Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study

ABSTRACT. Dementia is a public health issue making the screening and diagnosing of dementia and its prodromal phases in all health settings imperative. Objective: using PRISMA, this systematic review aimed to identify how low-, middle-, and high-income countries establish dementia and cognitive dysfunction diagnoses in primary health care. Methods: studies from the past five years in English, Spanish, and Portuguese were retrieved from Scopus, PubMed, Embase, Lilacs, Scielo, and Web of Science. Of 1987 articles, 33 were selected for analysis. Results: only three articles were from middle-income countries and there were no studies from low-income countries. The most used instrument was the Mini-Mental State Examination (MMSE). Mild Cognitive Impairment (MCI) and dementia criteria were based on experts’ recommendation as well as on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), respectively. Conclusion: differences between these criteria among high- and middle-income countries were observed.

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Projected health-care resource needs for an effective response to COVID-19 in 73 low-income and middle-income countries: a modelling study

The Lancet Global Health ◽

10.1016/s2214-109x(20)30383-1 ◽

2020 ◽

Vol 8 (11) ◽

pp. e1372-e1379 ◽

Cited By ~ 2

Author(s):

Tessa Tan-Torres Edejer ◽

Odd Hanssen ◽

Andrew Mirelman ◽

Paul Verboom ◽

Glenn Lolong ◽

...

Keyword(s):

Health Care ◽

Low Income ◽

Health Care Resource ◽

Effective Response ◽

Middle Income ◽

Middle Income Countries ◽

Resource Needs ◽

Modelling Study

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Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region

BMJ Global Health ◽

10.1136/bmjgh-2019-001487 ◽

2019 ◽

Vol 4 (Suppl 8) ◽

pp. e001487 ◽

Cited By ~ 5

Author(s):

Rebecca Dodd ◽

Anna Palagyi ◽

Stephen Jan ◽

Marwa Abdel-All ◽

Devaki Nambiar ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Community Engagement ◽

Asia Pacific ◽

Pacific Region ◽

Asia Pacific Region ◽

Middle Income ◽

Middle Income Countries ◽

What Works ◽

Primary Health

IntroductionThis paper synthesises evidence on the organisation of primary health care (PHC) service delivery in low-income and middle-income countries (LMICs) in the Asia Pacific and identifies evidence of effective approaches and pathways of impact in this region.MethodsWe developed a conceptual framework describing key inputs and outcomes of PHC as the basis of a systematic review. We searched exclusively for intervention studies from LMICs of the Asia-Pacific region in an effort to identify ‘what works’ to improve the coverage, quality, efficiency, equity and responsiveness of PHC. We conducted a narrative synthesis to identify key characteristics of successful interventions.ResultsFrom an initial list of 3001 articles, we selected 153 for full-text review and included 111. We found evidence on the impact of non-physician health workers (NPHWs) on coverage and quality of care, though better integration with other PHC services is needed. Community-based services are most effective when well integrated through functional referral systems and supportive supervision arrangements, and have a reliable supply of medicines. Many studies point to the importance of community engagement in improving service demand. Few studies adopted a ‘systems’ lens or adequately considered long-term costs or implementation challenges.ConclusionBased on our findings, we suggest five areas where more practical knowledge and guidance is needed to support PHC systems strengthening: (1) NPHW workforce development; (2) integrating non-communicable disease prevention and control into the basic package of care; (3) building managerial capacity; (4) institutionalising community engagement; (5) modernising PHC information systems.

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Models of community-based primary care for epilepsy in low- and middle-income countries

Neurology ◽

10.1212/wnl.0000000000008839 ◽

2020 ◽

Vol 94 (4) ◽

pp. 165-175 ◽

Cited By ~ 4

Author(s):

Gagandeep Singh ◽

Meenakshi Sharma ◽

Anand Krishnan ◽

Tarun Dua ◽

Francesco d'Aniello ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Treatment Adherence ◽

Community Based ◽

Middle Income ◽

Middle Income Countries ◽

Community Awareness ◽

Primary Health ◽

Low And Middle Income

ObjectiveTo review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries.MethodsA systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles.ResultsThe 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans.ConclusionsCost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.

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Strengthening Primary Health Care in Low- and Middle-Income Countries

Asia Pacific Journal of Public Health ◽

10.1177/1010539513503869 ◽

2013 ◽

Vol 26 (4) ◽

pp. 339-348 ◽

Cited By ~ 8

Author(s):

John Rule ◽

Duc Anh Ngo ◽

Tran Thi Mai Oanh ◽

Augustine Asante ◽

Jennifer Doyle ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Middle Income ◽

Middle Income Countries ◽

Primary Health ◽

Low And Middle Income

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Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries

Risk Management and Healthcare Policy ◽

10.2147/rmhp.s239074 ◽

2020 ◽

Vol Volume 13 ◽

pp. 409-426 ◽

Cited By ~ 6

Author(s):

Mainul Haque ◽

Tariqul Islam ◽

Nor Azlina A Rahman ◽

Judy McKimm ◽

Adnan Abdullah ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health Care Services ◽

Middle Income ◽

Middle Income Countries ◽

Care Services ◽

Primary Health ◽

Primary Health Care Services ◽

And Control

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Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs

10.21203/rs.3.rs-35167/v3 ◽

2020 ◽

Author(s):

Lutfi Lokman ◽

Teresa Chahine

Keyword(s):

Health Care ◽

Primary Health Care ◽

Business Models ◽

Tertiary Care ◽

Social Enterprises ◽

Social Entrepreneurs ◽

Middle Income ◽

Middle Income Countries ◽

Primary Health ◽

Low And Middle Income

Abstract Background: Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area.Methods: We identify social entrepreneurs working to deliver primary care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories.Results: Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing; cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under ten years old.Conclusions: Social enterprise has been demonstrated as a feasible model for providing primary care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

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Utilization of traditional medicine in primary health care in low- and middle-income countries: a systematic review

Health Policy and Planning ◽

10.1093/heapol/czaa022 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1070-1083

Author(s):

Jae Kyoun Kim ◽

Kyeong Han Kim ◽

Yong Cheol Shin ◽

Bo-Hyoung Jang ◽

Seong-Gyu Ko

Keyword(s):

Systematic Review ◽

Health Care ◽

Primary Health Care ◽

Traditional Medicine ◽

National Health ◽

Health Workers ◽

Referral System ◽

Middle Income ◽

Middle Income Countries ◽

Primary Health

Abstract This paper reports the findings from the first systematic review of the utilization of traditional medicine (TM) in primary health care (PHC) in low- and middle-income countries (LMICs). PHC is an important component of health care and essential for achieving universal health coverage (UHC). For countries where there is a gap in PHC, TM plays a vital role. It is widely used and has the potential to increase the coverage of PHC and UHC. Hence in situations where TM is recognized in a considerable magnitude, there are scarce evidence and minimal regulation on it and TM practitioners (TMPs). This study aims to identify the current situation in the utilization of TM in PHC or UHC in LMICs. A systematic review and thematic synthesis of qualitative and quantitative studies have been conducted. A total of 56 articles met the criteria and were included in the review. In all, 14 analytic themes have been developed including the current use of TM in PHC, higher accessibility of TM, medical pluralism, national health system, national health policy and national health insurance to include TM, including TMPs in the referral system, utilizing TMPs as community health workers, the needs of scientific research on TM and the need for training both TMPs and conventional medical staffs for better collaboration. The study concluded that it is necessary to further focus on TM in the macro level on strengthening the referral system by including TM to establish a comprehensive service delivery network under UHC and in the micro level to focus on training the TMPs and conventional medicine health workers on both areas to attain more in-depth understanding of each other, which can lead to better collaboration and quality patient care.

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