A comparison of the quality of care provided and the rational use of drugs in rural public health facilities and private shops

Abstract

The problem of insufficient funding undermining health care in Nepal has led to
greater emphasis being placed on the private sector for service delivery. This study
compared the quality of service provided by primary health care public facilities and
private shops (the main private primary health care alternative) in rural remote areas of
hilly E. Nepal. A cross-sectional survey was done and WHO indicators used. It was
found that public facilities provided better access and value for money than shops.
Provided adequate levels of drug availability were maintained, public primary health
care facilities offered better quality of care than private shops, where there was often
misuse of drugs particularly antibiotics due to irrational self-medication or patients not
buying what they had been prescribed. However, in many public facilities (not
supported by any agency apart from HMG) drug availability was poorer than in the
larger shops, leading to a similar misuse of drugs, especially antibiotics, as occurred
in shops. When considering strategies to decrease the misuse of antibiotics it may be
easier to address poor drug availability in public facilities than change patient-retailer
behaviour in shops. The poor dispensing process and large number of people not
knowing how to take their drugs are two serious problems, needing urgent action, in
both the public and private sectors.