Date Published: April 12, 2011
Publisher: Public Library of Science
Author(s): Jishnu Das
Abstract: Jishnu Das provides a perspective on a research article by Paul Garner and colleagues that reports a systematic review of 80 studies comparing the quality of private versus public ambulatory health care in low and middle income countries.
Partial Text: It is widely believed that people in low- and middle-income countries (LMICs) are in poor health because they cannot reach medical services on time. Predicated on this belief, much of global health policy focuses on the physical provision of goods (clinics, equipment, and medicine) and getting doctors to “underserved” rural areas. Yet, recent evidence shows high utilization rates, even among the poor ,.
Typically, households can access multiple providers, ranging from fully qualified public and private sector providers to those without any formal medical training in the private sector. In Delhi, India’s capital, there are 70 doctors, most in the private sector, within a 15-minute walk of every household. In the private sector, about half are fully qualified and 10%–15% have no medical training, with a higher fraction of qualified providers in richer neighborhoods .
The paper by Garner and colleagues is a wake-up call for the global health community; the review could identify only 80 studies on quality of care across LMICs. Understanding health care in these contexts requires building on such provider-level data to construct market-level aggregates. Such market-level analysis can help answer policy questions ranging from regulatory issues to the trade-off between access and quality.