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 .
The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies.
Private pharmacies are an important source of health care in developing countries . A number of studies have documented deficiencies in treatment , but little has been done to improve practice s. We conducted two controlled trials to determine the efficacy of face-to-face educational outreach in improving communication and product sales for cases of diarrhoea in children in 194 private pharmacies in two developing countries . A training guide was developed to enable a national diarrhoea control programme to identify problems and their causes in pharmacies , using quantitative and qualitative research methods . The guide also facilitates the design , implementation , and evaluation of an educational intervention , which includes brief one-on-one meetings between diarrhoea programme educators and pharmacists/owners , followed by one small group training session with all counter attendants working in the pharmacies . We evaluated the short-term impact of this intervention using a before- and -after comparison group design in Kenya , and a r and omized controlled design in Indonesia , with the pharmacy as unit of analysis in both countries ( n = 107 pharmacies in Kenya ; n = 87 in Indonesia ) . Using trained surrogate patients posing as mothers of a child under five with diarrhoea , we measured sales of oral rehydration salts ( ORS ) ; sales of antidiarrhoeal agents ; and history-taking and advice to continue fluids and food .  We also measured knowledge about dehydration and drugs to treat diarrhoea among Kenyan pharmacy employees after training . Major discrepancies were found at baseline between reported and observed behaviour . For example , 66 % of pharmacy attendants in Kenya , and 53 % in Indonesia , reported selling ORS for the previous case of child diarrhoea , but in only 33 % and 5 % of surrogate patient visits was ORS actually sold for such cases . After training , there was a significant increase in knowledge about diarrhoea and its treatment among counter attendants in Kenya , where these changes were measured . Sales of ORS in intervention pharmacies increased by an average of 30 % in Kenya ( almost a two-fold increase ) and 21 % in Indonesia compared to controls ( p < 0.05 ) ; antidiarrhoeal sales declined by an average of 15 % in Kenya and 20 % in Indonesia compared to controls ( p < 0.05 ) . There was a trend toward increased communication in both countries , and in Kenya we observed significant increases in discussion of dehydration during pharmacy visits ( p < 0.05 ) . We conclude that face-to-face training of pharmacy attendants which targets deficits in knowledge and specific problem behaviours can result in significant short-term improvements in product sales and communication with customers . The positive effects and cost-effectiveness of such programmes need to be tested over a longer period for other health problems and in other countries
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 .