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 .
[Adhesion of physicians to the national malaria policy: situation in Antananarivo (Madagascar), 5 years after the policy revision].
Our goal was to evaluate and analyze physicians ' adherence  to the national malaria policy in Antananarivo , 5 years after its revision . This prospect i ve descriptive study was conducted in public and private health centers in Antananarivo in 2010 , from May 1 to June 30 . Adhesion to the new policy included adoption of the rapid diagnostic test for malaria ( RDT ) and /or microscopy as diagnostic methods and prescription of artemisinin-based combination therapy ( ACT ) as first-line treatment for uncomplicated malaria . A question naire was used to collect data from 106 physicians . Their average age was 43.9 years ( range : 26 to 59 years ) . The male-female sex-ratio was 0.59 . Physicians trained in using RDTs were confident in this means of diagnosis ( p < 10(-4 ) ) . Prescription of ACT by physicians was associated with their participation in malaria training ( p = 0.02 ) . Only 2/3 of the physicians adhered to the current policy . Adherence increased with trust ( p < 10(-4 ) ) , availability of RDT ( p < 10(-5 ) ) , and training about the policy . Physician adhesion , training and confidence are essential to this policy and to changing physician behavior . Improvement of the health system is also needed
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 .