Document Detail

Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.
MedLine Citation:
PMID:  21532746     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options.
METHODS AND FINDINGS: We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred.
CONCLUSIONS: Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases.
Sima Berendes; Peter Heywood; Sandy Oliver; Paul Garner
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2011-04-12
Journal Detail:
Title:  PLoS medicine     Volume:  8     ISSN:  1549-1676     ISO Abbreviation:  PLoS Med.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-05-02     Completed Date:  2011-08-18     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  101231360     Medline TA:  PLoS Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1000433     Citation Subset:  IM    
Liverpool School of Tropical Medicine, Liverpool, UK.
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MeSH Terms
Ambulatory Care Facilities / organization & administration*
Delivery of Health Care / organization & administration,  standards
Developing Countries*
Health Policy
Health Services Needs and Demand
Primary Health Care / organization & administration*
Private Sector / organization & administration*
Public Sector / organization & administration*
Quality of Health Care*
Comment In:
PLoS Med. 2011 Apr;8(4):e1000432   [PMID:  21532744 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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