scholarly journals Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Jacy Zhou ◽  
Rebecca Blaylock ◽  
Matthew Harris
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Middle Income ◽  
Middle Income Countries ◽  
Service Delivery Models ◽  
Primary Care Settings ◽  
The Uk ◽  
Delivery Models ◽  
Low And Middle Income

Abstract Background In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes provided by trained, mid-level providers via “task-shifting”. The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. Methods We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms “nurses”, “midwives”, “general physicians”, “early medical/surgical abortion”. We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. Results A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This review showed that providing early medical abortion in primary care services is safe and feasible and “task-shifting” to mid-level providers can effectively replace doctors in providing abortion. Conclusion The way services are organised in LMICs, using a task-shifted and decentralised model, results in high quality services that should be considered for adoption in the UK. Collaboration with professional medical bodies and governmental departments is necessary to expand services from secondary to primary care.

scholarly journals Family planning for urban slums in low- and middle-income countries: a scoping review of interventions/service delivery models and their impact

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
John Kuumuori Ganle ◽  
Leonard Baatiema ◽  
Paul Ayamah ◽  
Charlotte Abra Esime Ofori ◽  
Edward Kwabena Ameyaw ◽  
...  
Keyword(s):  
Family Planning ◽  
Reproductive Health ◽  
Service Delivery ◽  
Urban Slums ◽  
Middle Income ◽  
Middle Income Countries ◽  
Service Delivery Models ◽  
Health Initiatives ◽  
Delivery Models ◽  
Low And Middle Income

Abstract Background Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings. Methods We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings. Results The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls’ club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services. Conclusions This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise.

scholarly journals eHealth Technologies Enable more Accessible Hearing Care

2020 ◽  
Vol 41 (02) ◽  
pp. 133-140
Author(s):  
De Wet Swanepoel
Keyword(s):  
Health Care ◽  
Service Delivery ◽  
Health Care Professionals ◽  
Patient Journey ◽  
Middle Income ◽  
Middle Income Countries ◽  
Service Delivery Models ◽  
Traditional Service ◽  
Delivery Models ◽  
Low And Middle Income

AbstractHearing loss is a pervasive global health care burden affecting up to one in every seven persons of whom 90% reside in low- and middle-income countries. Traditional service-delivery models are unable to support and promote accessible and affordable hearing care in these setting. Major barriers include a severe shortage of hearing health care professionals, costs associated with equipment, facilities and treatments, and centralized service-delivery models. Convergence of digital and connectivity revolutions are combining to enable new ways of delivering decentralized audiological services along the entire patient journey using integrated eHealth solutions. eHealth technologies are allowing nonprofessionals in communities (e.g., community health workers) to provide hearing services with point-of-care devices at reduced cost with remote surveillance and support by professionals. A growing body of recent evidence showcases community-based hearing care within an integrated eHealth framework that addresses some of the barriers of traditional service-delivery models at reduced cost. Future research, especially in low- and middle-income countries, must explore eHealth-supported hearing care services from detection through to treatment.

Quality-of-life in dementia: Assessment in low-and-middle income countries

2017 ◽  
Author(s):  
Kia-Chong Chua ◽  
Jan R. Böhnke ◽  
Martin Prince ◽  
Sube Banerjee
Keyword(s):  
Measurement Invariance ◽  
Core Component ◽  
Middle Income ◽  
Middle Income Countries ◽  
People With Dementia ◽  
Dementia Research ◽  
American Spanish ◽  
The Uk ◽  
Low And Middle Income

The global burden of dementia is disproportionately higher in low-and-middle income countries yet systematic assessments of health-related quality-of-life (HRQL) mostly rely on measures developed in the UK/US. A recent systematic review of dementia-specific HRQL measures concluded that none could be recommended without further linguistic validation. Using a unique dataset from the 10/66 Dementia Research Group, we conducted one of the first in-depth studies to investigate the measurement invariance of dementia-specific HRQL measures for low-and-middle income countries. HRQL of people with dementia was assessed by self-report (DEMQOL) and informant-report (DEMQOL-Proxy) in a community memory clinic in the UK and population cohort surveys of the 10/66 Dementia Research Group in the Dominican Republic, Mexico, Cuba, Peru and Venezuela. Measurement invariance between the UK English and Ibero-American Spanish versions was investigated using multiple-group confirmatory bifactor modelling. Our findings showed that UK and Latin America older adults differ in how they respond to “positive emotion” items in the DEMQOL and DEMQOL-Proxy. The remaining items of DEMQOL and DEMQOL-Proxy showed no major difference in conceptual meaning, sensitivity to individual differences, and standards of difficulty between the UK English and Ibero-American Spanish versions. Furthermore, we found that the core components of self- and informant appraisal of HRQL may differ. Negative emotion may be a core component in self-appraisal of HRQL whereas social functioning may be a core component in how informants appraise HRQL of people with dementia. Measurement invariance of translated HRQL assessment warrant continued investigation, particularly in low-and-middle income countries, where the societal and fiscal impact of dementia needs urgent attention.

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