Health Systems Program, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD 21205, USA.
Health Policy Plan. 2011 Jul;26(4):275-87. doi: 10.1093/heapol/czq074. Epub 2010 Nov 19.
BACKGROUND There is a growing interest in the role of private health providers in low- and middle-income countries (LMICs). Informal private providers (IPPs) provide a significant portion of health care in many LMICs, but they have not received training in allopathic medicine. Interventions have been developed to take advantage of their potential to expand access to essential health services, although their success is not well measured. This paper addresses this information gap through a review of interventions designed to improve the quality, coverage, or costs of health services provided by IPPs in LMICs. METHODS A search for published literature in the last 15 years for any intervention dealing with IPPs in a LMIC, where at least one outcome was measured, was conducted through electronic databases PubMed and Global Health, as well as Google for grey literature from the Internet. RESULTS A total of 1272 articles were retrieved, of which 70 separate studies met inclusion criteria. The majority (70%) of outcomes measured proximate indicators such as provider knowledge (61% were positive) and behaviour (56% positive). Training IPPs was the most common intervention tested (77% of studies), but the more effective strategies did not involve training alone. Interventions that changed the institutional relationships and contributed to changing the incentives and accountability environment were most successful, and often required combinations of interventions. CONCLUSION Although there are documented interventions among IPPs, there are few good quality studies. Strategies that change the market conditions for IPPs-by changing incentives and accountability-appear more likely to succeed than those that depend on building individual capacities of IPPs. Understanding the effectiveness of these and other strategies will also require more rigorous research designs that assess contextual factors and document outcomes over longer periods.
私人医疗服务提供者在中低收入国家（LMICs）中的作用越来越受到关注。在许多 LMICs 中，非正式私人提供者（IPPs）提供了很大一部分医疗保健服务，但他们没有接受过顺势疗法医学的培训。已经开发了干预措施来利用他们扩大基本卫生服务获取的潜力，尽管它们的成功程度尚未得到很好的衡量。本文通过审查旨在提高 LMICs 中 IPPs 提供的卫生服务的质量、覆盖范围或成本的干预措施，解决了这一信息差距。
通过电子数据库 PubMed 和 Global Health 以及互联网上的 Google 搜索过去 15 年中针对 LMICs 中 IPPs 的任何干预措施的已发表文献，其中至少有一个结果被测量。
共检索到 1272 篇文章，其中 70 项单独研究符合纳入标准。测量的结果大多是接近指标，如提供者的知识（61%为阳性）和行为（56%为阳性）。培训 IPPs 是测试最多的干预措施（77%的研究），但更有效的策略并不单独涉及培训。改变机构关系并有助于改变激励和问责制环境的干预措施最为成功，通常需要多种干预措施的结合。
尽管有针对 IPPs 的记录在案的干预措施，但高质量的研究很少。改变 IPPs 的市场条件的策略——通过改变激励和问责制——似乎比那些依赖于建立 IPPs 的个人能力的策略更有可能成功。了解这些和其他策略的有效性还将需要更严格的研究设计，评估背景因素并记录更长时间的结果。
