Institute of Development Studies, Brighton, UK.
Health Policy Plan. 2011 Jul;26 Suppl 1:i45-52. doi: 10.1093/heapol/czr025.
There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. In many countries poor people obtain a large proportion of their outpatient medical care and drugs from informal providers working outside a regulatory framework, with deleterious consequences in terms of the safety and efficacy of treatment and its cost. Interventions that focus only on improving the knowledge of these providers have had limited impact. There is a considerable amount of experience in other sectors with interventions for improving the performance of markets that poor people use. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria. These studies analyse the markets for informal health care services in terms of the sources of health-related knowledge for the providers, the livelihood strategies of these providers and the institutional arrangements within which they build and maintain their reputation. The paper concludes that there is a need to build a systematic understanding of these markets to support collaboration between key actors in building institutional arrangements that provide incentives for better performance.
在许多低收入和中等收入国家，市场关系已经迅速蔓延。这种蔓延速度远远超过了影响卫生服务提供者绩效的制度安排的发展。在许多国家，穷人的大部分门诊医疗和药品都来自在监管框架之外工作的非正式提供者，这对治疗的安全性、有效性和成本都产生了有害影响。仅关注提高这些提供者的知识的干预措施的影响有限。在其他部门，有许多关于改善穷人使用的市场绩效的干预措施的经验。本文借鉴孟加拉国和尼日利亚研究的结果，将这些经验应用于非正式提供者的问题。这些研究从提供者获得与健康相关的知识的来源、这些提供者的生计策略以及他们建立和维护声誉的制度安排等方面，对非正式医疗服务市场进行了分析。本文认为，有必要系统地了解这些市场，以支持关键行为者之间的合作，建立激励更好绩效的制度安排。
