Engaging with Health Markets in Low and Middle‐Income Countries

Bloom, Gerald; Standing, Hilary; Lucas, Henry C.

doi:10.1111/j.2040-0209.2014.00443.x

Cited by 6 publications

(3 citation statements)

References 61 publications

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“…We adapted the theoretical framework ( figure 1 ) for health market systems proposed by Bloom et al 43 to take into account key stakeholders in Uganda.…”

Section: Introductionmentioning

confidence: 99%

Health system effects of implementing integrated community case management (iCCM) intervention in private retail drug shops in South Western Uganda: a qualitative study

et al. 2017

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BackgroundIntervening in private drug shops to improve quality of care and enhance regulatory oversight may have health system effects that need to be understood before scaling up any such interventions. We examine the processes through which a drug shop intervention culminated in positive unintended effects and other dynamic interactions within the underlying health system.MethodsA multifaceted intervention consisting of drug seller training, supply of diagnostics and subsidised medicines, use of treatment algorithms, monthly supervision and community sensitisation was implemented in drug shops in South Western Uganda, to improve paediatric fever management. Focus group discussions and in-depth interviews were conducted with stakeholders (drug sellers, government officials and community health workers) at baseline, midpoint and end-line between September 2013 and September 2015. Using a health market and systems lens, transcripts from the interviews were analysed to identify health system effects associated with the apparent success of the intervention.FindingsStakeholders initially expressed caution and fears about the intervention’s implications for quality, equity and interface with the regulatory framework. Over time, these stakeholders embraced the intervention. Most respondents noted that the intervention had improved drug shop standards, enabled drug shops to embrace patient record keeping, parasite-based treatment of malaria and appropriate medicine use. There was also improved supportive supervision, and better compliance to licensing and other regulatory requirements. Drug seller legitimacy was enhanced from the community and client perspective, leading to improved trust in drug shops.ConclusionThe study showed how effectively using health technologies and the perceived efficacy of medicines contributed to improved legitimacy and trust in drug shops among stakeholders. The study also demonstrated that using a combination of appropriate incentives and consumer empowerment strategies can help harmonise common practices with medicine regulations and safeguard public health, especially in mixed health market contexts.

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“…We adapted the theoretical framework ( figure 1 ) for health market systems proposed by Bloom et al 43 to take into account key stakeholders in Uganda.…”

Section: Introductionmentioning

confidence: 99%

Health system effects of implementing integrated community case management (iCCM) intervention in private retail drug shops in South Western Uganda: a qualitative study

et al. 2017

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“…This happened mainly due to financial issues, as seeking care in the hospital or with a specialist doctor can entail expensive spending for diagnostic tests and consultation fees. Previous study has pointed out the preference of poor populations to seek care in informal providers, amongst others because of affordability issue [34]. However, the current study found that providers also failed to give appropriate treatment because they did not have the right diagnostic tool or medicine.…”

Section: Discussionmentioning

confidence: 59%

Perceptions of appropriate treatment among the informal allopathic providers: insights from a qualitative study in two peri-urban areas in Bangladesh

Sizear

Nababan

Siddique

et al. 2019

BMC Health Serv Res

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Background How the informal providers deliver health services are not well understood in Bangladesh. However, their practices are often considered inappropriate and unsafe. This study attempted to fill-in this knowledge gap by exploring their perceptions about diagnosis and appropriate treatment, as well as identifying existing barriers to provide appropriate treatment. Methods This exploratory study was conducted in two peri-urban areas of metropolitan Dhaka. Study participants were selected purposively, and an interview guideline was used to collect in-depth data from thirteen providers. Content analysis was applied through data immersion and themes identification, including coding and sub-coding, as well as data display matrix creation to draw conclusion. Results The providers relied mainly on the history and presenting symptoms for diagnosis. Information and guidelines provided by the pharmaceutical representatives were important aids in their diagnosis and treatment decision making. Lack of training, diagnostic tools and medicine, along with consumer demands for certain medicine i.e. antibiotics, were cited as barriers to deliver appropriate care. Effective and supportive supervision, training, patient education, and availability of diagnostics and guidelines in Bangla were considered necessary in overcoming these barriers. Conclusion Informal providers lack the knowledge and skills for delivering appropriate treatment and care. As they provide health services for substantial proportion of the population, it’s crucial that policy makers become cognizant of the fact and take measures to remedy them. This is even more urgent if government’s goal to reach universal health coverage by 2030 is to be achieved. Electronic supplementary material The online version of this article (10.1186/s12913-019-4254-3) contains supplementary material, which is available to authorized users.

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“…In 2012, we undertook work for the Rockefeller Foundation that sought to inform their future investments in health markets. Whereas health markets are sometimes viewed solely through the lens of private health care providers, our approach was broader, viewing such providers as one of many inter-connected actors who work within a market system [ 1 ]. We were interested in better understanding the interactions between these many actors, including public and private health care providers, payors, regulators, and civil society organizations, and the rules and regulations that govern the market.…”

mentioning

confidence: 99%