On September 23-24, the Center for Health Market Innovations (CHMI) will convene the first Working Group meeting of its inaugural thematic study – a look at the role of informal providers in mixed health systems.
Informal providers are an important source of care for the poor in many developing countries, yet very little is known about the size of the sector, cost and quality of services provided, and the success of programs that have attempted to leverage informal provider potential, while minimizing their harm. The current CHMI study is primarily designed to create policy recommendations on how to best harness informal providers to deliver quality health services, and will include a review of available literature, an analysis of existing interventions, and in-depth research on informal provider practices in several countries.
In partnership with the Global Health Group at UCSF, we have just completed the full literature review and initial scan for programs that work with informal providers. The literature has revealed a wide range of information about the size of the sector, from 51%, rural India versus 96% in rural Bangladesh, and patterns of utilization, as low as 11% (traditional practitioners only, Uganda) to as high as 90% (all types of IPs, including those providing care in conjunction with formal providers, cross-country review). Surprisingly, though many are quick to point out the potential harm caused by informal providers, few studies have looked specifically at service quality.
Health market innovations are addressing the informal provision of health care in many ways. In Bangladesh, Shasthya Sena is improving the quality of services delivered by informal providers by integrating them into the country’s health system. The program has trained 135 informal allopathic healthcare providers (known as village doctors) in Chakaria sub-district on 11 major diseases, and networked them to establish accountability and brand identity.
In Vietnam, the PATH-implemented Leveraging the Private Pharmacy Sector is increasing the capacity of pharmacy sellers, who often serve as the first point of care, to provide accurate health information to patients. The program has trained pharmacists and their staff to identify the symptoms of HIV/AIDS and TB, and to refer clients to appropriate counseling and testing centers for testing and treatment.
Accredited Drug Dispensing Outlets (ADDO), now operating in Tanzania and Uganda, trains and licenses small, privately operated retail outlets in rural and poor areas to sell a set list of essential medicines, including selected prescription drugs. Key to its success, the program has also engaged formal provider groups, helping to break down opposition to working with the informal sector and encouraging formal providers to take part in the regulation of their practice.
Is there an important gap in available information that you would like raised at the Working Group meeting? Share your thoughts!