Information, regulation and coordination: Realist analysis of the efforts of community health committees to limit informal health care providers in Nigeria

摘要: One of the consequences ineffective governments is that they leave space for unlicensed and unregulated informal providers without formal training to deliver a large proportion health services. Without institutions facilitate appropriate care transactions, patients tend navigate markets from one inappropriate provider another, receiving sub-optimal care, before find providers; all while incurring personal transaction costs. But top-down interventions address this barrier accessing are hampered by weak governments, as entrenched in communities. To explore role communities could play limiting providers, we applied costs theory firm which predicts economic agents organise production within firms when coordinating exchange through market greater than firm. In realist analysis qualitative data Nigeria, found community committees sometimes seek limit manner consistent with The deal not legal sanction but subtle influence persuasion slow faltering process institutional change, leveraging authority resources available their community, NGOs. First, provide information reduce share controlled then regulation keep at bay making more competitive. When these efforts or insufficient, faced “make-or-buy” decision. “make” decision involves coordination co-produce services referrals providers. What results quasi-firm—informal networked single loose unit. These findings suggest should to, among other things, augment existing responses.