Table 3 Proposed strategies for institutionalizing linkages between the formal health system and informal health providers

Advocacy to policymakers and gatekeepers

Seminars and sensitization workshops on integration, continuous stakeholders’ engagement

Open discussions on integration to ensure transparency

Mapping of informal providers in urban slum areas

Formalization of linkages with informal service providers involves obtaining information on who informal providers are, where and how they are operating

Mapping and categorization of informal providers in urban slums (e.g. PMVs, TBAs, TMPs, Bone setters, etc.) to help regulate their practices and control profusion of quacks questionable remedies.

Registration and accreditation

Creation of a legitimate association whose functions includes registration, renewal of licenses and accreditation

Creation of a legitimate board whose functions includes registration, renewal, accreditation, and discipline of defaulters

Training and certification

Training of informal providers on preventive care, data collection and client referrals. Encouraged certified training programmes for informal service providers

Training and re-training of informal service providers on rapid diagnostic tests, drug resistance, midwifery, early warning signs and emergency care, record keeping and infection prevention. Training should be based on curriculum and certified for only registered members

Engagement in service delivery

Involving the informal providers in curative care in very remote areas where there are no functional primary health centers. Standard referral protocols are encouraged

Advocates for more official recognition and support as contributors to health service delivery. (e.g. creation of unit in the Ministry of Health to coordinate and provide link with Informal sector, formal employment as a cadre of health workers in public service, a government-sponsored hospital complex for informal health providers)

Monitoring and supportive supervision

Activities of informal providers should be properly monitored and supervised by the Ministry of Health and other relevant agencies

Expressed preference for supportive supervision devoid of criticisms, condemnation or disparagement by Ministry of Health and relevant agencies

Platforms for communication

Monthly/quarterly meetings to facilitate referrals from informal providers to the formal providers. Monthly meetings were encouraged

Establish communication and open discussion channels between the formal and informal sectors for knowledge and idea sharing