Public stewardship of private for-profit healthcare providers in low- and middle-income countries.

Abstract:

BACKGROUND:Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review. OBJECTIVES:To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries. SEARCH METHODS:For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant articles, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and various electronic databases of grey literature. SELECTION CRITERIA:Randomised trials, non-randomised trials, interrupted time series studies, or controlled before-after studies. DATA COLLECTION AND ANALYSIS:Two authors independently assessed study eligibility and extracted data, comparing their results and resolving discrepancies by consensus. We expressed study results as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI), where appropriate, and assessed the certainty of the evidence using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). We did not conduct meta-analysis because of heterogeneity of interventions and study designs. MAIN RESULTS:We identified 20,177 records, 50 of them potentially eligible. We excluded 39 potentially eligible studies because they did not involve a rigorous evaluation of training, regulation, or co-ordination of private for-profit healthcare providers in LMICs; five studies identified after the review was submitted are awaiting assessment; and six studies met our inclusion criteria. Two included studies assessed training alone; one assessed regulation alone; three assessed a multifaceted intervention involving training and regulation; and none assessed co-ordination. All six included studies targeted private for-profit pharmacy workers in Africa and Asia.Three studies found that training probably increases sale of oral rehydration solution (one trial in Kenya, 106 pharmacies: RR 3.04, 95% CI 1.37 to 6.75; and one trial in Indonesia, 87 pharmacies: RR 1.41, 95% CI 1.03 to 1.93) and dispensing of anti-malarial drugs (one trial in Kenya, 293 pharmacies: RR 8.76, 95% CI 0.94 to 81.81); moderate-certainty evidence.One study conducted in the Lao People's Democratic Republic shows that regulation of the distribution and sale of registered pharmaceutical products may improve composite pharmacy indicators (one trial, 115 pharmacies: improvements in four of six pharmacy indicators; low-certainty evidence).The outcome in three multifaceted intervention studies was the quality of pharmacy practice; including the ability to ask questions, give advice, and provide appropriate treatment. The trials applied regulation, training, and peer influence in sequence; and the study design does not permit separation of the effects of the different interventions. Two trials conducted among 136 pharmacies in Vietnam found that the multifaceted intervention may improve the quality of pharmacy practice; but the third study, involving 146 pharmacies in Vietnam and Thailand, found that the intervention may have little or no effects on the quality of pharmacy practice (low-certainty evidence).Only two studies (both conducted in Vietnam) reported cost data, with no rigorous assessment of the economic implications of implementing the interventions in resource-constrained settings. No study reported data on equity, mortality, morbidity, adverse effects, satisfaction, or attitudes. AUTHORS' CONCLUSIONS:Training probably improves quality of care (i.e. adherence to recommended practice), regulation may improve quality of care, and we are uncertain about the effects of co-ordination on quality of private for-profit healthcare services in LMICs. The likelihood that further research will find the effect of training to be substantially different from the results of this review is moderate; implying that monitoring of the impact is likely to be needed if training is implemented. The low certainty of the evidence for regulation implies that the likelihood of further research finding the effect of regulation to be substantially different from the results of this review is high. Therefore, an impact evaluation is warranted if government regulation of private for-profit providers is implemented in LMICs. Rigorous evaluations of these interventions should also assess other outcomes such as impacts on equity, cost implications, mortality, morbidity, and adverse effects.

authors

Wiysonge CS,Abdullahi LH,Ndze VN,Hussey GD

doi

10.1002/14651858.CD009855.pub2

subject

Has Abstract

pub_date

2016-08-11 00:00:00

pages

CD009855

issue

8

issn

1469-493X

pub_type

杂志文章,评审
  • Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea.

    abstract:BACKGROUND:Although highly effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) is not universally accepted by users. Educational, supportive and behavioural interventions may help people with OSA initiate and maintain regular and continued use of CPAP. OBJECTIVES:To...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD007736.pub3

    authors: Askland K,Wright L,Wozniak DR,Emmanuel T,Caston J,Smith I

    更新日期:2020-04-07 00:00:00

  • Community-based antibiotic delivery for possible serious bacterial infections in neonates in low- and middle-income countries.

    abstract:BACKGROUND:The recommended management for neonates with a possible serious bacterial infection (PSBI) is hospitalisation and treatment with intravenous antibiotics, such as ampicillin plus gentamicin. However, hospitalisation is often not feasible for neonates in low- and middle-income countries (LMICs). Therefore, alt...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD007646.pub3

    authors: Duby J,Lassi ZS,Bhutta ZA

    更新日期:2019-04-11 00:00:00

  • Transcutaneous carbon dioxide monitoring for the prevention of neonatal morbidity and mortality.

    abstract:BACKGROUND:Carbon dioxide (CO2) measurement is a fundamental evaluation in a neonatal intensive care unit (NICU), as both low and high values of CO2 might have detrimental effects on neonatal morbidity and mortality. Though measurement of CO2 in the arterial blood gas is the most accurate way to assess the amount of CO...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD011494.pub2

    authors: Bruschettini M,Romantsik O,Zappettini S,Ramenghi LA,Calevo MG

    更新日期:2016-02-13 00:00:00

  • Zonisamide add-on therapy for focal epilepsy.

    abstract:BACKGROUND:The majority of people with epilepsy have a good prognosis, and their seizures can be well controlled with the use of a single antiepileptic agent, but up to 30% develop refractory epilepsy, especially those with focal seizures. In this review, we summarised the evidence from randomised controlled trials (RC...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD001416.pub4

    authors: Brigo F,Lattanzi S,Igwe SC,Behzadifar M,Bragazzi NL

    更新日期:2018-10-18 00:00:00

  • Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease.

    abstract:BACKGROUND:Approximately 25% of adults regularly experience heartburn, a symptom of gastro-oesophageal reflux disease (GORD). Most patients are treated empirically (without specific diagnostic evaluation e.g. endoscopy. Among patients who have an upper endoscopy, findings range from a normal appearance, mild erythema t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002095.pub4

    authors: van Pinxteren B,Sigterman KE,Bonis P,Lau J,Numans ME

    更新日期:2010-11-10 00:00:00

  • Supported housing for people with severe mental disorders.

    abstract:BACKGROUND:There has been a significant reduction in the number of people with severe mental illness who spend extended periods in long-stay hospitals. District health authorities, local authorities, housing associations and voluntary organisations are jointly expected to provide support for people with severe mental d...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000453.pub2

    authors: Chilvers R,Macdonald GM,Hayes AA

    更新日期:2006-10-18 00:00:00

  • Epidermal growth factor receptor (EGFR) inhibitors for metastatic colorectal cancer.

    abstract:BACKGROUND:Epidermal growth factor receptor (EGFR) inhibitors prevent cell growth and have shown benefit in the treatment of metastatic colorectal cancer, whether used as single agents or in combination with chemotherapy. Clear benefit has been shown in trials of EGFR monoclonal antibodies (EGFR MAb) but not EGFR tyros...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007047.pub2

    authors: Chan DLH,Segelov E,Wong RS,Smith A,Herbertson RA,Li BT,Tebbutt N,Price T,Pavlakis N

    更新日期:2017-06-27 00:00:00

  • Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery.

    abstract:BACKGROUND:Carpal tunnel syndrome is a common problem and surgical decompression of the carpal tunnel is the most effective treatment. After surgical decompression, the palmar skin may be closed using either absorbable or non-absorbable sutures. To date, there is conflicting evidence regarding the ideal suture material...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD011757.pub2

    authors: Wade RG,Wormald JC,Figus A

    更新日期:2018-02-01 00:00:00

  • Sedatives for opiate withdrawal in newborn infants.

    abstract:BACKGROUND:Neonatal abstinence syndrome (NAS) due to opiate withdrawal may result in disruption of the mother-infant relationship, sleep-wake abnormalities, feeding difficulties, weight loss and seizures. Treatments used to ameliorate symptoms and reduce morbidity include opiates, sedatives and non-pharmacological trea...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002053.pub2

    authors: Osborn DA,Jeffery HE,Cole MJ

    更新日期:2005-07-20 00:00:00

  • Opioid antagonists with minimal sedation for opioid withdrawal.

    abstract:BACKGROUND:Managed withdrawal is a necessary step prior to drug-free treatment or as the end point of long-term substitution treatment. OBJECTIVES:To assess the effectiveness of opioid antagonists in combination with minimal sedation to manage opioid withdrawal. SEARCH STRATEGY:We searched the Cochrane Central Regist...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002021.pub3

    authors: Gowing L,Ali R,White JM

    更新日期:2009-10-07 00:00:00

  • Rituximab as maintenance therapy for patients with follicular lymphoma.

    abstract:BACKGROUND:Rituximab, a monoclonal anti-CD20 antibody, in combination with chemotherapy improves overall survival compared to chemotherapy alone when used for induction therapy for patients with newly diagnosed or relapsed indolent lymphoma. Randomised controlled trials have demonstrated that maintenance treatment with...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006552.pub2

    authors: Vidal L,Gafter-Gvili A,Leibovici L,Shpilberg O

    更新日期:2009-04-15 00:00:00

  • Antenatal cardiotocography for fetal assessment.

    abstract:BACKGROUND:Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. CTG is widely used in pregnancy as a method of assessing fetal well-being, predominantly in pregnancies with increased risk of complications. OBJECTIVES:To assess th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007863.pub3

    authors: Grivell RM,Alfirevic Z,Gyte GM,Devane D

    更新日期:2012-12-12 00:00:00

  • Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury.

    abstract:BACKGROUND:Increased intracranial pressure (ICP) has been shown to be strongly associated with poor neurological outcomes and mortality for patients with acute traumatic brain injury (TBI). Currently, most efforts to treat these injuries focus on controlling the ICP. Hypertonic saline (HTS) is a hyperosmolar therapy th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD010904.pub2

    authors: Chen H,Song Z,Dennis JA

    更新日期:2019-12-30 00:00:00

  • Magnesium for treating sickle cell disease.

    abstract:BACKGROUND:Sickle cell disease is an autosomal recessive inherited haemoglobinopathy which causes painful vaso-occlusive crises due to sickle red blood cell dehydration. Vaso-occlusive crises are common painful events responsible for a variety of clinical complications; overall mortality is increased and life expectanc...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD011358.pub2

    authors: Than NN,Soe HHK,Palaniappan SK,Abas AB,De Franceschi L

    更新日期:2017-04-14 00:00:00

  • Topical treatments for scalp psoriasis.

    abstract:BACKGROUND:People with chronic plaque psoriasis often have lesions on the scalp. Hair makes the scalp difficult to treat and the adjacent facial skin is particularly sensitive to topical treatments. OBJECTIVES:To assess the efficacy and safety of topical treatments for scalp psoriasis. SEARCH METHODS:We searched the ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009687.pub2

    authors: Schlager JG,Rosumeck S,Werner RN,Jacobs A,Schmitt J,Schlager C,Nast A

    更新日期:2016-02-26 00:00:00

  • Pharmacological interventions for recurrent abdominal pain (RAP) in childhood.

    abstract:BACKGROUND:Between 4% and 25% of school age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003017

    authors: Huertas-Ceballos A,Macarthur C,Logan S

    更新日期:2002-01-01 00:00:00

  • Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants.

    abstract:BACKGROUND:Necrotizing enterocolitis continues to be a problem, particularly in preterm neonates. There have been reports published suggesting that the use of enteral antibiotics may be effective as prophylaxis. This systematic review was undertaken to clarify the issue. OBJECTIVES:To evaluate the benefits and harms o...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000405

    authors: Bury RG,Tudehope D

    更新日期:2001-01-01 00:00:00

  • Inhaled sodium cromoglycate for asthma in children.

    abstract:BACKGROUND:Sodium cromoglycate has been recommended as maintenance treatment for childhood asthma for many years. Its use has decreased since 1990, when inhaled corticosteroids became popular, but it is still used in many countries. OBJECTIVES:To determine the efficacy of sodium cromoglycate compared to placebo in the...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002173.pub2

    authors: van der Wouden JC,Uijen JH,Bernsen RM,Tasche MJ,de Jongste JC,Ducharme F

    更新日期:2008-10-08 00:00:00

  • Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients.

    abstract:BACKGROUND:Hypertonic solutions are considered to have a greater ability to expand blood volume and thus elevate blood pressure and can be administered as a small volume infusion over a short time period. On the other hand, the use of hypertonic solutions for volume replacement may also have important disadvantages. O...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002045.pub2

    authors: Bunn F,Roberts I,Tasker R,Akpa E

    更新日期:2004-01-01 00:00:00

  • Remote ischaemic conditioning for preventing and treating ischaemic stroke.

    abstract:BACKGROUND:Remote ischaemic conditioning (RIC) has been developed as a neuroprotective strategy to prevent and treat ischaemic stroke. It usually involves restricting blood flow to limbs and then releasing the ischaemic blood to promote a neuroprotective effect. Preclinical studies have suggested that RIC may have bene...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD012503.pub2

    authors: Zhao W,Zhang J,Sadowsky MG,Meng R,Ding Y,Ji X

    更新日期:2018-07-05 00:00:00

  • Intranasal steroids for acute sinusitis.

    abstract:BACKGROUND:Acute sinusitis is a common reason for primary care visits. It causes significant symptoms and often results in time off work and school. OBJECTIVES:We examined whether intranasal corticosteroids (INCS) are effective in relieving symptoms of acute sinusitis. SEARCH STRATEGY:We searched the Cochrane Central...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005149.pub3

    authors: Zalmanovici A,Yaphe J

    更新日期:2009-10-07 00:00:00

  • Oral aspirin for treating venous leg ulcers.

    abstract:BACKGROUND:Venous leg ulcers (VLUs) or varicose ulcers are the final stage of chronic venous insufficiency (CVI), and are the most common type of leg ulcer. The development of VLUs on ankles and lower legs can occur spontaneously or after minor trauma. The ulcers are often painful and exudative, healing is often protra...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009432.pub2

    authors: de Oliveira Carvalho PE,Magolbo NG,De Aquino RF,Weller CD

    更新日期:2016-02-18 00:00:00

  • Growth hormone for in vitro fertilization.

    abstract:BACKGROUND:In an effort to improve outcomes of in-vitro fertilisation cycles the use of growth hormone has been considered. Improving the outcomes of in-vitro fertilisation is especially important for subfertile women who are considered 'poor responders'. OBJECTIVES:To assess the effectiveness of adjuvant growth hormo...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000099.pub3

    authors: Duffy JM,Ahmad G,Mohiyiddeen L,Nardo LG,Watson A

    更新日期:2010-01-20 00:00:00

  • Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer.

    abstract:BACKGROUND:This review sets out to assess the efficacy of pre-operative chemoradiation when compared to radiotherapy alone before surgery in the treatment of advanced non metastatic rectal surgery. OBJECTIVES:To determine the efficacy of pre-operative chemoradiation (CRT) compared with radiation (RT) alone, in locally...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008368.pub2

    authors: McCarthy K,Pearson K,Fulton R,Hewitt J

    更新日期:2012-12-12 00:00:00

  • Heated, humidified air for the common cold.

    abstract:BACKGROUND:Heated, humidified air has long been used by sufferers of the common cold. The theoretical basis is that steam may help congested mucus drain better and heat may destroy the cold virus as it does in vitro. OBJECTIVES:To assess the effects of inhaling heated water vapour (steam) in the treatment of the commo...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001728.pub4

    authors: Singh M,Singh M

    更新日期:2011-05-11 00:00:00

  • Primary surgery versus primary radiation therapy with or without chemotherapy for early adenocarcinoma of the uterine cervix.

    abstract:BACKGROUND:For early squamous cell carcinoma of the uterine cervix, the outcome is similar after either primary surgery or primary radiotherapy. There are reports that this is not the case for early adenocarcinoma (AC) of the uterine cervix: some studies have reported that the outcome is better after primary surgery. T...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006248.pub2

    authors: Baalbergen A,Veenstra Y,Stalpers LL,Ansink AC

    更新日期:2010-01-20 00:00:00

  • Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

    abstract:BACKGROUND:Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action pl...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD011682.pub2

    authors: Lenferink A,Brusse-Keizer M,van der Valk PD,Frith PA,Zwerink M,Monninkhof EM,van der Palen J,Effing TW

    更新日期:2017-08-04 00:00:00

  • Screening children in the first four years of life to undergo early treatment for otitis media with effusion.

    abstract:BACKGROUND:Otitis media with effusion (OME) is the most common cause of acquired hearing loss in childhood and has been associated with delayed language development and behavioural problems. This condition has a prevalence of about 20% at the age of two years, a time of rapid language development. It is most often asym...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004163

    authors: Butler CC,van der Linden MK,MacMillan H,van der Wouden JC

    更新日期:2003-01-01 00:00:00

  • Skin preparation for preventing infection following caesarean section.

    abstract:BACKGROUND:The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section than for vaginal birth. With the increasing rate of caesarean section, it is important that the risks to the mother are minimised as far as possible. This review focuses on different forms and ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007462.pub3

    authors: Hadiati DR,Hakimi M,Nurdiati DS,Ota E

    更新日期:2014-09-17 00:00:00

  • Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults.

    abstract:BACKGROUND:Delayed union and non-union of fractures are a considerable cause of morbidity to patients. Laboratory studies have shown that electromagnetic fields can stimulate the formation of new bone, indicating a potential role for electromagnetic stimulation in the treatment of fractures that have failed to heal. O...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008471.pub2

    authors: Griffin XL,Costa ML,Parsons N,Smith N

    更新日期:2011-04-13 00:00:00