI and costs of homecare, hospitalization, and outpatient treatment by practitioner type in rural Bangladesh. From each of 100 randomly selected population clusters we sampled 17 households with at least one child < 5 years of age. Childhood diarrhea incidence was 3,451 and ARI incidence was 5,849/1,000 child-years. For diarrhea and ARI outpatient care per 1,000 child-years, parents spent more on unqualified ($2,361 and $4,822) than qualified health-care practitioners ($113 and $947). For outpatient care, visits to unqualified health-care practitioners were at least five times more common than visits to qualified practitioners. Costs for outpatient care treatment by unqualified healthcare practitioners per episode of illness were similar to those for qualified health-care practitioners. Homecare costs were similar for diarrhea and ARI ($0.16 and $0.24) as were similar hospitalization costs per episode of diarrhea and ARI ($35.40 and $37.76). On average, rural Bangladeshi households with children < 5 years of age spent 1.3% ($12 of $915) of their annual income managing diarrhea and ARI for those children. The majority of childhood illness management cost comprised visits to unqualified health-care practitioners. Policy makers should consider strategies to increase the skills of unqualified health-care practitioners, use community health workers to provide referral, and promote homecare for diarrhea and ARI. Incentives to motivate existing qualified physicians who are interested to work in rural Bangladesh could also be considered.

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Section: Discussionmentioning

confidence: 82%

“…Unqualified health-care practitioners based in rural areas are readily available and often provide services on credit. 24 The ARI = acute respiratory illness; CI = confidence interval; RR = risk ratio. *Diarrhea or ARI.…”

Section: Discussionmentioning

confidence: 99%

Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh

Halder

Luby

Akhter

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…This gap may be the result of low public health expenditure, or low efficiency of public expenditure, leading to lack of capacity to provide services. In Bangladesh a shortage of qualified healthcare professionals in rural areas has long been acknowledged as a key reason why a larger part of the population seeks assistance from unqualified allopathic providers (33). In Tanzania, the percentage of people utilizing the private sector was found to increase during drug stock-outs in the public sector (34).…”

Section: Structure and Performance Of The Public And Private Sectorsmentioning

confidence: 99%

Performance of private sector health care: implications for universal health coverage

2016

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While the private sector is an important health care provider in many low and middle income countries (LMICs), its role in relation to progress towards Universal Health Coverage (UHC) varies. Drawing on a review of the published and grey literature, we explore the factors that affect private sector contribution to UHC: i.e. we are interested in the overall impact on system outcomes such as . Evidence on the performance of both the private and public healthcare sectors is used to examine the characteristics of private providers that are associated with their performance, and the implications for how these factors might interrelate to influence progress towards UHC. Studies of private sector performance have focused on three main dimensions: quality, equity of access, and efficiency. We found that the characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers including their size, objectives, and technical competence the interaction of these factors influences how the sector performs within different contexts. Changing the performance of the private sector will require interventions which target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector appears to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health sector requires a regulatory response focused on the health sector as a whole. Key messages The critical policy relevant question about the private sector is not its performance in isolation, or relative to the public sector, but the extent to which it supports or detracts from progress towards Universal Health Coverage  There is a dearth of evidence on factors affecting system level performance, reflecting the complexity and heterogeneity of the private health sector and the difficulty in exploring the inter-relationships of factors at the system level, and their effect on overall performance.  Deriving population benefit from the private health sector will require interventions which target the sector as a whole, rather than individual providers alone.

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“…Pharmacies and drug shops are often the first, preferred source of health care in LMICs in light of their convenience, privacy, anonymity, and low cost (Ahmed and Hossain 2007; Chalker et al. 2000; Goel, Ross‐Degnan, Berman, and Soumerai 1996).…”

mentioning

confidence: 99%

Medical Abortion Provision by Pharmacies and Drug Sellers in Low‐ and Middle‐Income Countries: A Systematic Review

Footman¹,

Keenan²,

Reiss³

et al. 2018

Studies in Family Planning

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We undertook a systematic review to assess 1) the level and quality of pharmacy and drug shop provision of medical abortion (MA) in low‐ and middle‐income countries (LMICs) and 2) interventions to improve quality of provision. We used standardized terms to search six databases for peer‐reviewed and grey literature. We double‐extracted data using a standardized template, and double‐graded studies for methodological quality. We identified 22 studies from 16 countries reporting on level and quality of MA provision through pharmacies and drug sellers, and three intervention studies. Despite widespread awareness and provision of MA drugs, even in legally restricted contexts, most studies found that pharmacy workers and drug sellers had poor knowledge of effective regimens. Evidence on interventions to improve pharmacy and drug shop provision of MA was limited and generally low quality, but indicated that training could be effective in improving knowledge. Programmatic attention should focus on the development and rigorous evaluation of innovative interventions to improve women's access to information about MA self‐management in low‐and middle‐income countries.

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Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: Implications for the HRH problem

Cited by 67 publications

References 25 publications

Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh

Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh

Performance of private sector health care: implications for universal health coverage

Medical Abortion Provision by Pharmacies and Drug Sellers in Low‐ and Middle‐Income Countries: A Systematic Review

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