scholarly journals Strengthening medical specialisation policy in low-income and middle-income countries

2020 ◽  
Vol 5 (2) ◽  
pp. e002053 ◽  
Author(s):  
Veena Sriram ◽  
Sara Bennett
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Medical Tourism ◽  
Policy Formulation ◽  
Health Systems Strengthening ◽  
Health Coverage ◽  
Secondary Importance ◽  
Middle Income ◽  
Medical Specialties ◽  
Middle Income Countries

The availability of medical specialists has accelerated in low-income and middle-income countries (LMICs), driven by factors including epidemiological and demographic shifts, doctors’ preferences for postgraduate training, income growth and medical tourism. Yet, despite some policy efforts to increase access to specialists in rural health facilities and improve referral systems, many policy questions are still underaddressed or unaddressed in LMIC health sectors, including in the context of universal health coverage. Engaging with issues of specialisation may appear to be of secondary importance, compared with arguably more pressing concerns regarding primary care and the social determinants of health. However, we believe this to be a false choice. Policy at the intersection of essential health services and medical specialties is central to issues of access and equity, and failure to formulate policy in this regard may have adverse ramifications for the entire system. In this article, we describe three critical policy questions on medical specialties and health systems with the aim of provoking further analysis, discussion and policy formulation: (1) What types, and how many specialists to train? (2) How to link specialists’ production and deployment to health systems strengthening and population health? (3) How to develop and strengthen institutions to steer specialisation policy? We posit that further analysis, discussion and policy formulation addressing these questions presents an important opportunity to explicitly determine and strengthen the linkages between specialists, health systems and health equity.

scholarly journals Evaluating health systems strengthening interventions in low-income and middle-income countries: are we asking the right questions?

2012 ◽  
Vol 27 (suppl 4) ◽  
pp. iv9-iv19 ◽  
Author(s):  
T. Adam ◽  
J. Hsu ◽  
D. de Savigny ◽  
J. N. Lavis ◽  
J.-A. Rottingen ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Health Systems Strengthening ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Right

Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries

The Lancet ◽  
2010 ◽  
Vol 376 (9754) ◽  
pp. 1785-1797 ◽  
Author(s):  
Badara Samb ◽  
Nina Desai ◽  
Sania Nishtar ◽  
Shanti Mendis ◽  
Henk Bekedam ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Health Systems ◽  
Low Income ◽  
Health Systems Strengthening ◽  
Middle Income ◽  
Middle Income Countries ◽  
Litmus Test

scholarly journals Multimorbidity Patterns and Function Among Adults in Low- and Middle-income Countries: a Scoping Review Protocol

2021 ◽  
Author(s):  
Karina Berner ◽  
Nassib Tawa ◽  
Quinette Louw
Keyword(s):  
Scoping Review ◽  
Low Income ◽  
Data Extraction ◽  
Rehabilitation Services ◽  
Health Coverage ◽  
Policy Planning ◽  
Functional Impairments ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Function

Abstract BackgroundA fifth of adults in low-income and middle-income countries (LMICs) have multimorbid conditions, which are linked to socio-economic deprivation and aging. Multimorbidity is associated with high rates of functional problems and disability, increased healthcare utilization and lower quality of life. Literature on multimorbidity and associations with function is mostly from high-income countries (HICs) and focused among adults. Data regarding patterns and their impact on person-centered outcomes are limited. There is need for research into understanding common patterns of multimorbidity, and their association with functional impairment, particularly in LMICs. Therefore, the need for evidence-based, and context-relevant strategic policy, planning and delivery models for health and rehabilitation services is imperative in attaining Universal Health Coverage (UHC). The planned scoping review aims to provide an overview of the scope and nature of existing literature on multimorbidity patterns and function among adults in LMICs. MethodsA scoping review will be conducted according to a five-step framework guidance. The PRISMA-ScR guidelines will be followed in reporting. A comprehensive electronic search of PubMed, Scopus, EBSCOhost (including MEDLINE and the Cumulative Index to Nursing and Allied Health Literature [CINAHL]), Scielo, Cochrane and Google Scholar will be conducted from January 1976 onwards. Studies will be included if they are primary or secondary, qualitative or quantitative research reported in English, published (between January 1976 and the search date) in a peer-reviewed journal, and describe multimorbidity patterns and associations with physical functional impairments, activity limitations or participation restrictions among adults in LMICs. Search results will be independently screened by two reviewers and data extraction will cover; study characteristics, participants’ characteristics, multimorbidity measures, patterns analysis and functional measures. Descriptive statistics and narrative synthesis will be used to synthesize and summarize the findings.DiscussionPatients with multimorbidity have unique and cross-cutting needs, hence the need for an integrated and person-centered approaches to policy, planning and delivery of medical and rehabilitation services. Considering the shift towards primary healthcare-led management of chronic diseases and UHC, the proposed scoping review is timely and the findings will provide insights into the current extent and scope of multimorbidity research, and guide future inquiry in the field. Protocol registrationOpen Science Framework (OSF), osf.io/gcy7z

scholarly journals Advancing research on emergency care systems in low-income and middle-income countries: ensuring high-quality care delivery systems

2019 ◽  
Vol 4 (Suppl 6) ◽  
pp. e001265 ◽  
Author(s):  
Rachel T Moresky ◽  
Junaid Razzak ◽  
Teri Reynolds ◽  
Lee A Wallis ◽  
Benjamin W Wachira ◽  
...  
Keyword(s):  
Health Systems ◽  
Emergency Care ◽  
Low Income ◽  
Communicable Diseases ◽  
Middle Income ◽  
Care Research ◽  
Middle Income Countries ◽  
Emergency Care Systems ◽  
Care Systems ◽  
Research Questions

Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.

scholarly journals Closing the inequality gaps in reproductive, maternal, newborn and child health coverage: slow and fast progressors

2020 ◽  
Vol 5 (1) ◽  
pp. e002230 ◽  
Author(s):  
Agbessi Amouzou ◽  
Safia S Jiwani ◽  
Inácio Crochemore Mohnsam da Silva ◽  
Liliana Carvajal-Aguirre ◽  
Abdoulaye Maïga ◽  
...  
Keyword(s):  
Maternal Health ◽  
Child Health ◽  
Low Income ◽  
Health Surveys ◽  
Health Coverage ◽  
Middle Income ◽  
Child Illness ◽  
Middle Income Countries ◽  
The Past ◽  
And Child Health

IntroductionUniversal Health Coverage (UHC) is a critical goal under the Sustainable Development Goals (SDGs) for health. Achieving this goal for reproductive, maternal, newborn and child health (RMNCH) service coverage will require an understanding of national progress and how socioeconomic and demographic subgroups of women and children are being reached by health interventions.MethodsWe accessed coverage databases produced by the International Centre for Equity in Health, which were based on reanalysis of Demographic and Health Surveys, Multiple Indicator Cluster Surveys and Reproductive and Health Surveys. We limited the data to 58 countries with at least two surveys since 2008. We fitted multilevel linear regressions of coverage of RMNCH, divided into four main components—reproductive health, maternal health, child immunisation and child illness treatment—to estimate the average annual percentage point change (AAPPC) in coverage for the period 2008–2017 across these countries and for subgroups defined by maternal age, education, place of residence and wealth quintiles. We also assessed change in the pace of coverage progress between the periods 2000–2008 and 2008–2017.ResultsProgress in RMNCH coverage has been modest over the past decade, with statistically significant AAPPC observed only for maternal health (1.25, 95% CI 0.90 to 1.61) and reproductive health (0.83, 95% CI 0.47 to 1.19). AAPPC was not statistically significant for child immunisation and illness treatment. Progress, however, varied largely across countries, with fast or slow progressors spread throughout the low-income and middle-income groups. For reproductive and maternal health, low-income and lower middle-income countries appear to have progressed faster than upper middle-income countries. For these two components, faster progress was also observed in older women and in traditionally less well-off groups such as non-educated women, those living in rural areas or belonging to the poorest or middle wealth quintiles than among groups that are well off. The latter groups however continue to maintain substantially higher coverage levels over the former. No acceleration in RMNCH coverage was observed when the periods 2000–2008 and 2008–2017 were compared.ConclusionAt the dawn of the SDGs, progress in coverage in RMNCH remains insufficient at the national level and across equity dimensions to accelerate towards UHC by 2030. Greater attention must be paid to child immunisation to sustain the past gains and to child illness treatment to substantially raise its coverage across all groups.

scholarly journals Quality assurance systems of pharmaceutical distributors in low-income and middle-income countries: weaknesses and ways forward

2020 ◽  
Vol 5 (10) ◽  
pp. e003147
Author(s):  
Ariadna Nebot Giralt ◽  
Anthony Bourasseau ◽  
Gareth White ◽  
Corinne Pouget ◽  
Patricia Tabernero ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Low Income ◽  
Poor Quality ◽  
Health Coverage ◽  
Quality Systems ◽  
Model Quality ◽  
Convenience Sample ◽  
Middle Income ◽  
For Profit ◽  
Middle Income Countries

IntroductionAccess to quality-assured medicines is an essential prerequisite for universal health coverage, and pharmaceutical distributors play an important role to assure the quality of medicines along the supply chain.MethodsWe retrospectively assessed the compliance with WHO quality standards, that is, the Model Quality Assurance System for Procurement Agencies (MQAS) or the good distribution practices (GDP), of a convenience sample of 75 public, private-for-profit and non-for-profit distributors, audited by QUAMED in 14 low-income and middle-income countries (LMICs) between 2017 and 2019. We calculated the compliance per quality assurance activity, and we defined the percentage of compliant distributors, that is, the percentage (%) of distributors with MQAS or GDP levels of >2 for each activity.ResultsThe distributors in our sample were mainly private for-profit (66/75). Only one MQAS-audited distributor out of 11 was found compliant with all MQAS-activities, while none out of 64 GDP-assessed distributors were found compliant with all GDP activities. The GDP-assessed distributors were generally less compliant with WHO standards than MQAS-audited distributors. Common weaknesses and strengths were observed. The activities with lowest compliance were quality control, and physical storage conditions, while those with highest compliance were warehouse organisation and stock control.ConclusionsThe quality systems of pharmaceutical distributors in LMICs remain weak. For preventing harm caused by poor-quality medicines, a comprehensive and stringent regulatory oversight should be urgently implemented; the WHO MQAS-standards and GDP-standards should be incorporated in national regulations; and reliable information on the quality systems of distributors (and manufacturers from which they buy) should be publicly available.

scholarly journals Level of confidence in and endorsement of the health system among internet users in 12 low-income and middle-income countries

2020 ◽  
Vol 5 (8) ◽  
pp. e002205
Author(s):  
Sanam Roder-DeWan ◽  
Anna Gage ◽  
Lisa R Hirschhorn ◽  
Nana A Y Twum-Danso ◽  
Jerker Liljestrand ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Internet Survey ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Internet Users ◽  
Effective Care ◽  
Universal Health

IntroductionPeople’s confidence in and endorsement of the health system are key measures of system performance, yet are undermeasured in low-income and middle-income countries (LMICs). We explored the prevalence and predictors of these measures in 12 countries.MethodsWe conducted an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal and South Africa collecting demographics, ratings of quality, and confidence in and endorsement of the health system. We used multivariable logistic regression to assess the association between confidence/endorsement and self-reported quality of recent healthcare.ResultsOf 13 489 respondents, 62% reported a health visit in the past year. Applying population weights, 32% of these users were very confident that they could receive effective care if they were to ‘become very sick tomorrow’; 30% endorsed the health system, that is, agreed that it ‘works pretty well and only needs minor changes’. Reporting high quality in the last visit was associated with 4.48 and 2.69 greater odds of confidence (95% CI 3.64 to 5.52) and endorsement (95% CI 2.33 to 3.11). Having health insurance was positively associated with confidence and endorsement (adjusted odds ratio (AOR) 1.68, 95% CI 1.49 to 1.90 and AOR 1.34, 95% CI 1.22 to 1.48), while experiencing discrimination in healthcare was negatively associated (AOR 0.67, 95% CI 0.56 to 0.80 and AOR 0.63, 95% CI 0.53 to 0.76).ConclusionConfidence and endorsement of the health system were low across 12 LMICs. This may hinder efforts to gain support for universal health coverage. Positive patient experience was strongly associated with confidence in and endorsement of the health system.

scholarly journals Identifying health policy and systems research priorities on multisectoral collaboration for health in low-income and middle-income countries

2018 ◽  
Vol 3 (Suppl 4) ◽  
pp. e000970 ◽  
Author(s):  
Douglas Glandon ◽  
Ankita Meghani ◽  
Nasreen Jessani ◽  
Mary Qiu ◽  
Sara Bennett
Keyword(s):  
Low Income ◽  
Health Sector ◽  
Research Priorities ◽  
Implementation Strategies ◽  
Health Coverage ◽  
Middle Income ◽  
The Sustainable Development ◽  
Middle Income Countries ◽  
Systems Research ◽  
Review Articles

IntroductionWhile efforts to achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) have reinvigorated interest in multisectoral collaborations (MSCs) among the global health and development community, there remains a plethora of questions about how best to conceptualise, plan, implement, evaluate and sustain MSCs. The objective of this paper is to present research priorities on MSC for health from researchers and policymakers around the globe, with an emphasis on low-income and middle-income countries.MethodsThe authors identified 30 priority research questions from two sources: (1) 38 review articles on MSC for health, and (2) interviews and focus groups with a total of 81 policymakers, including government officials (largely from ministries of health and state/provincial departments of health, but also offices of planning, public service, social development, the prime minister and others), large multilateral or bilateral organisations, and non-governmental organisations. In a third phase, questions were refined and ranked by a diverse group of researchers from around the globe using an online voting platform.ResultsThe top-ranked questions focused predominantly on pragmatic questions, such as how best to structure, implement and sustain MSCs, as well as how to build stakeholder capacity and community partnerships. Despite substantial variation between review articles, policymakers’ reflections and online ranking by researchers, two topics emerged as research priorities for all three: (1) leadership, partnership and governance structures for MSCs; and (2) MSC implementation strategies and mechanisms. The review articles underscored the need for more guidance on appropriate study designs and methods for investigating MSCs, which may be a prerequisite for other identified research priorities.ConclusionThese findings could inform efforts within and beyond the health sector to better align research objectives and funding with the evidence needs of policymakers grappling with questions about how best to leverage MSCs to achieve UHC and the SDGs.

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