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 .
Syndrome packets and health worker training improve sexually transmitted disease case management in rural South Africa: randomized controlled trial
Background Sexually transmitted diseases ( STD ) are important co-factors in HIV transmission . We studied the impact of health worker training and STD syndrome packets ( containing recommended drugs , condoms , partner notification cards and information leaflets ) on the quality of STD case management in primary care clinics in rural South Africa . Methods A r and omized controlled trial of five matched pairs of clinics compared the  intervention with routine syndromic management . Outcomes were measured by simulated patients using st and ardized scripts , and included the proportion given recommended drugs ; correctly case managed ( given recommended drugs plus condoms and partner cards ) ; adequately counselled ; reporting good staff attitude ; and consulted in privacy . Results At baseline , the quality of STD case management was similarly poor in both groups . Only 36 and 46 % of simulated patients visiting intervention and control clinics , respectively , were given recommended drugs . After the intervention , intervention clinics provided better case management than controls : 88 versus 50 % ( P < 0.01 ) received recommended drugs ; 83 versus 12 % ( P < 0.005 ) were correctly case managed ; 68 versus 46 % ( P = 0.06 ) were adequately counselled ; 84 versus 58 % experienced good staff attitude ( P = 0.07 ) ; and 92 versus 86 % ( P = 0.4 ) were consulted privately . A syndrome packet cost US$ 1.50 ; the incremental cost was US$ 6.80 . The total intervention cost equalled 0.3 % of annual district health expenditure . Interpretation A simple and affordable health service intervention achieved substantial improvements in STD case management . Although this is a critical component of STD control and can reduce HIV transmission , community-level interventions to influence health-seeking behaviour are 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 .