Utilizing the Potential of Formal and Informal Private Practitioners in Child Survival

Foreword Over the past decade, significant progress has been made in reducing childhood mortality in developing countries. Childhood mortality rates have declined from 97 per thousand live births in the early 1980s, to 67 per thousand live births in 1999. But in developing countries—especially those in sub-Saharan Africa and South Asia—children continue to die in large numbers. An estimated 10.9 million childhood deaths occurred in the year 2000. Strategies such as maternal and childhood immunization and the Integrated Management of Childhood Illness (IMCI) have contributed to this reduction in childhood mortality. The IMCI strategy was developed by WHO and UNICEF in 1996, working in conjunction with several partner organizations. Five years later, it is being applied in over eighty countries around the world. There is a widespread acknowledgement that increased efforts are needed to scale up the application of these effective strategies. Alongside this, there is growing recognition that this cannot be done by the public sector alone. There is emerging consensus that efforts to strengthen public sector health systems to provide essential packages of health services need to be complemented with efforts to harness the growing strength and reach of health care providers in the private sector. Virtually all the world's countries have a range of private practitioners providing health services to children and other segments of the population. Studies suggest that these private practitioners are used by both the rich and the poor. Studies also suggest that especially in developing countries, mechanisms to ensure information exchange and collaboration between government bodies and practitioners in the private sector are weak, and need to be strengthened. As a result, in these countries there is a huge, largely unregulated resource which is not being utilized effectively to contribute to national child survival initiatives. This review and discussion paper by Dr. Youssef Tawfik is a timely one. It highlights the important role that private practitioners are already playing in providing health services to children in many countries, and the far greater contribution that they could be called upon to make. It provides a synthesis of experiences gained and lessons learned in initiatives around the world, to reach out to private practitioners and to work with them to improve and sustain the quality of care that they provide. And it points to what could be done by national authorities and international agencies to actively involve private practitioners as partners in child survival initiatives. …