Strategies for Changing the Behavior of Private Providers

"Changing provider behavior is a process; it takes time, dedication, and strategic planning."

Behaviour change is critical to achieve improved health outcomes - not only for clients but for providers, including private providers outside government, who are often the first line of health care in developing countries. This primer was designed as a resource for field staff who implement private provider behaviour change programmes designed to increase the appropriate use of health care products and services. Its purpose is to support the ongoing learning on provider behaviour change and to advance the practice within the international development field.

The authors reviewed literature from the pharmaceutical industry and other sources, analysed private sector strategies in developed and developing markets, interviewed executives in the pharmaceutical industry, evaluated market research, and examined research and lessons learned from the Strengthening Health Outcomes through the Private Sector (SHOPS) project.

The primer describes applicable behaviour change theories (behavioural economics, the ecological model, and the stages of change model) and outlines four factors that influence provider decisionmaking: company promotion, product experience, outside information sources, and environmental factors. It proposes strategies to change provider behaviour and includes real-world applications of multifaceted approaches used in the developing world. The primer concludes with information for programme design and implementation, discussing:

• Marketing: Traditional marketing strategies such as advertising in mass media to inform providers of products or services (but do not address individual provider challenges).
• Medical detailing: Interpersonal communication in which the product manufacturer or other stakeholder employs field representatives to educate and provide resources to the individual provider.
• Supportive supervision: An approach to programme monitoring that promotes continuous and focused learning, mentorship, joint problem solving, and improved communication between stakeholders.
• Total office call: An acknowledgment that the nursing staff, receptionist, assistant, and local pharmacist or retail provider all have influence on the client.
• Training: Sessions (ideally interactive and multidisciplinary) designed to help providers understand a client's underlying health condition, as well as the products and services they are expected to administer.
• Networks: Bringing providers together to enable peer influence, which, through champions, can channel new behavioural trends.
• Commercial and social franchising: Models that use the principles of commercial franchising to ensure consistency in service delivery, quality standards, and reporting.