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PubMed2004

Health care of female outpatients in south-central India: comparing public and private sector provision.

The object of this study was to compare components of quality of care provided to female outpatients by practitioners working in the private and public sectors in Karnataka State, India. Consultations conducted by 18 private practitioners and 25 public-sector practitioners were observed for 5 days using a structured protocol. Private practitioners were selected from members of the Indian Medical Association in a predominantly rural sub-district of Kolar District. Government doctors were selected from a random sample of hospitals and health centres in three sub-districts of Mysore District. A total of 451 private-sector and 650 public-sector consultations were observed; in each sector about half involved a female practitioner. The mean length of consultation was 2.81 minutes in the public sector and 6.68 minutes in the private sector. Compared with public-sector practitioners, private practitioners were significantly more likely to undertake a physical examination and to explain their diagnosis and prognosis to the patient. Privacy was much better in the private sector. One-third of public-sector patients received an injection compared with two-thirds of private patients. The mean cost of drugs dispensed or prescribed were Rupees 37 and 74 in public and private sectors, respectively. Both in terms of thoroughness of diagnosis and doctor-patient communication, the quality of care appears to be much higher in the private than in the public sector. However, over-prescription of drugs by private practitioners may be occurring.

Delivery of Health Care↗
PubMed2006

Improving tuberculosis control through public-private collaboration in India: literature review.

OBJECTIVE: To review the characteristics of public-private mix projects in India and their effect on case notification and treatment outcomes for tuberculosis. DESIGN: Literature review. DATA SOURCES: Review of surveillance records from Indian tuberculosis programme project, evaluation reports, and medical literature for public-private mix projects in India. DATA EXTRACTION: Project characteristics, tuberculosis case notification of new patients with sputum smear results positive for acid fast bacilli, and treatment outcome. DATA SYNTHESIS: Of 24 identified public-private mix projects, data were available from 14 (58%), involving private practitioners, corporations, and non-governmental organisations. In all reviewed projects, the public sector tuberculosis programme provided training and supervision of private providers. Among the five projects with available data on historical controls, case notification rates were higher after implementation of a public-private mix project. Among seven projects involving private practitioners, 2796 of 12 147 (23%) new patients positive for acid fast bacilli were attributed to private providers. Corporate based and non-governmental organisations served as the main source for tuberculosis programme services in seven project areas, detecting 9967 new patients positive for acid fast bacilli. In nine of 12 projects with data on treatment outcomes, private providers exceeded the programme target of 85% treatment success for new patients positive for acid fast bacilli. CONCLUSIONS: Public-private mix activities were associated with increased case notification, while maintaining acceptable treatment outcomes. Collaborations between public and private providers of health care hold considerable potential to improve tuberculosis control in India.

Communicable Disease Control↗
PubMed2006

Water privatization and public health in Latin America.

OBJECTIVES: This study had two objectives: (1) to determine what the public health and development literature has found regarding the public health outcomes of water privatization in Latin America and (2) to evaluate whether the benefits of water privatization, if any, outweigh the equity and justice concerns that privatization raises. METHODS: Using a standard set of terms to search several databases, the authors identified and reviewed articles and other materials from public health and development sources that were published between 1995 and 2005 and that evaluated the public health effects of water privatizations in Latin America from 1989 to 2000, based on (1) access to water by the poor and/or (2) improvements in public health. Next, the authors examined the experiences of three cities in Bolivia (Cochabamba, El Alto, and La Paz) in order to illuminate further the challenges of water privatization. Finally, the authors considered the equity and justice issues raised by the privatization of water. RESULTS: The literature review raised persistent concerns regarding access to water by the poor under privatization. The review also suggested that the public sector could deliver public health outcomes comparable to those of the private sector, as measured by access rates and decreasing child mortality rates. In terms of social equity and justice, privatization marked a troubling shift away from the conception of water as a "social good" and toward the conception of water--and water management services--as commodities. CONCLUSIONS: Our results indicated there is no compelling case for privatizing existing public water utilities based on public health grounds. From the perspective of equity and justice, water privatization may encourage a minimalist conception of social responsibility for public health that may hinder the development of public health capacities in the long run.

Adult↗
PubMed2005

[The efficacy and acceptability of mifepristone medical abortion with home administration misoprostol provided by private providers linked with the hospital: a prospective study of 433 patients].

BACKGROUND: Until July 2001 medical abortion was only authorized in France in public hospitals or private clinics. A new law effective in July 2001 allows private practitioners (gynaecologists or general practitioners) to provide medical abortion in their offices as long as they are linked to a hospital official agreement. Unfortunately mifepristone was not available outside hospitals before September 2004, so the study was conducted still providing the drugs in the hospital family planning clinic. OBJECTIVE: To evaluate the efficacy and the acceptability of mifepristone medical abortion with home administration of misoprostol provided by private practitioners linked with the hospital. PATIENTS AND METHODS: Four hundred thirty-three women seeking medical abortion before 7 weeks LMP were included between 2 January 2003 and 7 July 2004. All consultations before abortion and 2 weeks after abortion took place in a private provider's office. Drugs were administrated in the hospital family planning clinic: patients were given 3 tablets of mifepristone (600 mg) orally by the midwife and received 2 tablets of misoprostol (400 microg) that they would take at home 48 hours later. In case of any problems or complications, patients could phone or meet their private providers, phone the hospital midwife or go to the hospital emergency service. Private providers received training in medical abortion training and could at any time reach a medical specialist in the hospital family planning clinic for information or to refer a patient. RESULTS: - Efficacy was evaluated for 339 women, because 94 patients were lost to follow-up (21.7%). Efficacy of medical abortion was 93.8% (318/339). There were 21 surgical aspirations (6.2%): for women's decision in 1.5% of cases, for medical decision without complications in 3.5% of cases, and for failure of the method in 1.2% of cases (2 ongoing pregnancies and 2 heavy haemorrhages with transfusion). The family planning midwife received a phone call from 21 patients after mifepristone (4.8%), Twenty-five patients had an emergency consultation (5.7%), and 22 patients went back to their private providers before their appointment for follow-up (5%). Twenty-two patients (5%) were referred by the private provider to the hospital medical specialist. Acceptability is known for 26% of patients; 96.2% thought that the abortion procedure was acceptable. DISCUSSION AND CONCLUSIONS: The failure rate of medical abortion in this study is largely due to aspirations for incomplete abortion. To improve the efficacy of medical abortion offered by private providers linked with the hospital, all the relevant professionals (private providers, residents in the emergency service, family planning providers) must be well trained in medical abortion, especially in how to interpret and react to ultrasound images obtained in the follow up visit. The procedure is very acceptable to women. Medical abortion offered via a network should be well accepted by practitioners, since only 5% of women will need more than two consultations and only 6.2% will need surgical aspiration in the hospital. This study allows us to be optimistic about the expansion of medical abortion in France outside the hospital via a provider-hospital network based on the fact that since September 2004 private providers can get mifepristone directly in the pharmacies of the city.

Abortifacient Agents, Nonsteroidal↗
PubMed2003

Involving private health care providers in delivery of TB care: global strategy.

Most poor countries have a large and growing private medical sector. Evidence suggests that a large proportion of tuberculosis patients in many high TB- burden countries first approach a private health care provider. Further, private providers manage a significant proportion of tuberculosis cases. Surprisingly though, there is virtually no published evidence on linking private providers to tuberculosis programmes. As a part of global efforts to control tuberculosis through effective DOTS implementation, the World Health Organization has recently begun addressing the issue of private providers in TB control through an evolving global strategy. As a first step, a global assessment of private providers' participation in tuberculosis programmes was undertaken. The findings of the assessment were discussed and debated in a consultation involving private practitioners, TB programme managers and policy makers. Their recommendations have contributed to the evolving global strategy called Public-Private Mix for DOTS implementation (PPM DOTS). This paper presents the guiding principles of PPM DOTS and major elements of the global strategy. These include: informed advocacy; setting-up "learning projects"; scaling-up successful projects and formulation of regional, national and local strategies; developing practical tools to facilitate PPM DOTS and pursuing an operational research agenda to help better design and shape PPM DOTS strategies. Encouraging results from some ongoing project sites are discussed. The paper concludes that concerted global efforts and local input are required for a sustained period to help achieve productive engagement of private practitioners in DOTS implementation. Such efforts have to be targeted as much towards national tuberculosis programmes as towards private providers and their associations. Continued apathy in this area could not only potentially delay achieving global targets for TB control but also undo, in the long run, the hard-earned achievements of National TB Programmes.

Communicable Disease Control↗
PubMed2004

Effects of increased private health insurance on hospital utilisation in Victoria.

The proportion of Victorians and Australians generally with private health insurance (PHI) increased from 31% in 1998 to 45% in 2001. We analysed a dataset containing all hospital separations throughout Victoria to determine whether changes in the level of private health insurance have had any impact on patterns of public and private hospital utilisation in Victoria. Total utilisation of private hospitals grew by 31% from 1998-99 to 2002-03, whereas utilisation of public hospitals increased by 18%. Total bed-days have increased in both private hospitals and public hospitals by 12%. The proportion of all separations at private hospitals has remained relatively stable between these 2 years, with 33% of all separations being private patients in private hospitals in 1998-99, increasing slightly to 35% by 2002-03. Analysis of a number of specific DRGs shows that patients with more severe disease are more likely to be seen at public hospitals; notably this trend has strengthened between 1998-99 and 2002-03. The number of patients treated in Victorian public hospitals has continued to grow, despite a rapid increase in the utilisation of private hospitals. Given the limited extent of the shift in caseload share between the two sectors, the effectiveness of the Commonwealth's subsidy of private health insurance as a mechanism to reduce pressure on the public sector needs to be carefully examined.

Adolescent↗
PubMedDate not supplied

Public and private psychiatry: can they work together and is it worth the effort?

OBJECTIVE: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems. METHOD: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area. RESULTS: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors. CONCLUSIONS: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

Attitude of Health Personnel↗
PubMed2004

Strategies for engaging the private sector in sexual and reproductive health: how effective are they?

The private health sector provides a significant portion of sexual and reproductive health (SRH) services in developing countries. Yet little is known about which strategies for intervening with private providers can improve quality or coverage of services. We conducted a systematic review of the literature through PubMed from 1980 to 2003 to assess the effectiveness of private sector strategies for SRH services in developing countries. The strategies examined were regulating, contracting, financing, franchising, social marketing, training and collaborating. Over 700 studies were examined, though most were descriptive papers, with only 71 meeting our inclusion criteria of having a private sector strategy for one or more SRH services and the measurement of an outcome in the provider or the beneficiary. Nearly all studies (96%) had at least one positive association between SRH and the private sector strategy. About three-quarters of the studies involved training private providers, though combinations of strategies tended to give better results. Maternity services were most commonly addressed (55% of studies), followed by prevention and treatment of sexually transmitted diseases (32%). Using study design to rate the strength of evidence, we found that the evidence about effectiveness of private sector strategies on SRH services is weak. Most studies did not use comparison groups, or they relied on cross-sectional designs. Nearly all studies examined short-term effects, largely measuring changes in providers rather than changes in health status or other effects on beneficiaries. Five studies with more robust designs (randomized controlled trials) demonstrated that contraceptive use could be increased through supporting private providers, and showed cases where the knowledge and practices of private providers could be improved through training, regulation and incentives. Although tools to work with the private sector offer considerable promise, without stronger research designs, key questions regarding their feasibility and impact remain unanswered.

Delivery of Health Care↗
PubMed2005

Comparative quality of private and public health services in rural Vietnam.

BACKGROUND: Private health care services were officially recognized in Vietnam in 1989, and for the last 15 years have competed with the public health system in providing primary curative care and pharmaceutical sales to rural populations. However, the quality of these private and public health care services has not been evaluated and compared. METHODS: A community-based survey was conducted in 30 of the 160 communes in Hung Yen, which were selected by probability proportional to population size (PPS) sampling. All commune health centres (CHCs) and private health care providers in the selected communes were surveyed on human resources, services provided, availability of medical equipment and pharmaceuticals, knowledge and clinical performance for acute and chronic problems. Patient satisfaction and cost of care associated with recent illness were measured using a random household survey covering 30 households from each of the selected communes. RESULTS: There were 11.5 private providers per 10,000 population, compared with 6.7 public providers per 10,000. A quarter of private providers were employees of the public health sector. Less than 20% of the private providers had registered their practice with the government system. Eleven per cent (26/234) had no professional qualifications. Fifty-eight per cent (135/234) provided treatment as well as selling medications. Public sector infrastructure was superior to that of the private providers. The quality of services provided by public providers was poor but significantly better than that of private providers. Patient satisfaction and costs of care were similar between the two groups. CONCLUSIONS: Private providers are successfully competing with the public health centre system in rural areas but not because they provide cheaper or better services. The quality of private health care services is not controlled and is significantly poorer than public services. Current practice in both systems falls below the national standard, especially for the management of chronic health problems. The low quality of health care services at a community level may help explain the previously observed phenomena of high levels of self-medicating, low utilization of commune health centres and over-utilization of tertiary health care facilities.

Adult↗
PubMedDate not supplied

The privatization of environmental health services: a national survey of practices and perspectives in local health departments.

OBJECTIVES: This article presents nationally representative data on environmental health (EH) services privatized by local public health departments, enforcement and assurance mechanisms for privatized services, and administrators' views about EH services that should not be privatized. METHODS: A national sample of 380 local public health departments, stratified by jurisdiction size, was drawn from a universe of 2,488 departments. Telephone interviews were conducted with 347 administrators of departments. Results were weighted to be nationally representative. RESULTS: Approximately one-quarter of departments had privatized at least one EH service, almost always to for-profit organizations. The two most common reasons given for privatizing EH services were cost savings or increased efficiency and lack of capacity or expertise to carry out the service. The most rigorous, although infrequent, technique of enforcement and assurance of EH standards when services were privatized was double-testing of samples. Departments more commonly relied on state licensing and certification of contractors. When asked what services should not be privatized, 27% of respondents cited EH services. Many respondents argued against privatizing environmental services that have inherent regulatory functions. They expressed concern that privatization would fragment the public health infrastructure by impairing communication, diminishing control over performance, or weakening health departments' capacity to respond to environmental and other health crises. CONCLUSION: These findings raise serious concerns about the privatization of EH.

Attitude of Health Personnel↗
PubMed2006

Veterans Health Administration patients' use of the private sector for coronary revascularization in New York: opportunities to improve outcomes by directing care to high-performance hospitals.

OBJECTIVE: We sought to quantify Veterans Health Administration (VA) patients' utilization of coronary revascularization in the private sector and to assess the potential impact of directing this care to high-performance hospitals. METHODS: Using VA and New York State administrative and clinical databases, we conducted a retrospective cohort study examining residents of New York State who were enrolled in the VA and underwent either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) in 1999 or 2000 (n=6562) in either the VA or the private sector. We first calculated the proportion of revascularizations obtained in the VA and the private sector. We then identified the private sector hospitals in which these men obtained revascularizations and determined potential changes in mortality and travel burden associated with directing private sector care to high performance hospitals. RESULTS: VA patients in New York were much more likely to undergo revascularization in the private sector than in VA hospitals: 83% of CABGs (2341/2829) and 87% of PCIs (4054/4665) were obtained in the private sector. Private sector utilization was distributed evenly across high- and low-mortality hospitals. Directing private-sector CABG surgery to high-performance hospitals could have reduced expected mortality by 24% (from 2.3% to 1.7%) and would only increase median travel time from 21 to 30 minutes. The benefit of redirecting PCI care is minimal. CONCLUSIONS: For high-mortality procedures that veterans frequently obtain in the private sector, like CABG, directing care to high-performance hospitals may be an effective way to improve outcomes for veterans.

Angioplasty, Balloon, Coronary↗
PubMed1995

Privatization and just healthcare.

When advocates of insurance-privatization consider whether private insurance-dominated systems achieve justice at all, they tend to rely on an incomplete set of criteria for a just healthcare system. They also mistakenly assume that it is enough to show that justice is in principle achievable within a private insurance-dominated system. This essay offers a more complete set of criteria for a just healthcare system. It then argues that the motivational assumptions needed to make insurance-privatization at all plausible (on grounds of choice, efficiency, and quality of care) are inconsistent with the motivational assumptions needed to show that in practice a private insurance-dominated system will achieve justice. A private insurance-dominated system can be expected to satisfy the criteria for just healthcare only if (a) there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if (b) generous public funds are provided to fill the gaps in access left by the private insurance market. Yet the assumptions about the motivations and abilities of the public, regulators, and public officials needed to satisfy conditions (a) or (b) contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care.

Altruism↗
PubMed2000

Rates for obstetric intervention among private and public patients in Australia: population based descriptive study.

OBJECTIVE: To compare the risk profile of women receiving public and private obstetric care and to compare the rates of obstetric intervention among women at low risk in these groups. DESIGN: Population based descriptive study. SETTING: New South Wales, Australia. SUBJECTS: All 171,157 women having a live baby during 1996 and 1997. INTERVENTIONS: Epidural, augmentation or induction of labour, episiotomy, and births by forceps, vacuum, or caesarean section. MAIN OUTCOME MEASURES: Risk profile of public and private patients, intervention rates, and the accumulation of interventions by both patient and hospital classification (public or private). RESULTS: Overall, the frequency of women classified as low risk was similar (48%) among those choosing private obstetric care and those receiving standard care in a public hospital. Among low risk women, rates of obstetric intervention were highest in private patients in private hospitals, lowest in public patients, and generally intermediate for private patients in public hospitals. Among primiparas at low risk, 34% of private patients in private hospitals had a forceps or vacuum delivery compared with 17% of public patients. For multiparas the rates were 8% and 3% respectively. Private patients were significantly more likely to have interventions before birth (epidural, induction or augmentation) but this alone did not account for the increased interventions at birth, particularly the high rates of instrumental births. CONCLUSIONS: Public patients have a lower chance of an instrumental delivery. Women should have equal access to quality maternity services, but information on the outcomes associated with the various models of care may influence their choices.

Cesarean Section↗
PubMed2005

Public perception of drinking water from private water supplies: focus group analyses.

BACKGROUND: Over four million Canadians receive their drinking water from private water supplies, and numerous studies report that these supplies often exceed the minimal acceptable standards for contamination. Canadians in rural areas test their water intermittently, if at all, and treatment of water from private supplies is not common. Understanding the perceptions of drinking water among residents served by private systems will enable public health professionals to better target education and outreach activities, and to address the needs and concerns of residents in their jurisdictions. The purpose of this study was to explore the drinking water perceptions and self-described behaviours and needs of participants served by private water systems in the City of Hamilton, Ontario (Canada). METHODS: In September 2003, three focus group discussions were conducted; two with men and women aged 36-65 years, and one with men and women 20-35 years of age. RESULTS: Overall, participants had positive perceptions of their private water supplies, particularly in the older age group. Concerns included bacterial and chemical contamination from agricultural sources. Testing of water from private supplies was minimal and was done less frequently than recommended by the provincial government. Barriers to water testing included the inconvenience of the testing process, acceptable test results in the past, resident complacency and lack of knowledge. The younger participants greatly emphasized their need for more information on private water supplies. Participants from all groups wanted more information on water testing, and various media for information dissemination were discussed. CONCLUSION: While most participants were confident in the safety of their private water supply, the factual basis for these opinions is uncertain. Improved dissemination of information pertaining to private water supplies in this population is needed. Observed differences in the concerns expressed by users of different water systems and age groups may suggest the need for targeted public education strategies. These focus groups provided significant insight into the public perception of private water supplies and the need for public health outreach activities; however, to obtain a more representative understanding of the perceptions in this population, it is important that a larger scale investigation be performed.

Adult↗
PubMed2006

Public perceptions of drinking water: a postal survey of residents with private water supplies.

BACKGROUND: In Canada, the legal responsibility for the condition of private water supplies, including private wells and cisterns, rests with their owners. However, there are reports that Canadians test these water supplies intermittently and that treatment of such water is uncommon. An estimated 45% of all waterborne outbreaks in Canada involve non-municipal systems. An understanding of the perceptions and needs of Canadians served by private water supplies is essential, as it would enable public health professionals to better target public education and drinking water policy. The purpose of this study was to investigate the public perceptions of private water supplies in the City of Hamilton, Ontario (Canada), with the intent of informing public education and outreach strategies within the population. METHODS: A cross-sectional postal survey of 246 residences with private water supplies was conducted in May 2004. Questions pertained to the perceptions of water quality and alternative water sources, water testing behaviours and the self-identified need for further information. RESULTS: Private wells, cisterns or both, were the source of household water for 71%, 16% and 13% of respondents, respectively. Although respondents rated their water quality highly, 80% also had concerns with its safety. The most common concerns pertained to bacterial and chemical contamination of their water supply and its potential negative effect on health. Approximately 56% and 61% of respondents used in-home treatment devices and bottled water within their homes, respectively, mainly due to perceived improvements in the safety and aesthetic qualities compared to regular tap water. Testing of private water supplies was performed infrequently: 8% of respondents tested at a frequency that meets current provincial guidelines. Two-thirds of respondents wanted more information on various topics related to private water supplies. Flyers and newspapers were the two media reported most likely to be used. CONCLUSION: Although respondents rated their water quality highly, the majority had concerns regarding the water from their private supply, and the use of bottled water and water treatment devices was extensive. The results of this study suggest important lines of inquiry and provide support and input for public education programs, particularly those related to private water testing, in this population.

Adult↗
PubMed2003

A comparison of public and private obstructive sleep apnea clinics.

The aim of the present study was to compare the clinical findings and polysomnography results obtained at public and private clinics in Brazil, the follow-up after diagnosis, and the therapeutic aspects related to continuous positive airway pressure. Patients who snore and who have obstructive sleep apnea were retrospectively divided into two groups, i.e., public clinic (N=307) and private clinic (N=317). Data concerning age, sex, body mass index (BMI), neck circumference, medical history, sleepiness scale, follow-up after diagnosis, and acceptance of continuous positive airway pressure therapy were collected. Mean age was 50 +/- 12 (range: 15-80) for public patients and 48 +/- 12 years (range: 19-91) for private patients. Mean BMI was 30 +/- 6 (range: 19-67) for public patients and 31 +/- 6 kg/m (range: 21-59) for private patients. The public clinic had a significantly higher frequency of women than the private clinic (M:F ratio of 2.0:1 and 6.9:1, respectively). The condition of private patients (apnea-hypopnea index=31 +/- 25) was more severe than that of public patients (apnea-hypopnea index=25 +/- 24 events/h; P=0.0004). In the public and private clinics, 19 and 15% of patients were snorers, respectively, and 81 and 85% of them had sleep apnea. After diagnosis, follow-up was longer in the private group. The continuous positive airway pressure acceptance was similar for both groups (32 vs 35%), but patients from the public clinic abandoned treatment more than private ones (65 vs 13%). Social status was significant in terms of the severity of obstructive sleep apnea age and gender distribution. Private patients look for a diagnosis earlier in the course of the disease than public patients, adhere more to follow-up, and abandon continuous positive airway pressure treatment less than public patients do.

Adult↗
PubMed1998

Legislatory framework for private medical practice in Uganda.

BACKGROUND: In Uganda the private health sector has expanded dramatically in recent years with a striking proliferation of facilities for private medical practice which is particularly evident in urban areas. OBJECTIVES: The general objective of this study was to analyse the laws and regulations governing the private health sector in order to determine how they affect the operations and development of private medical practice in Uganda. METHODS: Between December 1995 and December 1996, we identified and reviewed all the laws, which affect private medical practice in Uganda. We discussed the contents of the laws with Ministry of Health officials and with representatives of private practitioners. We also made visits to a sample of clinics, which we inspected to ascertain compliance with the laws, and held interviews with managers of the clinics to get their views about the laws. RESULTS: Two categories of laws were identified. The first category includes two laws adopted in 1993, whose purpose is to ensure the availability at all times of efficacious and cost effective drugs in the country. The second category includes three laws, all adopted in 1996, which spell out the licensing procedures, supervision, disciplining and general control of different categories of professionals. The list of health professions, which are permitted to practice privately, was revised to include new categories, which were previously not allowed. We identified what we considered to be barriers to private health sector development, loopholes in the laws and also assessed the enforcement of the laws. The legal barriers include restrictions of drug imports, the requirement for the professionals to renew their practising licenses and to register the premises annually at one central place in the country, long periods of time mandated for acquiring experience before one can be permitted to practice privately and the finding that there are some capable professions which are still not allowed to practice privately. CONCLUSION: We made recommendations to the Ministry of Health to address all these barriers. We also recommended to the Ministry that non-professionals who have the ability to set up clinics should be allowed to register them provided they can engage professionals to operate them.

Cost-Benefit Analysis↗
PubMedDate not supplied

Private-public mix: a prioritisation under RNTCP--an Indian perspective.

Success of the public directly observed treatment, short course (DOTS) programmes have been widely reported from various parts of the world and have been described from the Indian subcontinent as well. But, it is being increasingly realised that further DOTS successes can take place only by ensuring a private sector participation under the programme. While discussing behaviour-profile of patients, this review enumerates possible reasons for their averseness of a public health facility and preference for a private health. facility. Similarly, behaviour-profile of private health providers brings out the discrepancies in their clinical practices. Both types of profiles are supported with the studies from India and abroad. A comparison is drawn between available services of the public and private health facilities, with a focus on the need for prioritisation of a private-public mix (PPM) in the Revised National Tuberculosis Control Programme (RNTCP). Furthermore, the salient features of schemes recommended by the Directorate General of Health Services, New Delhi, for involvement of the private- practitioners, and the Non-Governmental Organisations are briefly outlined. The underlying obstacles for private sector participation in RNTCP and the projected solutions so as to effect a private-public mix in the Revised Programme are also dealt with. A description of few operating models, trying in the best possible manner to bring about a private sector participation in programme, is presented to make the readers aware of the efforts going on in that direction within the country. The private health sector, easily being a patient's first choice, needs to be integrally involved in RNTCP on a priority basis, feasibility of which, has been successfully documented in the operational trials conducted within the country so far.

Antitubercular Agents↗