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Table 1 Overview of the studies and their main findings

From: From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance

No

Author, Year

Country

Scale of the study

Sample size

Response rate

Main findings and recommendations

1

Agrawal et al. 2012

Malaysia

Klang region

238 private practitioners

61%

• Implementation of an educational intervention to introduce details of pharmacovigilance into in undergraduate medical curriculum

2

Ahmadi et al. 2012

Iran

Provincial

16 disease managers for focus groups, 9 in-depth semi-structured interviews

100%

• Establishing an appropriate and simple notification process

• Training human resources in disease notification

• Offering incentives, privileges, and creating a positive perception of disease reporting

• All solutions improve when implemented along with a proper and feasible law to determine the jurisdiction, rights, liabilities, and incentives for stakeholders

3

Ambe et al. 2005

India

City: Mumbai

All relevant providers in the RNTCP by identifying suitable roles in DOTS delivery for various providers

NA

• Coordinate involvement of private sector health care providers in an individualized manner due the heterogeneity of the sector

4

Arora et al. 2003

India

City: three areas in Delhi

200 patients for patient survey, 18 private practitioners; 101 cases for treatment outcome

Not mentioned

• Involvement of medical associations

• Funding for programmes by the government

• Keep it simple

5

Artawan Eka Putra et al. 2013

Indonesia

District: two districts in Bali

181 practitioners

90.5%

• Credit point system for participation

• Personal contact

• Continuous supervision

6

Barakat et al. 2011

Morocco

National

2007–08: 997 influenza cases and 403 severe acute respiratory illnesses; 2008–09: 1252 and 450 cases respectively

NA

• Important to include the private sector in syndromic surveillance especially when major part of care is provided by them

• Even when surveillance was enhanced to include private practitioners the rate of detection remained low

• Training of practitioner is necessary to improve sensitivity and specificity of diagnosis

7

Caminero & Billo 2003

South America a

National

600 private practitioners

Not mentioned

• Training is the single most important factor

• Work towards change of attitudes

• Supervision

8

Chadha et al. 2014

India

District

8 Departments of a private medical college, 83 nursing homes, 131 peripheral health institutes; and 1766 cases

Not mentioned

• Awareness building

• Government rules for case notification by private practitioners

• Assistance in diagnostics and case notification, and documentation of treatment outcome

9

Chakaya et al. 2008

Kenya

City: Nairobi

46 private hospitals

57%

• Prepayment scheme as a case-holding tool

10

Chengsorn et al. 2009

Thailand

National

59 public and 26 private health care facilities and 7526 patients records.

Not mentioned

• Academic detailing’ (university-based educational outreach)

11

Chughtai et al. 2013

Pakistan

National

Number of practitioners is not mentioned

NA

• None explicit mentioned, implicitly: ensure continuous funding to support disease notification

12

Creswell et al. 2014

Pakistan

City: two cities

89 GPs and one outpatient dept. 529,447 patients

Not mentioned

• Add a new task/person or screeners in high disease burden areas

13

Daniel et al. 2013

Nigeria

State

8425 patients registered in 2011

34% in public and 1.5% private

• Provision of training and drugs for involving practitioners in a TB program (which also includes reporting activities)

14

Dowdy et al. 2013

Pakistan

City: two areas in Karachi

TB cases: 1569 (2010) pre intervention and 3140 (2011) post intervention; in the control area: 876 and 818 cases in the respective years

NA

• No recommendation on how to include private practitioners, just underlining the need to search for innovative approaches

15

Isabriye 2006

Uganda

District

109 managers, private sector providers and key informants

100%

• Ensure that all clinics and drug shops are registered and manned by qualified staff.

• Identify and train nursing assistants to carry out the IDS activities (task shifting)Organize continuing professional development (CPD) courses on surveillance to improve knowledge regularly

• Print and disseminate Information, Education and Communication (IEC) materials on regular basis.Regular supervision

16

John et al. 2004

India

State

NA

NA

• With participation of private practitioners district level disease surveillance system was highly successful and enabled detecting disease clustering at the start of an outbreak

• Post card based disease reporting method is effective for capturing clusters of disease outbreaks

• Success factors: ease of reporting, sense of contribution to the society, regular feedback through monthly disease summary bulletins

17

Khan et al. 2006

Pakistan

City: two slum areas in Lahore

5540 children 2–16 years and 5329 samples tested for microbiology

96%

• Cooperation of private practitioners is essential for complete detection of cases

18

Khan et al. 2012

Pakistan

City: two areas in Karachi

Screeners assessed 388,196 individuals at family clinics and 81,700 at Indus Hospital’s outpatient department

NA

• Engagement of intermediaries such as community members and larger hospitals as drivers of case detection

• Create effective links between the public sector, private practitioners, and communities, which may include screening by community members and mass communication campaigns

19

Krishnan. 2006

India

Sub-district

146 private practitioners

72%

• Alternative healers play important role in India as private healthcare providers.

• Non-involvement of the informal sector would mean large burden is missed.

• They also show greater interest in working with the government, primarily because it may indirectly sanction their presence.

• Involving RMPs from urban areas had more returns than from rural areas.

20

Lal 2011

India

City: 14 cities

>80,000 cases of TB

NA

• Up scaling of pp. involvement is needed; crucial: continuous mapping/registration of facilities

• Continuous training with standardised material

• Focus on those who expressed interest

• Proactive programme officers (public health sector)

21

Lau et al. 2011

China

City: Hong Kong

247 GPs, 14 Obstetrics and Gynecology doctors and 16 Skin and Venereal Disease Specialists

27.6% for GP, 11.2% for O&B and 39.0% SVD.

• Inclusion of private practitioners in sexually transmitted disease surveillance systems can improve completeness and accuracy of reported data, which has important implications for the prevention of such diseases

22

Masjedi et al. 2007

Iran

City: Tehran

646 cases that were diagnosed as positive in the labs were followed up

NA

• Performance of the private sector should be regularly evaluated

• Communications between private and public sector should be strengthened for better case notification

23

Maung et al. 2006

Myanmar

Division: Mandalay

NA

NA

• Success factors in increasing case notification through involvement of private practitioners in case notification were strong managerial support, a well-developed local medical organization, training and supervision by the public sector, and provision of free drugs and consumables

24

Naqui et al. 2012

Pakistan

City: several towns of Karachi

94 GPs from the selected towns, and 309 enrolled patients

37.50%

• Greater regulation of private practitioners to set standard guidelines

• Sustained government support, and a two-way feedback mechanism from health providers necessary

25

Newell 2004

Nepal

City: Lalitpur

759 patients registered in first 24 months

67%

• Not all private practitioners need to be involved in regular surveillance.

• Sentinel surveillance can work best involving larger hospitals

• Provide guideline booklets

26

Palave et al. 2015

India

Sub-district: Rahata, Ahmednagar, Maharashtra

148 private practitioners

96.6% for visits/interview; 89.1% for workshop

• Strengthening of public-private partnerships through the provision of free materials, incentives, and periodic modular training in disease notification and treatment

27

Pethani et al. 201

Pakistan

City: six towns of Karachi

94 GPs, 23 Union Councils in the 6 towns. 389 patients

Not mentioned

• The use of contact screening to increase further case detection by private practitioners

• Legislative approach to enforce the participation of private practitioners to participate in public-private initiatives after they have received training

28

Phalkey et al. 2015

India

City: Pune

258 private practitioners

86%

• Simplified reporting mechanisms (preferably electronic formats)

• Providing clear guidelines and reporting procedures.

• Organizing CMEs to strengthen practitioner knowledge and awarding CME points to those who report cases regularly are feasible solutions and should be piloted

29

Philip et al. 2015

India

District: Alappuzha, Kerala

169 private practitioners in quantitative and 34 in qualitative component

80% for quantitative; 94.4% qualitative

• Consistent motivational and attitudinal building (both private and public) to ensure compliance

• Demonstrating disease notification as a mode of disease control to private practitioners

• Targeting specialists in private hospitals for involvement in case notification

• Behavioural changes such as timely dissemination of policy changes, and soft skills training, and improvement of interpersonal skills

• Involvement of a liaison officer dedicated to public-private coordination

30

Portero et al. 2003

Philippines

National

1355 private practitioners

57.9%

• Awareness building among private practitioners (responsibility)

• Establish a network with well-trained practitioners

• Establish clear treatment and referral structures (also from private to public sector in the case of TB)

31

Quy et al. 2003

Vietnam

City: 22 districts of Ho Chi Minh City

30 practitioners

96.6%

• Involvement of private practitioners through training and distribution of referral forms

• Introduction of financial incentives for private practitioners

• Supervision of private practitioners

32

Rangan et al. 2003

India

City: Mumbai

NA

NA

Improvement of the quality of care, e.g., through training in patient - health care provider interaction

33

Sarkar et al. 2012

India

Sub-district: Alipurduar, Jalpaiguri, West Bengal

6191 cases of malaria; 336 cases of severe malaria

NA

• Further research to identify the reasons for under reporting (burden of paper work, unfamiliarity with notifiable diseases, etc.)

• An annual review of case records at facilities to identify unreported deaths and enhance completeness of reporting

34

Shinde et al. 2012

India

City: seven health posts of municipal ward, Mumbai

104 private medical practitioners (PMP)

Not mentioned

• Greater emphasis by public health agencies on legal and public health basis for reporting conditions

• Training private practitioners to report the presumptive as well as confirmed cases of diseases under surveillance

• Use of appropriate software for paperless communication in case reporting

• Encourage the use of standard the prescribed formats for reporting by private practitioners

• Provision of private practitioners with periodic telephonic communication and alert messages regarding notification

35

Singh et al. 2015a

South Africa

National

NA

NA

• Considerable education and relationship building exercises necessary

• Stakeholder consultation essential for common understanding and shared vision

• Large hospitals more compliant than independent practitioners

• Despite legislation reporting is poor

• Absence of electronic data biggest challenge

• Peer networking e.g. Senior Oncologist to champion the cause of case reporting

•

36

Srivastava et al. 2011

India

District: Gwalior

200 allopathic private practitioners

Not mentioned

• Regular upgrade in knowledge

• Provision of additional benefits to the private practitioners to increase the rates of notification

37

Tan et al. 2009

Taiwan

National

15 of 26 counties/cities selected, 1093 private practitioners

87.4%

• Modify doctor’s attitude to disease reporting

• Developing a convenient and widely-accepted reporting system (phone reporting where possible)

• Establishing reward/penalty system essential in improving reporting compliance in private doctors.

38

Yeole et al. 2015

India

City: Pimpri Chinchwad Municipal Corporation(PCMC) area, Pune

831 for the quantitative, 24 for qualitative

64% for quantitative and 100% qualitative

• Provision of training for private practitioners

• Targeted media communication campaigns

• Establish alternative mechanisms for notification (to facilitate notification), e.g., internet and mobile telephones, to save the time spent on notification

39

Yimer et al. 2012

Ethiopia

Region: Amhara

112 private practitioners

77%

• Regular training

• Feedback and mutual information between private sector and referral institutions in the public sector

40

Zafar Ullah et al. 2012

Bangladesh

City: four areas in Dhakacity; later scaled up to twomajor cities

97 PMPs in 2004, 703 at the end of 2009

100%

• Provision of training

• Provision of tools and protocols

• Mutual trust

  1. aMexico, El Salvador, Honduras, Guatemala, Nicaragua, Peru, Dominican Republic, Costa Rica, Bolivia