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 clinical training unit for diarrhoea and acute respiratory infections: an intervention for primary health care physicians in Mexico.
In Tlaxcala State , Mexico , we determined that 80 % of children who died from diarrhoea or acute respiratory infections ( ARI ) received medical care before death ; in more than 70 % of the cases this care was provided by a private physician . Several strategies have been developed to improve physicians ' primary health care practice s but private practitioners have only rarely been included . The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians . The training consisted of a five-day course of in-service practice during which physicians diagnosed and treated sick children attending a centre and conducted clinical discussion s of cases under guidance . Each training course was limited to six physicians . Clinical performance was evaluated by observation before and after the courses . The evaluation of diarrhoea case management covered assessment of dehydration , hydration therapy , prescription of antimicrobial and other drugs  , advice on diet , and counselling for mothers ; that of ARI case management covered diagnosis , decisions on antimicrobial therapy , use of symptomatic drugs , and counselling for mothers . In general the performance of public physicians both before and after the intervention was better than that of private doctors . Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course ; the proportion of private physicians who had five or six correct elements out of six increased from 14 % to 37 % : for public physicians the corresponding increase was from 53 % to 73 % . In ARI case management , decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups ; the proportion of private physicians with at least three correct elements out of four increased from 13 % to 42 % , while among public doctors the corresponding increase was from 43 % to 78 % . H and s-on training courses thus seemed to be effective in improving the practice of physicians in both the private and public sectors
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 .