Utilizing the potential of formal and informal private practitioners in child survival in Uganda : situation analysis and outline for developing a national strategy

However, less than half of Uganda"s 20 million people have access to these facilities, and the overwhelming majority prefer to seek care for their sick children from formal and informal private practitioners. The situation analysis summarized in this document revealed that the sources of outside home care for children with fever, acute respiratory illness (ARI), and diarrhea are mainly private clinics, drug shops, ordinary shopkeepers, and pharmacies. While laws to regulate private practitioners exist, the capacity of government regulating councils and authorities is limited. An estimated 65% of private practitioners are not registered. Even when registered, drug shops and private clinics are often operated by unqualified staff. The quality of case management offered by private practitioners for childhood illness is poor, with major deviations from the national clinical standards for malaria, diarrhea, and ARI. Despite this poor quality, public perception of private practitioners" services is favorable. Formal and informal private practitioners are accessible, courteous to their clients, have medicine, and will dispense it on credit. Reaching private practitioners, especially informal practitioners in remote rural areas, with messages and interventions is challenging. Identified channels include: professional associations, NGOs, community-based organizations (CBOs), district health teams, pharmaceutical companies, drug distribution networks, and mass media. In Uganda, interventions to improve the quality of care given by private practitioners are limited and do not form a cohesive strategy. It is recommended that a national strategy be developed to improve case management of childhood illness by formal and informal practitioners, and that the strategy have two components: (1) a policy component to review regulations, registration procedures, limitations to enforce regulations, and apply modifications to close the existing gap between regulations and practice; and (2) a field intervention component to develop and test effective and sustainable interventions on a large scale. Adopted interventions need to consider other countries" experiences, particularly a focus on improving private practitioners" actual practices, not just their knowledge and use of innovative techniques of persuasion and negotiation for behavior change. (Author abstract, modified)