'Tackling theshortage of HRH :Are Informal Health Providers the solution?'Examples of health sector engagement with informal providers.
14:00-16:00.
Organized by NHRHO Asma ElSony
Modified from Prof S Bertel “Bertie” Squire Feb 2013 Presentation on Triage-Plus Dissemination Meeting, NHRHO Khartoum, and personal experience
Overview1. Experience with engagement of informal providers in
health care prior to Triage-Plus
People the asset for Investment S Africa Kenya Malawi
2. Recent systematic review on the role of informal providers in developing countries
3. Conclusions
European UnionTotal FDI: 52% of world total
USA (Total FDI: 21% of world total
Japan (Total FDI: 5% of world total
Concentration of global FDI
Source: based on data in UNCTAD, 2001
Diversity of total FDI inflows within the developing world
Source: United Nations Conference on Trade and Development (UNCTAD) Online Databases, Feb. 2006
WB Report 1993Health
Health is essential for growth and economic development and access to sustainable development
• The remarkable improvement in health in E Asian countries & miracle on health Performance indicators, was due to the accumulation of Human Capital Through education info and K and investing in Health.
• Addressing health policy , issues of health as an inclusive right is not limited to the provision of appropriate health care in a timely manner , but also to provide underlying determinants of health, to ensure the active participation, in economy & development.
From a TB Unit to …The STOP TB Partnership
The STOP TB Partnership with the aim to improve global tuberculosis (TB) control through expanding accessto the Union’s model of directly observed treatment short course (DOTS) strategy.
Advocated the approach of 'Engaging all Care Providers in the EDS.
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0-14 15-24 25-34 35-44 45-54 55-64 65<=
age group
% o
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atie
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n
the
hea
lth
fac
ilit
yReferral hospitals PHC facilities
Figure 1: Age distribution in health institutions
Asma ElSony, MD, DTCD PhD,1& Gunnar Bjune, M.D., PhD,
0100020003000400050006000700080009000
1997 1998 2000 2001
No.
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pati
ents
Referal hospital PHC facilities
Figure 2: Case finding in health facilities
Asma ElSony, MD, DTCD PhD,1& Gunnar Bjune, M.D., PhD
0102030405060708090
1997 1998 1999 2000
% o
f ca
ses
Referral hospitals PHC facilities
Asma ElSony, MD, DTCD PhD,1& Gunnar Bjune, M.D., PhD
Figure 3: Trend in location of diagnosis in women
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55-64
65<% o
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PH
C f
acil
itie
s
1997199819992000
Asma ElSony, MD, DTCD PhD,1& Gunnar Bjune, M.D PhDs.,
Figure 4: Age distribution in PHC facilitie (1997-2000)
Hlabisa 1991-1995
Formal Sector health workers least effective supervisors (79% completion)
Laypeople (85%), CHWs (88%) or Storekeepers (84%)(p=0.0008)
South Africa – who observes TB treatment (DOT supporters)
Kenya – improving malaria home treatment Over the C
3 districts Kenya–: random allocation to the Intervention (Training Private AM sellers): improving malaria home treatment
PMV Practice Pre & Post Intervention for simple and Complicated Malaria, simulate visits 2003, 2004
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49 43
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32 1315
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3142
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0 1 2 3 4 5 Kilometers
Population %with Secondary Education
Pop < 100
Secondary Education
Source: 1998 National Census
0 - 6
7 - 23
25 - 30
31 - 47
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49 43
46
47
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35
36
56
23
38
50
57
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29
29
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18
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12
37
39
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433
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16
28
20
17
32 1315
48
40
3142
11
0 1 2 3 4 5 Kilometers
Percentage of Householdswith Private Piped Water
Private Piped Water
Source: 1998 National Census
0 - 20
21 - 40
41 - 60
61 - 80
81 - 100
Poverty indicators/area – Lilongwe (Malawi)
n=179 patients
Poverty measured against Integrated Household Survey (IHS) - 72% poor
Patient costs for TB diagnosis (US$)[Urban] When a woman or when the poor are sick, the opportunity costs faced by their households are greater.
•On average, patients spent 13 US$ or 18 days’ income; lost 22 days from work while accessing a TB diagnosis.
•For non-poor patients, the total costs amounted to 129% of total monthly income, or 184% after food expenditures.
• For the poor, this cost rose to 248% of monthly income or 574% after food.
Patients made multiple visits to store-keepers
Terms for Informal Providers
Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D (2013) What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review. PLoS ONE 8(2): e54978. doi:10.1371/journal.pone.0054978http://www.plosone.org/article/info:doi/10.1371/journal.pone.0054978
Conclusions
1. Informal providers can provide a bridge between poor patients and formal health services for a variety of health care issues
2. More work needed to build consensus on definition of informal provider and understanding of most effective role in health care provision
3. Growing momentum to use robust, randomised intervention designs to further develop and test effectiveness and cost-effectiveness of engaging informal providers
Thank you
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