Utilizing the potential of formal and informal private practitioners in child survival: situation analysis and summary of promising interventions.

Studies from different parts of the world show that formal and informal private practitioners are popular sources of treatment for diarrhea acute respiratory infection and malaria which combined are estimated to cause over half of childhood mortality in developing countries. Private practitioners are generally perceived by the community to be more accessible more sensitive to client needs and more willing to spend time with their clients compared to the service given in the public sector. However because of the wide evidence of their substandard clinical services most national health policies prohibit the practice of unqualified practitioners and ignore them in national child survival programs. Health authorities fear that involving unqualified private practitioners could be perceived as formal recognition and encouragement to continue their substandard practices. The complex factors influencing their practices and the unclear channels of contacting them make it challenging to include them in child health programs. This paper analyzes interventions to improve private practitioners’ case management of childhood diseases. It concludes that most interventions have only been tested on a small scale; few been adequately documented or evaluated. This review found that interventions that only address practitioner knowledge are unlikely to succeed. Yet realistic interventions that focus on improving a limited number of key practices consider the multiple factors influencing practitioners’ practices use local entities that are trusted by the targeted practitioners and treat practitioners as health “partners” are more likely to succeed. Considering the high proportion of sick children treated by formal and informal private practitioners often ineffectively or unsafely continuing to ignore these providers is no longer acceptable. Child health programs in general should be based on the community’s health care seeking practices. Investment in child survival programs needs to consider the sources of care used by caretakers of sick children not just public facilities. National health policies should allow for interventions that improve the quality of practice of both formal and informal private practitioners. Further testing of pilot interventions to improve the effectiveness of private practitioners’ case management of childhood illnesses should be conducted. Interventions should be conducted with sustainability and large-scale implementation in mind. Thus these interventions need to mobilize locally available resources and avoid to the extent possible injecting temporary resources. Adequate evaluation and documentation are needed to assess the impact of interventions in achieving a lasting change in the practice of private providers. This paper offers guidance for designing effective strategies to maximize child survival by improving the ability of private practitioners to provide effective treatment counseling and referral of sick children. (excerpt)