3203.0: Monday, November 13, 2000 - 5:45 PM

Abstract #9071

Improving the IMCI Performance of Private Practitioners in Pakistan and Senegal

Robert S. Northrup, MD, Management Sciences for Health, 165 Allandale Road, Boston, MA 02130, 617 524 7799, rnorthrup@msh.org and Youssef M. Tawfik, MD, MPH, BASICS (Basic Support for Institutionalizing Child Survival), 1600 Wilson Blvd. Suite 300, Arlington, VA 22209, 703 312 6868, ytawfik@basics.org.

Background: Private Practitioners (PPs)provide health services to more than 65% of the world's children, but are often not included in efforts to achieve child survival objectives. This is particularly true for unlicenced practitioners who provide the majority of sick child care in India. PPs have been shown to provide sub-standard quality of care, but they are unlikely to attend long courses such as the 11 day IMCI course, and unlicenced practitioners are usually not invited. A practical method for assessing and improving PP's care is needed.

Methedology: Through BASICS we developed a method - PRACTION - which combines practical assessment - the Verbal Case Review (VCR), a delayed exit interview method - with a four step intervention (INFECTOM)to improve case management of sick children through: 1) providing PPs with INformation about national standards of care; 2) giving FEedback from assessment their current practices; 3) obtaining behavioral "ConTracts" for specific practices; and 4)conducting Ongoing Monitoring by repeating the VCR. The full method was implemented in Pakistan and we have initiated assessment and will have initiated intervention in Senegal.

Results: VCR showed a high rate of use of PPs for treating sick children compared to public sector nurses or doctors, with unlicenced doctors and drug sellers providing majority of care. The interventions in Pakistan proved statistically significant improvements in case assessment, treatment and counseling.

Conclusion: PRACTION is a feasible method for assessing and improving PPs care. The method needs to be assessed in a wider varity of providers and in different cultural settings.

Learning Objectives: By the conclusion of the session, participants will: 1. Understand the characteristics of private practitioners and their quantitative role in child health. 2. Describe methods for assessing the quality of sick child care and for intervening to improve it. 3. Learn about improvements in IMCI performance in Pakistan

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: The presented paper is based on work conducted by BASICS (Basic Support for Institutionalizing Child Survival), funded by USAID; the Agha Khan University; and Health & Nutrition Development Society, Pakistan
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA