Quality of private and public services central to improving health outcomes

The quality of outpatient healthcare is central to improving health outcomes in low and middle income countries, yet a new systematic review shows that the quality is low. This is particularly important with 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 Effective Health Care RPC and colleagues and recently published in the open access journal 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 recognised, such as shopkeepers). The authors found that both formal private providers and the public sector scored low on buildings and equipment, clinical competence, and practice, and research on the informal sector was practically non-existent. 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 in how competent the providers were, or how satisfied the patients.

Author Sima Berendes comments: “Government efforts to improve care are often restricted to the public sector on the grounds that public funds should be spent on the public sector. However many poor people spend their money on services provided by the private sector so raising the quality of care in that sector (as well as the public sector) will lead to better health services and in turn, better health for individuals“.

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.
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