Dear Neil, Eid el Fitr to you and all Muslim friends.
As you certainly expect I disagree with your view of 'let's allow the health center to generate money as a vital contribution towards the cost...'.
See your country or mine: how do private clinics make money? By selling drugs? No, it wouldn't be allowed. For drugs we 'invented' pharmacies, private as well but separated from the prescriber, physically and as profit source.
Let me add another aspect: laboratory tests. Most clinics in lmic enjoy a small laboratory where diagnosis is made through rapid tests (strips). Mind you that Widal test (WT)is one of the most requested and performed?
Found positive (or 'slightly positive' as it happened to me to read) and therefore requiring 10 days of treatment i.e drugs sold (again!) within the premises?
Literature is full of information about Widal test, produced in African countries, by African scientists : most conclude that WT should not be imported or performed anymore for it is grossly unreliable, i.e sensitivity and sensibility very low. Yet...it generates money, that as you say 'is vital to cover the cost of running the centre'.
The same applies to Helicobacter pilory (HP), found positive through a quick rapid test and 'causing' an epidemic of gastric ulcer among the population.
Also here 15 days of triple therapy (3 drugs sold as usual in the centre) will expect to save the patient...(but not his/her pockets!).
Information on drugs or medicine in general is there, Neil. I've been working in 6 African countries and 3 Asian, Internet connection is all over, including rural areas. Antibiotics are over prescribed, especially to children. Note that all prescriptions are recorded, also in private settings.
Yet, more than 80% of children leave the clinic •with• an antibiotic prescribed.
Consider that WHO recommend that this % should never exceed 20.
Greetings from Dodoma
Massimo
PS.
HIFA profile: Massimo Serventi is a long-standing Pediatrician working in Africa since 1982. He has worked for several NGOs in 6 African/2 Asian countries. His interests include clinical and community pediatrics, adherence to clinical guidelines and school education as the major determinant of good health. massimoser20 AT gmail.com
