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December 1999 Insights Issue #32Fighting malaria in urban IndiaPublic and private sector stakeholders join forcesMany diseases that most endanger public health are now being dealt with by private sector providers rather than public sector or not-for-profit agencies. This shift is especially marked in South and Southeast Asia where even the poor usually choose private services. Policymakers can no longer afford to ignore private healthcare's potential for achieving - or undermining - public health goals. Studies in Surat, India by researchers from the Government Medical College, Surat and the London School of Hygiene and Tropical Medicine have forged new cross-sector linkages for better malaria control. The research hinged on developing a process for understanding the prevailing policy context, attitudes and concerns of health professionals. It simultaneously canvassed service user viewpoints and assessed service quality, to influence professional behaviour for the better. Researching quality of care was not the sole object of the exercise. No less important was active engagement with all relevant stakeholders from the outset. A working assumption was that the business of identifying feasible and acceptable policies should be carried out in parallel with - not as an afterthought to - other strands of the research. Otherwise, powerful independent stakeholders would pay no heed to pleas from researchers to change their ways |
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| The project has been framed around
two parallel and related research activities, namely inquiries into
quality of care and a systematic stakeholder engagement process. Quality
of care provided by different types of qualified and unqualified private
providers was assessed, using technical criteria: facility assessments,
provider knowledge and reported practices, together with perceptions of
patients on the quality of the treatment.
The stakeholder engagement process (see chart) identified stakeholder concerns and priorities and prompted interactions between stakeholders and providers in a search for agreed strategies to promote service quality. A neutral broker - the research team - was essential to facilitating interactions and building trust. The process started with open-ended interviews with representatives of provider organisations and policymakers to identify problems and potential solutions. Stakeholder questionnaires were then used to assess the views of different groups on the range of strategies proposed. The process highlighted the need for inter-organisational encounters where consensus and differences could be discussed and priorities collectively agreed. This led to the establishment of a number of technical advisory groups (TAGs), bringing together representatives of 13 relevant organisations, where initial baseline research results were presented. TAG participants agreed priority areas for strategy development such as:
The project has piloted an innovative process, developed tools, and identified mechanisms for bringing policy makers and private sector providers together. It depends on building confidence and trust between stakeholders, sharing perspectives, and flexibility in time-lines and resource usage. It is a non-threatening process for identifying and agreeing the respective roles each can play in improving the management of an important public health condition which could have wide applicability.
Contributor(s): Anthony Zwi, Ruairķ Brugha and Daniel Chandramohan, Vikas Desai Source(s): Funded by: DFID, LSHTM Malaria Control and Research Project Date: 13 December 1999 Further information: Ruairí Brugha Vikas Desai Search Eldis for sources on Health and Population issues |
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