'Tackling theshortage of  HRH :Are Informal Health Providers the solution?'Examples of health sector engagement with informal providers.

14:00-16:00.

Organized by NHRHO Asma ElSony

Modified from Prof S Bertel “Bertie” Squire Feb 2013 Presentation on Triage-Plus Dissemination Meeting, NHRHO Khartoum, and personal experience

Overview1. Experience with engagement of informal providers in

health care prior to Triage-Plus

People the asset for Investment S Africa Kenya Malawi

2. Recent systematic review on the role of informal providers in developing countries

3. Conclusions

European UnionTotal FDI: 52% of world total

USA (Total FDI: 21% of world total

Japan (Total FDI: 5% of world total

Concentration of global FDI

Source: based on data in UNCTAD, 2001

Diversity of total FDI inflows within the developing world

Source: United Nations Conference on Trade and Development (UNCTAD) Online Databases, Feb. 2006

WB Report 1993Health

Health is essential for growth and economic development and access to sustainable development

• The remarkable improvement in health in E Asian countries & miracle on health Performance indicators, was due to the accumulation of Human Capital Through education info and K and investing in Health.

• Addressing health policy , issues of health as an inclusive right is not limited to the provision of appropriate health care in a timely manner , but also to provide underlying determinants of health, to ensure the active participation, in economy & development.

From a TB Unit to …The STOP TB Partnership

The STOP TB Partnership with the aim to improve global tuberculosis (TB) control through expanding accessto the Union’s model of directly observed treatment short course (DOTS) strategy.

Advocated the approach of 'Engaging all Care Providers in the EDS.

0

5

10

15

20

25

30

0-14 15-24 25-34 35-44 45-54 55-64 65<=

age group

% o

f p

atie

nts

dia

gnos

ed i

n

the

hea

lth

fac

ilit

yReferral hospitals PHC facilities

Figure 1: Age distribution in health institutions

Asma ElSony, MD, DTCD PhD,1& Gunnar Bjune, M.D., PhD,

0100020003000400050006000700080009000

1997 1998 2000 2001

No.

of

pati

ents

Referal hospital PHC facilities

Figure 2: Case finding in health facilities

Asma ElSony, MD, DTCD PhD,1& Gunnar Bjune, M.D., PhD

0102030405060708090

1997 1998 1999 2000

% o

f ca

ses

Referral hospitals PHC facilities

Asma ElSony, MD, DTCD PhD,1& Gunnar Bjune, M.D., PhD

Figure 3: Trend in location of diagnosis in women

0

10

20

30

40

50

60

70

80

0-14

15-24

25-34

35-44

45-54

55-64

65<% o

f p

atie

nt

dia

gnos

ed in

PH

C f

acil

itie

s

1997199819992000

Asma ElSony, MD, DTCD PhD,1& Gunnar Bjune, M.D PhDs.,

Figure 4: Age distribution in PHC facilitie (1997-2000)

Hlabisa 1991-1995

Formal Sector health workers least effective supervisors (79% completion)

Laypeople (85%), CHWs (88%) or Storekeepers (84%)(p=0.0008)

South Africa – who observes TB treatment (DOT supporters)

Kenya – improving malaria home treatment Over the C

3 districts Kenya–: random allocation to the Intervention (Training Private AM sellers): improving malaria home treatment

PMV Practice Pre & Post Intervention for simple and Complicated Malaria, simulate visits 2003, 2004

44

25

45

49 43

46

47

3

35

36

56

23

38

50

57

24

7

1

29

29

10

8

22

18

34

21

30

6

5

12

37

39

14

433

41

16

28

20

17

32 1315

48

40

3142

11

0 1 2 3 4 5 Kilometers

Population %with Secondary Education

Pop < 100

Secondary Education

Source: 1998 National Census

0 - 6

7 - 23

25 - 30

31 - 47

44

25

45

49 43

46

47

3

35

36

56

23

38

50

57

24

7

1

29

29

10

8

22

18

34

21

30

6

5

12

37

39

14

433

41

16

28

20

17

32 1315

48

40

3142

11

0 1 2 3 4 5 Kilometers

Percentage of Householdswith Private Piped Water

Private Piped Water

Source: 1998 National Census

0 - 20

21 - 40

41 - 60

61 - 80

81 - 100

Poverty indicators/area – Lilongwe (Malawi)

n=179 patients

Poverty measured against Integrated Household Survey (IHS) - 72% poor

Patient costs for TB diagnosis (US$)[Urban] When a woman or when the poor are sick, the opportunity costs faced by their households are greater.

•On average, patients spent 13 US$ or 18 days’ income; lost 22 days from work while accessing a TB diagnosis.

•For non-poor patients, the total costs amounted to 129% of total monthly income, or 184% after food expenditures.

• For the poor, this cost rose to 248% of monthly income or 574% after food.

Patients made multiple visits to store-keepers

Terms for Informal Providers

Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D (2013) What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review. PLoS ONE 8(2): e54978. doi:10.1371/journal.pone.0054978http://www.plosone.org/article/info:doi/10.1371/journal.pone.0054978

Conclusions

1. Informal providers can provide a bridge between poor patients and formal health services for a variety of health care issues

2. More work needed to build consensus on definition of informal provider and understanding of most effective role in health care provision

3. Growing momentum to use robust, randomised intervention designs to further develop and test effectiveness and cost-effectiveness of engaging informal providers

Thank you