Abstract
Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector. To address this gap we conducted a comprehensive literature review on the informal health care sector in developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for data abstraction. Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on quality is notably incomplete and poor quality of care is generally assumed. There was a wide variation in how quality of care is measured. The review found that IPs reported inadequate drug provision, poor adherence to clinical national guidelines, and that there were gaps in knowledge and provider practice; however, studies also found that the formal sector also reported poor provider practices. Reasons for using IPs included convenience, affordability, and social and cultural effects. Recommendations from the literature amount to a call for more engagement with the IP sector. IPs are a large component of nearly all developing country health systems. Research and policies of engagement are needed.
Highlights
In many developing nations, the informal sector provides the bulk of health care, for the poor [1]
Informal providers represent a significant portion of the healthcare system
This review is the first comprehensive view of studies focusing on the size, scope, and quality of informal providers (IPs), and is timely given this growing sector of the health system
Summary
The informal sector provides the bulk of health care, for the poor [1]. Defining Informal Provider While the precise definition of the term ‘‘informal health care providers’’ is inconsistent across studies [2] and we found no developed typology in the literature, we provide a working definition in order to identify relevant studies. We used a flexible set of criteria as opposed to specific delineations for characteristics such as duration of training or group membership. Such rigid definitions are inappropriately constrictive in light of significant contextual variation. To be classified as such, IPs must meet our first criteria below, and at least two of the remaining three criterion
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