Often in public-private partnerships it is seen as private companies and NGOs entering into local populations to assist where public health care systems have not prevailed. This can lead the direction of health systems toward the drives of the private entities. Yet this is also neglects the influence that the public sector has on current private companies and people that exist already in the community settings. While with the best of intentions, foreign agencies often unknowingly direct funds and resources away from culturally sensitive practitioners, yet a current change exists by some organizations. They have realized this issue and changed their programs. A prime example of this is midwives in different countries.
Many people in various countries use midwives for birthing due to cultural sensitivities. This issue has been shown in many countries such as Afghanistan and Uganda. Countries such as these and Ecuador use midwives to assist in birth especially in rural settings. Midwives often use complementary and alternative medicine as a complement for health practices. These methods are based in historically practiced treatments and integration into a health system has been scientifically proven to be effective. An example of an excellent program that is being established in with CARE, public health centers and midwives in Ecuador.
Currently, CARE is funding the transportation of midwives in rural parts of Ecuador to attend training sessions with local obstetricians in order to improve clinical knowledge. These midwives then return to the rural sector to use these new practices in conjunction with traditional methods during the pre-natal, birth and post-partum stages of childbearing.
This method incorporates diagonal implementation, which has been shown to be one of the most effective program styles because it uses a well-established framework. It uses outside funding to pass on knowledge, which is sustainable and can be passed down through midwives. Additionally, it gives many women the security of being treated by a known community member who keeps with local customs and practices as well. Finally, this system supports a communication between local traditional health-practitioners and clinical professionals.
 Camurdan, C, Gül, A (2013) Complementary and alternative medicine use among undergraduate nursing & midwifery students in Turkey. Nurse Education in Practice. 13(5): 350-354
 Reich, MR, Takemi, K, Roberts, MJ, Hsiao, WC. (2008) “Global action on health systems: a proposal for the Toyako G8 summit.” Lancet 371: 865-869.