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

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

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.