title: Leveraging the private sector for child health: a qualitative examination of caregiver and provider perspectives on private sector care for childhood pneumonia in Uttar Pradesh, India.
abstract: The private health sector is a primary source of curative care for childhood illnesses in many low- and middle-income countries. Therefore ensuring appropriate private sector care is an important step towards improving outcomes from illnesses like pneumonia, which is the leading infectious cause of childhood mortality worldwide. This study aimed to provide evidence on private sector care for childhood pneumonia in Uttar Pradesh, India, by simultaneously exploring providers' knowledge and practices and caregivers' experiences.
  
  
  
  We conducted in-depth interviews with a purposive sample of 36 practitioners and 34 caregivers in two districts. Practitioners included allopathic doctors, AYUSH providers, and drug sellers. Caregivers were mothers of children under the age of five with symptoms consistent with pneumonia who had seen one of those practitioners. Interview transcripts were analyzed thematically.
  
  
  
  Caregivers were generally prompt in seeking care outside the home, but many initially favored local informal providers based on access and cost. Drug sellers were not commonly consulted for treatment. Formal providers had imperfect, but reasonable, knowledge of pneumonia and followed appropriate steps for diagnosis, though some gaps were noticed that were primarily related to lack of (or failure to use) diagnostic tools. Most practitioners prescribed antibiotics and supportive symptomatic treatment. Relational and structural factors encouraged overuse of antibiotics and treatment interruption. Caregivers often had a limited understanding of treatment but wanted rapid symptomatic improvements, frequently leading to sequentially consulting multiple providers and interrupting treatment when symptoms improved. Providers were confronted with these expectations and care-seeking patterns.
  
  
  
  This study contributes in-depth evidence on private sector care for childhood pneumonia in UP. Achieving appropriate care requires an enriched perspective that simultaneously considers the critical role of provider-caregiver interactions and of the context in which they occur in shaping treatment outcomes.
authors.affiliation: Program Sciences and Technical Support, FHI 360, 1825 Connecticut Ave NW, Washington, DC, 20009, USA. abrunie@fhi360.org.
authors.forename: Aurélie
authors.identifier: 0000-0002-9515-1420
authors.initials: A
authors.lastname: Brunie
authors.affiliation: Global Health Research, FHI 360, 359 Blackwell St Suite 200, Durham, NC, 27701, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lenzi
authors.affiliation: Independent Researcher, New Delhi, India.
authors.forename: Anamika
authors.initials: A
authors.lastname: Lahiri
authors.affiliation: Global Health Program, Bill & Melinda Gates Foundation, 500 5th Avenue North, Seattle, WA, 98109, USA.
authors.forename: Rasa
authors.initials: R
authors.lastname: Izadnegahdar
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017028:Caregivers / Q000523:psychology*; D000067576:Child Health / Q000592:standards; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D017149:Private Sector / Q000592:standards; D015397:Program Evaluation; D036301:Qualitative Research; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000458:organization & administration*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Child health; India; Pneumonia; Private sector; Qualitative research