Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers

Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria’s large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical facilities, laboratories, pharmacies, and drug shops it trained to deliver TB services. The study used a standardized patient (SP) survey methodology to measure case management protocol adherence among 837 private and 206 public providers in urban Lagos and Kano. It examined two different scenarios: a “textbook” case of presumptive TB and a treatment initiation case where SPs presented as referred patients with confirmed TB diagnoses. Private sector results were benchmarked against public sector results. A bottleneck analysis examined protocol adherence departures at key points along the case management sequence that providers were trained to follow. Except for laboratories, few providers met the criteria for fully correct management of presumptive TB, though more than 70% of providers correctly engaged in TB screening. In the treatment initiation case 18% of clinical providers demonstrated fully correct case management. Private and public providers’ adherence was not significantly different. Bottleneck analysis revealed that the most common deviations from correct management were failure to initiate sputum collection for presumptive patients and failure to conduct sufficiently thorough treatment initiation counseling for confirmed patients. This study found the quality of private providers’ TB case management to be comparable to public providers in Nigeria, as well as to providers in other high burden countries. Findings support continued efforts to include private providers in Nigeria’s national TB program. Though most providers fell short of desired quality, the bottleneck analysis points to specific issues that TB stakeholders can feasibly address with system- and provider-level interventions.

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A National Survey of Private-Sector Outpatient Care of Sick Infants and Young Children in Nepal

10.21203/rs.2.16706/v2 ◽

2020 ◽

Author(s):

Bharat Ban ◽

Steve Hodgins ◽

Pranita Thapa ◽

Surakschha Thapa ◽

Deepak Joshi ◽

...

Keyword(s):

Quality Of Care ◽

Private Sector ◽

Outpatient Care ◽

Service Providers ◽

Infants And Children ◽

Sub Saharan Africa ◽

Scope Of Practice ◽

Urban Centers ◽

Young Infants

Abstract Background: Previous research has documented that across South Asia, as well as in some countries in Sub-Saharan Africa, the private sector is the primary source of outpatient care for sick infants and children and, in many settings, informal providers play a bigger role than credentialed health professionals (particularly for the poorer segments of the population). This is the case in Nepal. This study sought to characterize medicine shop-based service providers in rural areas and small urban centers in Nepal, their role in the care and treatment of sick infants and children (with a particular focus on infants aged <2 months), and the quality of the care provided. A secondary objective was to characterize availability and quality of such care provided by physicians in these settings.Methods: A nationally representative sample of medicine shops was drawn, in rural settings and small urban centers in Nepal, from 25 of the 75 districts in Nepal, using multi-stage cluster methodology, with a final sample of 501 shops and 82 physician-run clinics. Face-to-face interviews were conducted.Results: Most medicine shops outside urban areas were not registered with the Department of Drug Administration (DDA). Most functioned as de facto clinics, with credentialed paramedical workers (having 2-3 years of training) diagnosing patients and making treatment decisions. Such a role falls outside their formally sanctioned scope of practice. Quality of care problems were identified among medicine shop-based providers and physicians, including over-use of antibiotics for treating diarrhea, inaccurate weighing technique to determine antibiotic dose, and inappropriate use of injectable steroids for treating potentially severe infections in young infants.Conclusions: Medicine shop-based practitioners in Nepal represent a particular type of informal provider; although most have recognized paramedical credentials, they offer services falling outside their formal scope of practice. Nevertheless, given the large proportion of the population served by these practitioners, engagement to strengthen quality of care by these providers and referral to the formal health sector is warranted.

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Egypt: Expand access to postabortion care

10.31899/rh2000.1023 ◽

2000 ◽

Author(s):

Keyword(s):

Infection Control ◽

Case Management ◽

Teaching Hospitals ◽

Population Council ◽

Vacuum Aspiration ◽

Brief Training ◽

Postabortion Care ◽

Management Protocol ◽

Training Physicians

The Population Council has supported a series of studies to improve the quality of postabortion care (PAC) in Egypt. A 1994 pilot study in two Egyptian hospitals showed that upgrading PAC and training physicians in manual vacuum aspiration (MVA), infection control, and counseling led to significant improvements in the care of postabortion patients. The 1997 study, conducted by the Egyptian Fertility Care Society with support from the Population Council, sought to institutionalize improved postabortion medical care and counseling procedures in ten hospitals. Five senior physicians from each hospital attended a five-day training course in MVA, infection control, and family planning (FP) counseling. The physicians then supervised four months of on-the-job training of doctors and nurses at the ten hospitals. A case management protocol, including emergency medical treatment, pain control, and FP counseling, was also introduced. As reported in this brief, training providers and introducing a case management protocol led to improved PAC at ten government and teaching hospitals in Egypt.

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Holding private prisons to account: what role for Controllers as ‘the eyes and ears of the state’?

Marketisation and Privatisation in Criminal Justice ◽

10.1332/policypress/9781447345701.003.0011 ◽

2020 ◽

pp. 151-170

Author(s):

Joanna Hargreaves ◽

Amy Ludlow

Keyword(s):

Private Sector ◽

Qualitative Data ◽

The State ◽

Contract Management ◽

Private Prisons ◽

Theoretical Position ◽

Private Providers ◽

Private Prison ◽

Practical Nature

The advent of the private sector’s contemporary involvement in prisons in England and Wales saw the creation of a new role – that of the Controller. Controllers are embedded within all privately managed prisons as the ‘eyes and ears’ of the State. They hold the private sector to account on a day-to-day basis, ensuring that private providers deliver on their contractual promises and that the State’s delegated penal power is wielded in accordance with the law. While Controllers occupy an essential theoretical position within the prison accountability landscape, little is known about how Controllers understand and practice their roles and what this might mean for the nature and quality of accountability achieved. Drawing on qualitative data from interviews with Controllers, this chapter explores the vision of accountability pursued by Controllers, their orientations to contract management, and the practical nature and impact of their accountability work. The chapter focuses on the form and significance of Controllers’ relationships with private prison Directors, especially exploring themes of trust and relationality.

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Private sector engagement and contributions to immunisation service delivery and coverage in Sudan

BMJ Global Health ◽

10.1136/bmjgh-2019-001414 ◽

2019 ◽

Vol 4 (2) ◽

pp. e001414

Author(s):

Nada Ahmed ◽

Denise DeRoeck ◽

Nahad Sadr-Azodi

Keyword(s):

Private Sector ◽

Lessons Learned ◽

Haemophilus Influenzae Type ◽

State Governments ◽

Health Providers ◽

For Profit ◽

National Immunisation ◽

Private Providers ◽

Immunisation Service

For more than two decades, the private sector in the Sudan (henceforth, Sudan), including non-governmental organisations and for-profit providers, has played a key role in delivering immunisation services, especially in the conflict-affected Darfur region and the most populated Khartoum state. The agreements that the providers enter into with state governments necessitate that they are licenced; follow the national immunisation policy and reporting and supervision requirements; use the vaccines supplied by government; and offer vaccinations free-of-charge. These private providers are well integrated into the states’ immunisation programmes as they take part in the Ministry of Health immunisation trainings and district review meetings and they are incorporated into annual district immunisation microplans. The purpose of this article is to describe the private sector contributions to equitable access to immunisation services and coverage, as well as key challenges, lessons learned and future considerations. Fifty-five per cent of private health facilities in Sudan (411 out of 752) provide immunisation services, with 75% (307 out of 411) based in Khartoum state and the Darfur region. In 2017, private providers administered around 16% of all third doses of pentavalent (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type b) vaccines to children. Private health providers of immunisation services have especially been critical in filling the gaps in government services in hard-to-reach or conflict-affected areas and among marginalised populations, and thus in reducing inequities in access. Through its experience in engaging the private sector, Sudan has learned the importance of regulating and licencing private facilities and incorporating them into the immunisation programme’s decision-making, planning, regular evaluation and supervision system to ensure their compliance with immunisation guidelines and the overall quality of services. In moving forward, strategic engagement with the private sector will become more prominent as Sudan transitions out of donors’ financial assistance with its projected income growth.

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PENYULUHAN PERTANIAN INDONESIA : ISU PRIVATISASI DAN IMPLIAKISNYA

Agro Ekonomi ◽

10.22146/agroekonomi.16798 ◽

2016 ◽

Vol 9 (2) ◽

pp. 27

Author(s):

Subejo Subejo

Keyword(s):

Private Sector ◽

Service Providers ◽

Government Expenditure ◽

Agricultural Extension ◽

Quality Of Services ◽

Global Changes ◽

Extension System ◽

Efficient Delivery ◽

Private Sector Participation

The organization, mandate, and practices of agricultural and rural extension systems are changing worldwide, and it is vital that each region keep pace with the latest developments. The challenges of introducing appropriate institutional measures must be accepted by each government in order to reform the national agricultural extension systems in response to the global changes, otherwise the extension systems will become obsolete.Diverse agricultural extension funding and delivery arrangements have been undertaken since the mid-1980s by governments worldwide in the name of "privatization". Privatization is used in the broadest sense of introducing or increasing private sector participation, which does not necessarily imply transfer of designated state-owned assets to the private sector. The arguments for privatization are based upon: more efficient delivery of service, lowered government expenditure. and higher quality of services. Privatization of agricultural extension system implies0 a division of appropriate role between public sector and private sector. Cost and service sharing among extension service providers can be formed into some systems encompass contract, vouchers, competitive grant fund, subsidize, and commercial extension service.This paper aims to discuss about privatization issues and its implications on Indonesian agricultural extension system. Related parties and sectors on Indonesian agricultural extension system should pay more attention in order to reform the old system and to reconstruct it into a new system--client-oriented extension

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MODEL PELAYANAN PUBLIK di DINAS PENANAMAN MODAL di PELAYANAN PERIZINAN TERPADU SATU PINTU PRO.RIAU

10.31227/osf.io/q8a4r ◽

2018 ◽

Author(s):

SRI ULINA MARGARETH

Keyword(s):

Public Service ◽

Public Services ◽

Service Providers ◽

Developed Countries ◽

Reform Movements ◽

The Public ◽

Private Providers ◽

Public Pressure ◽

The Government

Preeprint: ABSTRAKPelayanan publik pada dasarnya menyangkut aspek kehidupan yang sangat luas. Dalam kehidupan berbangsa dan bernegara, maka pemerintah memiliki fungsi memberikan berbagai pelayanan publik yang diperlukan oleh masyarakat, mulai dari pelayanan dalam bentuk pengaturan ataupun pelayanan-pelayanan lain dalam rangka memenuhi kebutuhan masyarakat dalam bidang pendidikan, kesehatan, utilitas, dan lainnya. Berbagai gerakan reformasi publik yang dialami oleh negara-negara maju pada awal tahun 1990-an banyak diilhami oleh tekanan masyarakat akan perlunya peningkatan kualitas pelayanan publik yang diberikan oleh pemerintah. Peningkatan kualitas pelayanan publik mutlak diperlukan mengingat kondisi sosial masyarakat yang semakin baik sehingga mampu merespon setiap penyimpangan dalam pelayanan publik melalui gerakan maupun tuntutan dalam media cetak dan elektronik. Apalagi dengan adanya persaingan terutama untuk pelayanan publik yang disediakan swasta membuat sedikit saja pelanggan merasakan ketidakpuasan maka akan segera beralih pada penyedia pelayanan publik yang lain.Hal ini membuat penyedia pelayanan publik swasta harus berlomba-lomba memberikan pelayanan publik yang terbaik. Ini yang seharusnya ditiru oleh penyedia pelayanan publik pemerintah sehingga masyarakat merasa puas menikmati pelayanan publik tersebut.Kata kunci : pelayanan publik di provinsi riauABSTRACTPublic service is basically about a vast aspect of life. In the life of nation and state, the government has a function to provide various public services needed by the community, ranging from services in the form of arrangements or other services in order to meet the needs of the community in the field of education, health, utilities, and others. The various public reform movements experienced by developed countries in the early 1990s were much inspired by public pressure on the need to improve the quality of public services provided by the government. Improving the quality of public services is absolutely necessary given the improved social conditions of the community so as to respond to any deviations in public services through the movement or demand in print and electronic media. Especially with the competition especially for public services provided by the private makes little customers feel dissatisfaction it will soon switch to other public service providers.This makes private providers of public services must compete to provide the best public service. This should be imitated by government public service providers so that people feel satisfied to enjoy the public service.Keywords: public service in riau province

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A National Survey of Private-Sector Outpatient Care of Sick Infants and Young Children in Nepal

10.21203/rs.2.16706/v1 ◽

2019 ◽

Author(s):

Bharat Ban ◽

Steve Hodgins ◽

Pranita Thapa ◽

Surakschha Thapa ◽

Deepak Joshi ◽

...

Keyword(s):

Quality Of Care ◽

Private Sector ◽

Outpatient Care ◽

Service Providers ◽

Infants And Children ◽

Sub Saharan Africa ◽

Scope Of Practice ◽

Urban Centers ◽

Young Infants

Abstract Background: Previous research has documented that across South Asia, as well as in some countries in Sub-Saharan Africa, the private sector is the primary source of outpatient care for sick infants and children and, in many settings, informal providers play a bigger role than credentialed health professionals (particularly for the poorer segments of the population). This is the case in Nepal. This study sought to characterize medicine shop-based service providers in rural areas and small urban centers in Nepal, their role in the care and treatment of sick infants and children (with a particular focus on infants aged <2 months), and the quality of the care provided. A secondary objective was to characterize availability and quality of such care provided by physicians in these settings. Methods: A nationally representative sample of medicine shops was drawn, in rural settings and small urban centers in Nepal, from 25 of the 75 districts in Nepal, using multi-stage cluster methodology, with a final sample of 501 shops and 82 physician-run clinics. Face-to-face interviews were conducted. Results: Most medicine shops outside urban areas were not registered with the Department of Drug Administration (DDA). Most functioned as de facto clinics, with credentialed paramedical workers (having 2-3 years of training) diagnosing patients and making treatment decisions. Such a role falls outside their formally sanctioned scope of practice. Quality of care problems were identified among medicine shop-based providers and physicians, including over-use of antibiotics for treating diarrhea, inaccurate weighing technique to determine antibiotic dose, and inappropriate use of injectable steroids for treating potentially severe infections in young infants. Conclusions : Medicine shop-based practitioners in Nepal represent a particular type of informal provider; although most have recognized paramedical credentials, they offer services falling outside their formal scope of practice. Nevertheless, given the large proportion of the population served by these practitioners, engagement to strengthen quality of care by these providers and referral to the formal health sector is warranted.

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Community and Health Care Providers Perception on Quality of Private Sector Outpatient Malaria Care in North West Ethiopia: A Qualitative Study

10.21203/rs.3.rs-32063/v1 ◽

2020 ◽

Author(s):

Mesele Damte Argaw ◽

Thandisizwe Redford Mavundla ◽

Kassa Daka Gidebo

Keyword(s):

Focus Group ◽

Private Sector ◽

Health Care Providers ◽

Service Providers ◽

Good Governance ◽

Health Workers ◽

Care Providers ◽

Focus Group Discussions ◽

Group Discussions

Abstract Malaria is one of the most important public health problems in Ethiopia contributing to significant patient morbidity and mortality. Prompt diagnosis and effective malaria case management-through public, private and community health facilities has been one of the key malaria prevention, control and elimination strategies. The objective of this study was to evaluate perceptions of adult malaria patients and healthcare provider on quality of malaria management at private sector outpatient facilities. An exploratory, descriptive, contextual, qualitative research methodology was conducted with 101 participants (i.e. 33 in-depth interviews and ten Focus Group Discussions with 68 discussants). All interview and Focus Group Discussions were audio recorded, transcribed verbatim and analysed using eight steps of Tesch (1990). During data analysis a single theme, two categories and six sub categories were emerged, namely (1) Perceived quality of malaria management at outpatient facilities; (a) essential resources ; (a1) safe outpatient services; (a2) antimalarial drugs and supplies; (a3) health workers; (b) factors influencing service utilization ; (b1) Physical accessibility; (b2) “Art of care’’; and (b3) efficient malaria diagnosis and treatment services. Finally, enhancing good governance and stewardship of the public sector to tap the potential of private sector, build the service providers capacity and empowering the community on seeking early medical and safety were recommended.

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Investment climate and government turnover in russian regions

Voprosy Ekonomiki ◽

10.32609/0042-8736-2014-2-88-117 ◽

2014 ◽

pp. 88-117 ◽

Cited By ~ 4

Author(s):

G. Syunyaev ◽

L. Polishchuk

Keyword(s):

Economic Development ◽

Theoretical Model ◽

Private Sector ◽

Authoritarian Regimes ◽

Russian Regions ◽

Investment Climate ◽

Regional Data ◽

Endogenous Property Rights ◽

The Impact

We study the impact of Russian regional governors’ rotation and their affiliation with private sector firms for the quality of investment climate in Russian regions. A theoretical model presented in the paper predicts that these factors taken together improve “endogenous” property rights under authoritarian regimes. This conclusion is confirmed empirically by using Russian regional data for 2002—2010; early in that period gubernatorial elections had been canceled and replaced by federal government’s appointments. This is an indication that under certain conditions government rotation is beneficial for economic development even when democracy is suppressed.

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