This paper aims to present a systematic review of literature to identify and synthesize the existing knowledge on role, activities and position of non-formal biomedical prescribers and providers (NFBPs) in developing countries. It argues this cadre is different from two established groups: formal biomedical practitioners and informal health care providers, who usually function outside the “formal” and “informal” domain in terms of their experience, skills, training and negotiating capacity with the biomedical world of practice.
With an operational definition of practitioners who function as “Non-formal biomedical prescribers and provider” the databases searched include: PubMed, JSTOR, SocioFile, Cochrane Library, Anthropology Plus, CINAHL and PsycINFO. Grey literature were searched as well. Searches were limited to published papers since 1 January 2000, in English. A structured data appraisal sheet was used following PRISMA guidelines and applied to the papers to assess their quality.
Of 90 papers initially read, 25 were selected for inclusion in this review. The most frequently-reported activity was drug selling or prescribing without a prescription (15/25 studies). Dispensing on the basis of “floating” prescriptions (i.e. prescriptions that are kept by the patient and have become recurring tickets to receive medication) was also described. Five studies described NFBPs who provided health care (e.g. diarrheal illnesses, gynecological care, and malaria diagnosis and treatment).
The NFBP is often a pragmatic, emergent response to meet everyday primary and emergency health needs, and are imbued with community trust and reliance to provide. However they operate at the margin, and occupy a liminal space, being both medical but not-medical. Their positioning within the biomedical global medicine market is indistinct, grappling with direct and indirect influence by the pharmaceutical industry, and outside the formal regulatory mechanisms.
Sufficiently flexible and thoughtful use of socio-cultural frameworks can lead to more theoretically informed analysis of the research in systematic reviews, and clear recognition of NFBPs as an emerging distinct group needed to develop policy and effective interventions to capitalize on the existing roles and practices of non-formal biomedical prescribers and providers.
Table of Contents
Chapter One- Introduction
Background
Review objectives and questions
Rationale for systematic review on the topic
Structure of the Thesis
Chapter Two- Methods
Defining key terms “non-formal biomedical providers and prescribers” and a conceptual framework
Search strategy
Operational definitions of prescriber and provider
Database selection
Inclusion/exclusion criteria
Review procedures
Quality assessment of the papers
Data extraction, abstraction and analysis
Search results
Chapter Three- Results
Study attributes
Major issues observed in review
Typologies and definitions: scoping the practice of Non-formal biomedical prescribers or providers (NFBPs)
Qualifications of the providers and their activities
Chapter Four- Studying health workers in a pluralistic system: methodological challenges of systematic reviews
Quality assessment and synthesis of data: methodological challenges in systematic review
Confusing and unexplained terms used in the literature
What does prescription mean in developing countries?
“Self-medication” or consumer interactions in the pharmacy?
Vendors, distributors, sellers: problematic use of marketing terms in health
Non-formal Biomedical Prescriber/providers: ‘Definition dilemma’
Chapter Five- Cultural competence and theoretical approaches in positioning non-formal biomedical prescribers and providers
Cultural competency in health research:
A glance at cultural concepts as analytical frames
Habitus, Capital and Communitas: Cultural economy and NFBPs
Positioning the community in regard to NFBPs: everyday resistance
The global pharmaceutical market and NFBPs: neoliberalism in the non-formal clinic
Chapter Six- Conclusions
Research Objectives and Themes
This thesis aims to systematically review the existing literature to identify and synthesize knowledge regarding the roles, actions, and positions of non-formal biomedical prescribers and providers (NFBPs) in developing countries, distinguishing them from both formal biomedical practitioners and informal non-biomedical health providers.
- Characterization of the "non-formal" sector versus "informal" and "formal" health sectors.
- Methodological challenges in performing systematic reviews within pluralistic medical systems.
- Socio-cultural and political-economic positioning of NFBPs in the global pharmaceutical market.
- Evaluation of the quality, efficacy, and acceptability of non-formal healthcare services.
Excerpt from the Thesis
Typologies and definitions: scoping the practice of Non-formal Biomedical Prescribers or providers (NFBPs)
Most studies merged non-formal biomedical practices with all other non-biomedical (informal, alternative) practices. Seven papers did not specify any term or definitions that would be useful in identifying NFBPs, used the more general term, health care providers. Four papers used the term ‘Informal health care providers’ [17, 39, 40, 53]; among these, only one paper clarified that the term referred ‘Private informal biomedical providers’ [40]. Two papers used “primary care providers” [43, 44]. The other definitional terms used for NFBPs are
• ‘non-doctor prescribing’[46];
• ‘untrained health care provider’ [57];
• ‘private providers’[56];
• ‘unlicensed provider’[50];
• ‘unlicensed private provider’ [52];
• ‘informal for profit provider’ [37];
Summary of Chapters
Chapter One- Introduction: Presents the background of the study and the rationale for defining a distinct "non-formal" sector for health practitioners who lack formal qualifications but operate within a biomedical paradigm.
Chapter Two- Methods: Details the systematic review process, including search strategy, database selection, criteria for inclusion/exclusion, and the operational definitions used to categorize NFBPs.
Chapter Three- Results: Analyzes the 25 selected studies, highlighting the roles, qualifications, and geographical distribution of NFBPs and their common practices such as drug selling and prescribing.
Chapter Four- Studying health workers in a pluralistic system: methodological challenges of systematic reviews: Discusses the difficulties in synthesizing diverse data types and highlights the ambiguity of terms used in literature, such as "prescription" and "self-medication."
Chapter Five- Cultural competence and theoretical approaches in positioning non-formal biomedical prescribers and providers: Applies anthropological and socio-political frameworks, such as habitus, capital, and everyday resistance, to understand the positioning of NFBPs in neoliberal economies.
Chapter Six- Conclusions: Summarizes the findings and provides recommendations for policy-makers to recognize and engage with NFBPs as an emerging distinct group to improve healthcare accessibility and safety.
Keywords
Non-formal biomedical prescribers and providers, systematic review, informal providers, health care, drug sellers, prescription, liminality, communitas, developing countries, medical pluralism, pharmaceutical marketing, public health.
Frequently Asked Questions
What is the central focus of this research?
The research examines the roles, actions, and positioning of "non-formal" health workers who provide biomedical-based services in developing countries despite lacking official qualifications or formal licensing.
What distinguishes NFBPs from other informal providers?
NFBPs are characterized by their reliance on experience and training within the biomedical sector (e.g., former clinic assistants, pharmacy sellers), whereas "informal" providers often rely on traditional or non-biomedical knowledge.
What is the primary objective of this systematic review?
The primary objective is to identify and synthesize current knowledge on this cadre of workers to demonstrate that they form a distinct group that is often misclassified in existing literature.
Which methodology was employed for this study?
The author conducted a systematic review following PRISMA guidelines, searching databases like PubMed, JSTOr, Cochrane Library, and others to analyze 25 relevant papers published after 2000.
What are the key themes discussed in the main body?
The main body covers the typology and definitions of NFBPs, the methodological challenges of reviewing them in pluralistic systems, and the socio-cultural positioning of these workers relative to pharmaceutical markets and the formal health sector.
Which keywords best characterize this work?
The work is best defined by terms such as non-formal biomedical prescribers, systematic review, medical pluralism, pharmaceutical marketing, and developing countries.
How do NFBPs interact with the global pharmaceutical market?
The research suggests that NFBPs are often integrated into the pharmaceutical supply chain, acting as vital links for drug distribution, sometimes under the influence of medical representatives.
Why does the author argue that "non-formal" requires a separate definition?
The author argues that merging them with traditional or alternative healers masks their unique role as biomedical actors who are subject to different regulatory challenges and community expectations.
- Citar trabajo
- Nur Khan (Autor), 2015, What are the roles, actions and positions of non-formal biomedical prescribers and providers in developing countries? A systematic literature review, Múnich, GRIN Verlag, https://www.grin.com/document/335917
