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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
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