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Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies

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Berendes, Sima, Heywood, Peter, Oliver, Sandy and Garner, Paul ORCID: https://orcid.org/0000-0002-0607-6941 (2011) 'Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies'. PLoS Medicine, Vol 8, Issue 4, e1000433.

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Abstract

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.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 74 Medical economics. Health care costs
WA Public Health > WA 20.5 Research (General)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Administration and Organization > WA 525 General works
Faculty: Department: Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pmed.1000433
Depositing User: Faye Moody
Date Deposited: 29 Jun 2011 12:16
Last Modified: 06 Sep 2019 10:14
URI: https://archive.lstmed.ac.uk/id/eprint/2056

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