The effectiveness of supervision strategies to improve health care provider practices in low- and middle-income countries: secondary analysis of a systematic review.

Background: Although supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives of this study are to describe the effect of supervision strategies on HCP practices in LMICs and to identify attributes associated with greater effectiveness of routine supervision.

Methods: We performed a secondary analysis of data on HCP practice outcomes (e.

The effectiveness of training strategies to improve healthcare provider practices in low-income and middle-income countries.

Introduction: In low/middle-income countries (LMICs), training is often used to improve healthcare provider (HCP) performance. However, important questions remain about how well training works and the best ways to design training strategies. The objective of this study is to characterise the effectiveness of training strategies to improve HCP practices in LMICs and identify attributes associated with training effectiveness.

Identifying the most effective essential medicines policies for quality use of medicines: A replicability study using three World Health Organisation data-sets.

Background: Poor quality use of medicines (QUM) has adverse outcomes. Governments' implementation of essential medicines (EM) policies is often suboptimal and there is limited information on which policies are most effective.

Methods: We analysed data on policy implementation from World Health Organisation (WHO) surveys in 2007 and 2011, and QUM data from surveys during 2006-2012 in developing and transitional countries.

A systematic review of the effectiveness of strategies to improve health care provider performance in low- and middle-income countries: Methods and descriptive results.

Background: Health care provider (HCP) performance in low- and middle-income countries (LMICs) is often inadequate. The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of the effectiveness and cost of strategies to improve HCP performance in LMICs. We present the HCPPR's methods, describe methodological and contextual attributes of included studies, and examine time trends of study attributes.

Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review.

Background: Inadequate health-care provider performance is a major challenge to the delivery of high-quality health care in low-income and middle-income countries (LMICs). The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of strategies to improve health-care provider performance in LMICs.

Methods: For this systematic review we searched 52 electronic databases for published studies and 58 document inventories for unpublished studies from the 1960s to 2016.

Promoting quality use of medicines in South-East Asia: reports from country situational analyses.

Background: Irrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low. The aim was to determine whether public-sector QUM is better in SEAR countries implementing essential medicines (EM) policies than in those not implementing them.

Methods: Data on six QUM indicators and 25 EM policies were extracted from situational analysis reports of 20 country (2-week) visits made during 2010-2015.

Antibiotic use in South East Asia and policies to promote appropriate use: reports from country situational analyses.

discuss findings from a rapid assessment of antibiotic use and policies undertaken by South East Asian countries to drive further actions to reduce inappropriate use

The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics.

Background: Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries.

Aims: To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies.

Materials And Methods: Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared.

WHO essential medicines policies and use in developing and transitional countries: an analysis of reported policy implementation and medicines use surveys.

Background: Suboptimal medicine use is a global public health problem. For 35 years the World Health Organization (WHO) has promoted essential medicines policies to improve quality use of medicines (QUM), but evidence of their effectiveness is lacking, and uptake by countries remains low. Our objective was to determine whether WHO essential medicines policies are associated with better QUM.

Prescribing for acute childhood infections in developing and transitional countries, 1990-2009.

Background: Evidence of global progress in treating acute paediatric infections is lacking.

Objectives: To assess progress over two decades in prescribing for childhood infections and interventions to improve treatment by reviewing empirical evidence in developing and transitional countries.

Methods: Data were systematically extracted on the use of medicines for diarrhoea, respiratory infections and malaria from published and unpublished studies (1990-2009) in children under 5 years of age.

Patterns of antibiotic use in the community and challenges of antibiotic surveillance in a lower-middle-income country setting: a repeated cross-sectional study in Vellore, South India.

Objectives: There is considerable evidence linking antibiotic usage to bacterial resistance. Intervention strategies are needed to contain antibiotic use and thereby resistance. To plan appropriate strategies, it is imperative to undertake surveillance in the community to monitor antibiotic encounters and drivers of specific antibiotic misuse.

Combating inappropriate use of medicines.

Globally, it is possible that less than half of all patients are treated in compliance with guidelines and more than half of all patients fail to take their medicines as prescribed or dispensed. Such inappropriate use is wasteful of resources and causes patient harm in terms of lack of satisfactory outcome, serious adverse events and increased antimicrobial resistance. Combating inappropriate use of medicines involves four major steps: measuring the use of medicines; identifying the determinants of inappropriate use; developing, implementing and evaluating the impact of interventions to improve the use of medicines while taking into account the factors underlying inappropriate use; and working towards an enabling policy framework that encourages appropriate use.

Does shortening the training on Integrated Management of Childhood Illness guidelines reduce its effectiveness? A systematic review.

Objective: Implementation of the Integrated Management of Childhood Illness (IMCI) strategy with an 11-day training course for health workers improves care for ill children in outpatient settings in developing countries. The 11-day course duration is recommended by the World Health Organization, which developed IMCI. Our aim was to determine if shortening the training (to reduce cost) reduces its effectiveness.

Community intervention to promote rational treatment of acute respiratory infection in rural Nepal.

Objective: To evaluate a community education program about treatment of acute respiratory infection (ARI).

Methods: First, community case definitions for severe and mild ARI were developed. The intervention was then evaluated using a controlled before-and-after design.

The effect of user fees on prescribing quality in rural Nepal: two controlled pre-post studies to compare a fee per drug unit vs. a fee per drug item.

Objective: To compare prescribing quality with a fee per drug unit vs. a fee per drug item.

Methods: Prescribing data were collected prospectively over 10 years from 21 health facilities in two districts of rural eastern Nepal.

The influence of user fees and patient demand on prescribers in rural Nepal.

Irrational prescribing and over-prescription is a world-wide problem. Prescribers often cite patient demand as one of the main reasons why they over-prescribe, but the degree to which this is so is unknown. This article describes a study to test the hypothesis that patient demand causes over-prescription.