scholarly journals Crossing borders: the PACK experience of spreading a complex health system intervention across low-income and middle-income countries

2018 ◽  
Vol 3 (Suppl 5) ◽  
pp. e001088 ◽  
Author(s):  
Ruth Cornick ◽  
Camilla Wattrus ◽  
Tracy Eastman ◽  
Christy Joy Ras ◽  
Ajibola Awotiwon ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Low Income ◽  
Resource Constraints ◽  
Care Delivery ◽  
Middle Income ◽  
System Intervention ◽  
Learning Health System ◽  
Primary Care Delivery ◽  
Health System Intervention

Developing a health system intervention that helps to improve primary care in a low-income and middle-income country (LMIC) is a considerable challenge; finding ways to spread that intervention to other LMICs is another. The Practical Approach to Care Kit (PACK) programme is a complex health system intervention that has been developed and adopted as policy in South Africa to improve and standardise primary care delivery. We have successfully spread PACK to several other LMICs, including Botswana, Brazil, Nigeria and Ethiopia. This paper describes our experiences of localising and implementing PACK in these countries, and our evolving mentorship model of localisation that entails our unit providing mentorship support to an in-country team to ensure that the programme is tailored to local resource constraints, burden of disease and on-the-ground realities. The iterative nature of the model’s development meant that with each country experience, we could refine both the mentorship package and the programme itself with lessons from one country applied to the next—a ‘learning health system’ with global reach. While not yet formally evaluated, we appear to have created a feasible model for taking our health system intervention across more borders.

scholarly journals Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries – Study protocol

2018 ◽  
Vol 2 ◽  
pp. 27 ◽  
Author(s):  
Wolfgang Munar ◽  
Birte Snilstveit ◽  
Jennifer Stevenson ◽  
Nilakshi Biswas ◽  
John Eyers ◽  
...  
Keyword(s):  
Primary Care ◽  
Global Health ◽  
Performance Measurement ◽  
Study Design ◽  
Care Delivery ◽  
Delivery Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Care Delivery ◽  
Low And Middle Income

Background. For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion. Implications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.

scholarly journals Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries – Study protocol

2018 ◽  
Vol 2 ◽  
pp. 27 ◽  
Author(s):  
Wolfgang Munar ◽  
Birte Snilstveit ◽  
Jennifer Stevenson ◽  
Nilakshi Biswas ◽  
John Eyers ◽  
...  
Keyword(s):  
Primary Care ◽  
Global Health ◽  
Performance Measurement ◽  
Study Design ◽  
Care Delivery ◽  
Delivery Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Care Delivery ◽  
Low And Middle Income

Background. For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion. Applications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.

A Team-based Model of Primary Care Delivery and Physician-patient Interaction

2015 ◽  
Vol 128 (9) ◽  
pp. 1025-1028 ◽  
Author(s):  
Anita D. Misra-Hebert ◽  
Andrew Rabovsky ◽  
Chen Yan ◽  
Bo Hu ◽  
Michael B. Rothberg
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Patient Interaction ◽  
Primary Care Delivery ◽  
Physician Patient

Development and Implementation of a Team-Based, Primary Care Delivery Model: Challenges and Opportunities

2019 ◽  
Vol 94 (7) ◽  
pp. 1298-1303 ◽  
Author(s):  
Jay D. Mitchell ◽  
Jordan D. Haag ◽  
Eric Klavetter ◽  
Rachel Beldo ◽  
Nilay D. Shah ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Delivery Model ◽  
Primary Care Delivery ◽  
Care Delivery Model ◽  
Challenges And Opportunities

scholarly journals Unraveling PBF effects beyond impact evaluation: results from a qualitative study in Cameroon

2018 ◽  
Vol 3 (2) ◽  
pp. e000693 ◽  
Author(s):  
Manuela De Allegri ◽  
Maria Paola Bertone ◽  
Shannon McMahon ◽  
Idrissou Mounpe Chare ◽  
Paul Jacob Robyn
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Low Income ◽  
Impact Evaluation ◽  
Healthcare Providers ◽  
Analytical Techniques ◽  
Demand Side ◽  
Middle Income ◽  
Implementation Processes ◽  
Heterogeneous Effects

IntroductionPerformance-based financing (PBF) has acquired increased prominence as a means of reforming health system purchasing structures in low-income and middle-income countries. A number of impact evaluations have noted that PBF often produces mixed and heterogeneous effects. Still, little systematic effort has been channelled towards understanding what causes such heterogeneity, including looking more closely at implementation processes.MethodsOur qualitative study aimed at closing this gap in knowledge by attempting to unpack the mixed and heterogeneous effects detected by the PBF impact evaluation in Cameroon to inform further implementation as the country scales up the PBF approach. We collected data at all levels of the health system (national, district, facility) and at the community level, using a mixture of in-depth interviews and focus group discussions. We combined deductive and inductive analytical techniques and applied analyst triangulation.ResultsOur findings indicate that heterogeneity in effects across facilities could be explained by pre-existing infrastructural weaknesses coupled with rigid administrative processes and implementation challenges, while heterogeneity across indicators could be explained by providers’ practices, privileging services where demand-side barriers were less substantive.ConclusionIn light of the country’s commitment to scaling up PBF, it follows that substantial efforts (particularly entrusting facilities with more financial autonomy) should be made to overcome infrastructural and demand-side barriers and to smooth implementation processes, thus, enabling healthcare providers to use PBF resources and management models to a fuller potential.

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