Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.
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 thos...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2011-04-01
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| Series: | PLoS Medicine |
| Online Access: | http://europepmc.org/articles/PMC3075233?pdf=render |
| _version_ | 1818193744767221760 |
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| author | Sima Berendes Peter Heywood Sandy Oliver Paul Garner |
| author_facet | Sima Berendes Peter Heywood Sandy Oliver Paul Garner |
| author_sort | Sima Berendes |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-12T00:51:16Z |
| format | Article |
| id | doaj.art-556c5d468712464a825f069d9767a4a5 |
| institution | Directory Open Access Journal |
| issn | 1549-1277 1549-1676 |
| language | English |
| last_indexed | 2024-12-12T00:51:16Z |
| publishDate | 2011-04-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj.art-556c5d468712464a825f069d9767a4a52022-12-22T00:44:01ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762011-04-0184e100043310.1371/journal.pmed.1000433Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.Sima BerendesPeter HeywoodSandy OliverPaul GarnerBACKGROUND: 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.http://europepmc.org/articles/PMC3075233?pdf=render |
| spellingShingle | Sima Berendes Peter Heywood Sandy Oliver Paul Garner Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Medicine |
| title | Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. |
| title_full | Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. |
| title_fullStr | Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. |
| title_full_unstemmed | Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. |
| title_short | Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. |
| title_sort | quality of private and public ambulatory health care in low and middle income countries systematic review of comparative studies |
| url | http://europepmc.org/articles/PMC3075233?pdf=render |
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