Got ACTs? Availability, price, market share and provider knowledge of anti-malarial medicines in public and private sector outlets in six malaria-endemic countries Unravelling the quality of HIV counselling and testing services in the private and public sectors in Zambia Perceptions and utilization of primary health care services in Iraq: findings from a national household survey Study protocol for a cluster-randomised controlled trial of an NCD access to medicines initiative: evaluation of Novartis Access in Kenya Partner Management for Gonococcal and Chlamydial Infection: Expansion of Public Health Services to the Private Sector and Expedited Sex Partner Treatment Through a Partnership With Commercial Pharmacies Institutional delivery in rural India: the relative importance of accessibility and economic status Quality of generic medicines in South Africa: Perceptions versus Reality – A qualitative study
Background Artemisinin-based combination therapy ( ACT ) is the first-line malaria treatment throughout most of the malaria-endemic world . Data on ACT availability , price and market share are needed to provide a firm evidence base from which to assess the current situation concerning quality -assured ACT supply . This paper presents supply side data from ACTwatch outlet surveys in Benin , the Democratic Republic of Congo ( DRC ) , Madagascar , Nigeria , Ug and a and Zambia . Methods Between March 2009 and June 2010 , nationally representative surveys of outlets providing anti-malarials to consumers were conducted . A census of all outlets with the potential to provide anti-malarials was conducted in clusters sample d r and omly . Results 28,263 outlets were censused , 51,158 anti-malarials were audited , and 9,118 providers interviewed . The proportion of public health facilities with at least one first-line quality -assured ACT in stock ranged between 43 % and 85 % . Among private sector outlets stocking at least one anti-malarial , non-artemisinin therapies , such as chloroquine and sulphadoxine-pyrimethamine , were widely available ( > 95 % of outlets ) as compared to first-line quality -assured ACT ( < 25 % ) . In the public/not-for-profit sector , first-line quality -assured ACT was available for free in all countries except Benin and the DRC ( US$ 1.29 [ Inter Quartile Range ( IQR ) : $ 1.29-$1.29 ] and $ 0.52[IQR : $ 0.00-$1.29 ] per adult equivalent dose respectively ) . In the private sector , first-line quality -assured ACT was 5 - 24 times more expensive than non-artemisinin therapies . The exception was Madagascar where , due to national social marketing of subsidized ACT , the price of first-line quality -assured ACT  ( $ 0.14 [ IQR : $ 0.10 , $ 0.57 ] ) was significantly lower than the most popular treatment ( chloroquine , $ 0.36 [ IQR : $ 0.36 , $ 0.36 ] ) .  Quality -assured ACT accounted for less than 25 % of total anti-malarial volumes ; private-sector quality -assured ACT volumes represented less than 6 % of the total market share . Most anti-malarials were distributed through the private sector , but often comprised non-artemisinin therapies , and in the DRC and Nigeria , oral artemisinin monotherapies .  Provider knowledge of the first-line treatment was significantly lower in the private sector than in the public/not-for-profit sector . Conclusions These st and ardized , nationally representative results demonstrate the typically low availability , low market share and high prices of ACT , in the private sector where most anti-malarials are accessed , with some exceptions . The results confirm that there is substantial room to improve availability and affordability of ACT treatment in the surveyed countries . The data will also be useful for monitoring the impact of interventions such as the Affordable Medicines Facility for malaria Background Despite the substantial investment for providing  HIV counselling and testing ( VCT ) services in Zambia , there has been little effort to systematic ally evaluate the quality of  VCT services provided by various types of health providers . This study , conducted in 2009 , examines  VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula . Methods The study used five primary data collection methods to gauge quality of  VCT services  : closed-ended client interviews with clients exiting  VCT sites ; open-ended client interviews ; interviews with facility managers ; review of service statistics ; and an observation of the physical environment for VCT by site .  Over 400 clients and 87 facility managers were interviewed from almost 90 facilities . Sites were r and omly selected and results are generalizable at the provincial level . Results The study shows concerning levels of underperformance in VCT services  across the sectors . It reveals serious underperformance in counselling about key risk-reduction methods . Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5 % of clients received counselling about disclosing test results to partners . In terms of client profiles , the NGO sector attracts the most educated clients and less educated Zambians seek  VCT  services at very low rates ( 7 % ) . The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV . Conclusion The private for-profit sector provides  VCT services  on par in quality with the other sectors . Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners . In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease , risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling Background After many years of sanctions and conflict , Iraq is rebuilding its health system , with a strong emphasis on the traditional hospital-based services . A network exists of public sector hospitals and clinics , as well as private clinics and a few private hospitals . Little data are available about the approximately 1400 Primary Health Care clinics ( PHCCs ) staffed with doctors . How do Iraqis utilize primary health care services ? What are their preferences and perceptions of public primary health care clinics and private primary care services in general ? How does household wealth affect choice of services ? Methods A 1256 household national survey was conducted in the catchment areas of r and omly selected PHCCs in Iraq . A cluster of 10 households , beginning with a r and omly selected start household , were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq 's 18 governorates . A question naire was developed using key informants . Teams of interviewers , including both males and females , were recruited and provided a week of training which included field practice . Teams then gathered data from households in the service areas of r and omly selected clinics . Results Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector . Private clinics are generally the most popular source of primary care , however the PHCCs are utilized more by poorer households . In spite of free services available at PHCCs many households expressed difficulty in affording health care , especially in the purchase of medications . There is no evidence of informal payments to secure health services in the public sector . Conclusions There is widespread satisfaction reported with primary health care services , and levels did not differ appreciably between public and private sectors . The public sector PHCCs are preferentially used by poorer population s where they are important providers . PHCC services are indeed free , with little evidence of informal payments to providers Introduction Novartis recently launched Novartis Access , an initiative to provide a basket of reduced price medicines for non-communicable diseases ( NCDs ) to be sold through the public and private non-profit sectors in programme countries . This study will evaluate the impact of Novartis Access on the availability and price of NCD medicines at health facilities and households in Kenya , the first country to receive the programme . Methods and analysis This study will be a cluster-r and omised controlled trial . 8 counties in Kenya will be r and omly assigned to the intervention or control group using a covariate constrained r and omisation method to maximise balance on demographic and health characteristics . In intervention counties , public and private non-profit health facilities will be able to order Novartis Access NCD medicines from the Mission for Essential Drugs and Supplies ( MEDS ) . Data will be collected from a r and om sample of 384 health facilities and 800 households at baseline , midline after 1-year of intervention , and end-line after 2 years . Quarterly surveillance data will also be collected from health facilities and a sub sample of households through phone-based interviews . Households will be eligible if at least one resident has been previously diagnosed and prescribed a medicine for an NCD addressed by Novartis Access , including hypertension and diabetes . The primary outcomes will be availability and price of NCD medicines at health facilities , and availability , price , and expenditures on NCD medicines at households . Impacts will be estimated using intention-to-treat analysis . Ethics and dissemination This protocol was approved by the Institutional Review Boards at Strathmore University and at Boston University . Informed consent will be obtained from all participants at the start of the trial . The findings of the trial will be disseminated through peer- review ed journals , international conferences , and meetings and events organised with local stakeholders . Trial registration number NCT02773095 Background Public health partner notification ( PN ) services currently affect only a small minority of patients with gonorrhea or chlamydial infection and new approaches to PN are needed . Objectives To exp and PN for gonorrhea and chlamydial infection to private sector patients and to assess the feasibility of treating sex partners through commercial pharmacies . Methods Selected patients were offered PN assistance  and were r and omly offered medication to deliver to their partners . Results Providers permitted the health department to contact 3613 ( 91 % ) of 3972 potentially eligible patients , and 1693 ( 67 % ) of 2531 successfully contacted patients consented to interview . Of these , 1095 ( 65 % ) reported at least one untreated partner . Most patients ( 90 % ) wished to notify partners themselves . Patients were more likely to have partners who had not yet been treated and to request  PN assistance  if they had more than one sex partner in the preceding 60 days or a partner they did not anticipate having sex with in the future . These two factors characterized 49 % of all patients interviewed , 70 % of those with a partner that was untreated 7 or more days after index patient treatment , and 83 % of those accepting PN assistance . Among 458 r and omly selected patients with untreated partners at time of study interview , 346 ( 76 % ) agreed to deliver treatment to a partner . Of these , most ( 266 ) chose to obtain medication for a partner at a pharmacy , of whom 223 ( 84 % ) successfully did so . Conclusion A substantial minority of private sector patients have untreated partners more than 7 days after their own treatment ; some need help with PN , but most will agree to deliver medication to partners themselves Background Skilled attendance at delivery is an important indicator in monitoring progress towards Millennium Development Goal 5 to reduce the maternal mortality ratio by three quarters between 1990 and 2015 . In addition to professional attention , it is important that mothers deliver their babies in an appropriate setting , where life saving equipment and hygienic conditions can also help reduce the risk of complications that may cause death or illness to mother and child . Over the past decade interest has grown in examining influences on care-seeking behavior and this study investigates the determinants of place of delivery in rural India , with a particular focus on assessing the relative importance of community access and economic status . Methods A descriptive analysis of trends in place of delivery using data from two national representative sample surveys in 1992 and 1998 is followed by a two-level (  child/mother  and  community ) r and om-effects logistical regression model using the second survey to investigate the determinants . Results In this investigation of institutional care seeking for child birth in rural India , economic status emerges as a more crucial determinant than access . Economic status is also the strongest influence on the choice between a private-for-profit or public facility amongst institutional births . Conclusion Greater availability of obstetric services will not alone solve the problem of low institutional delivery rates . This is particularly true for the use of private-for-profit institutions , in which the distance to services does not have a significant adjusted effect . In the light of these findings a focus on increasing dem and for existing services seems the most rational action . In particular , financial constraints need to be addressed , and results support current trials of dem and side financing in India Background Generic Medicines are an important policy option allowing for access to affordable , essential medicines . Quality of generic medicines must be guaranteed through the activities of national medicines regulatory authorities . Existing negative perceptions surrounding the quality of generic medicines must be addressed to ensure that people use them with confidence . Campaigns to increase the uptake of generic medicines by consumers and providers of healthcare need to be informed by local norms and practice s. This study sought to compare South African consumers ’ and healthcare providers ’ perceptions of quality of generics to the actual quality of selected products . Methods The study was conducted at the local level in three cities of South Africa : Johannesburg , Durban and Cape Town . Purposive sampling was used to recruit consumer participants ( n = 73 ) and r and om sampling used to recruit healthcare providers from public and private sectors ( n = 15 ) . Data were obtained through twelve focus group discussion s with consumers and semi-structured interviews ( n = 15 ) with healthcare providers in order to gain familiarity with perceptions of quality . One hundred and thirty five products comprising paracetamol tablets ( n = 47 ) , amoxicillin capsules ( n = 45 ) and hydrochlorothiazide tablets ( n = 43 ) were source d from public and private sector healthcare providers . These products were subjected to in vitro dissolution , uniformity of weight and identity ( Fourier Transformed Infrared Spectroscopy ) tests using prescribed methods from the British ( 2005 ) and United States Pharmacopeias ( 2006 ) . Results Respondents described drug quality in relation to the effect on symptoms . Procurement and use behavior of healthcare providers was influenced by prior experience , manufacturers ’ names and consumers ’ ability to pay . All formulations passed the in vitro tests for quality . Conclusions This study showed clear differences between perceptions of quality and actual quality of medicines suggesting deficiencies in public engagement by government regarding the implementation of generic medicines policy . Implementation of generic medicines policy requires the involvement of consumers and healthcare providers to specifically address their information gaps and needs
It was , however , evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people .
Background There has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries .
The private sector represents an important source of care for all socioeconomic groups , including the poorest and substantial concerns have been raised about the quality of care it provides .
Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals .
Limited information is available on the extent to which these interventions have successfully exp and ed access to quality health services for poor and disadvantaged population s. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor .