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 .
Background Governments use different approaches to ensure that private for‐profit healthcare services meet certain quality st and ards .
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 .
A Cluster Randomised Trial Introducing Rapid Diagnostic Tests into Registered Drug Shops in Uganda: Impact on Appropriate Treatment of Malaria
Background Inappropriate treatment of malaria is widely reported particularly in areas where there is poor access to health facilities and self-treatment of fevers with anti-malarial drugs bought in shops is the most common form of care-seeking . The main objective of the study was to examine the impact of introducing rapid diagnostic tests for malaria ( mRDTs ) in registered drug shops in Ug and a , with the aim to increase appropriate treatment of malaria with artemisinin-based combination therapy ( ACT ) in patients seeking treatment for fever in drug shops . Methods A cluster-r and omized trial of introducing mRDTs in registered drug shops was implemented in 20 geographical clusters of drug shops in Mukono district , central Ug and a. Ten clusters were r and omly allocated to the intervention ( diagnostic confirmation of malaria by mRDT followed by ACT ) and ten clusters to the control arm ( presumptive treatment of fevers with ACT ) . Treatment decisions by providers were vali date d by microscopy on a reference blood slide collected at the time of consultation . The primary outcome was the proportion of febrile patients receiving appropriate treatment with ACT defined as : malaria patients with microscopically-confirmed presence of parasites in a peripheral blood smear receiving ACT or rectal artesunate , and patients with no malaria parasites not given ACT . Findings A total of 15,517 eligible patients ( 8672 intervention and 6845 control ) received treatment for fever between January-December 2011 . The proportion of febrile patients who received appropriate ACT treatment was 72·9 % versus 33·7 % in the control arm ; a difference of 36·1 % ( 95 % CI : 21·3 – 50·9 ) , p<0·001 . The majority of patients with fever in the intervention arm accepted to purchase an mRDT ( 97·8 % ) , of whom 58·5 % tested mRDT-positive . Drug shop vendors adhered to the mRDT results , reducing over-treatment of malaria by 72·6 % ( 95 % CI : 46·7– 98·4 ) , p<0·001 ) compared to drug shop vendors using presumptive diagnosis ( control arm ) . Conclusion Diagnostic testing with mRDTs compared to presumptive treatment of fevers implemented in registered drug shops substantially improved appropriate treatment of malaria with ACT . Trial Registration Clinical Trials.gov NCT01194557
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 .
Background Governments use different approaches to ensure that private for‐profit healthcare services meet certain quality st and ards .
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 .