What are the roles, actions and positions of non-formal biomedical prescribers and providers in developing countries? A systematic literature review

Master's Thesis from the year 2015 in the subject Medicine - Public Health, grade: 6.68/7, The Australian National University (College of Arts and Social Science & ANU College of Medicine, Biology and Environment), course: THES8103 Master's (Advanced) Thesis, language: English, abstract: 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.