scholarly journals 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

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001487 ◽  
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.

scholarly journals Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001467 ◽  
Author(s):  
Anna Palagyi ◽  
Rebecca Dodd ◽  
Stephen Jan ◽  
Devaki Nambiar ◽  
Rohina Joshi ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Service Planning ◽  
Essential Medicines ◽  
Asia Pacific ◽  
Future Research ◽  
Pacific Region ◽  
Health Coverage ◽  
Asia Pacific Region ◽  
Primary Health

Health system planners in low- and middle-income countries (LMIC) of the Asia-Pacific region seeking to reorient primary health care (PHC) systems to achieve universal health coverage may be hindered by lack of knowledge of what works in their setting. With limited resources for research available, it is important to identify evidence-based strategies for reorganising PHC delivery, determine where relevant evidence gaps exist and prioritise these for future study. This paper describes an approach for doing this using the best available evidence combined with consultation to establish evidence priorities. We first reviewed PHC organisational interventions in Asia-Pacific LMICs and ascertained evidence gaps. The largest gaps related to interventions to promote access to essential medicines, patient management tools, effective health promotion strategies and service planning and accountability. Evidence from Pacific Island countries was particularly scant. We then engaged an expert panel of 22 PHC stakeholders from seven Asia-Pacific LMICs in a Delphi exercise to identify priority questions for future research. Research priorities were: (1) identifying effective PHC service delivery models for chronic diseases; (2) devising sustainable models of disease integration; (3) optimising task shifting; (4) understanding barriers to care continuity; (5) projecting future PHC needs; and (6) designing appropriate PHC service packages. Notably, stakeholder-determined priorities reflected large, context-dependent system issues, while evidence gaps centred on discrete interventions. Future research on the organisation of PHC services in Asia-Pacific LMICs should incorporate codesign principles to engage researchers and national PHC system stakeholders, and innovative methods that build on existing evidence and account for system complexity.

scholarly journals Primary health care financing interventions: a systematic review and stakeholder-driven research agenda for the Asia-Pacific region

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001481 ◽  
Author(s):  
Blake Angell ◽  
Rebecca Dodd ◽  
Anna Palagyi ◽  
Thomas Gadsden ◽  
Seye Abimbola ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Primary Health Care ◽  
Service Delivery ◽  
Research Agenda ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Primary Health ◽  
Delphi Exercise

IntroductionInterventions targeting the financing of primary health care (PHC) systems could accelerate progress towards universal health coverage; however, there is limited evidence to guide best-practice implementation of these interventions. This study aimed to generate a stakeholder-led research agenda in the area of PHC financing interventions in the Asia-Pacific region.MethodsWe adopted a two-stage process: (1) a systematic review of financing interventions targeting PHC service delivery in the Asia-Pacific region was conducted to develop an evidence gap map and (2) an electronic-Delphi (e-Delphi) exercise with key national PHC stakeholders was undertaken to prioritise these evidence needs.ResultsThirty-one peer-reviewed articles (including 10 systematic reviews) and 10 grey literature reports were included in the review. There was limited consistency in results across studies but there was evidence that some interventions (removal of user fees, ownership models of providers and contracting arrangements) could impact PHC service access, efficiency and out-of-pocket cost outcomes. The e-Delphi exercise highlighted the importance of contextual factors and prioritised research in the areas of: (1) interventions to limit out-of-pocket costs; (2) financing models to enhance health system performance and maintain PHC budgets; (3) the design of incentives to promote optimal care without unintended consequences and (4) the comparative effectiveness of different PHC service delivery strategies using local data.ConclusionThe research questions which were deemed most important by stakeholders are not addressed in the literature. There is a need for more research on how financing interventions can be implemented at scale across health systems. Such research needs to be pragmatic and balance academic rigour with practical considerations.

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

2019 ◽  
Vol 7 (11) ◽  
pp. e1500-e1510 ◽  
Author(s):  
Karin Stenberg ◽  
Odd Hanssen ◽  
Melanie Bertram ◽  
Callum Brindley ◽  
Andreia Meshreky ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Low Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Resource Needs ◽  
Modelling Study

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

Neurology ◽  
2020 ◽  
Vol 94 (4) ◽  
pp. 165-175 ◽  
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.

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

2013 ◽  
Vol 26 (4) ◽  
pp. 339-348 ◽  
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

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

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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