Abstract
Background: Healthcare reforms (HCRs) are performed by many resource-limited countries to improve the quality of health care. However, reforms do not always lead to the expected benefits and implementation problems are not fully considered due to lack of a systematic analysis of HCRs in these countries. Thus, the present study aimed to review the challenges of health care reforms in low and middle-income countries systematically.Method: A systematic review of qualitative studies was used in the present study. Data were searched in five databases. The references related to the selected articles were searched for any relevant study irrespective of gray literature. The articles were screened based on PRISMA. The duplicates were removed, others were screened based on the title and abstract, and the eligible ones were selected for full-text reading and those matched with inclusion and exclusion criteria were selected for review. Framework analyses were used for data analysis, and the quality of the studies was evaluated by the CASP checklist for qualitative studies.Results: 702 articles were found, among which 149 were duplicated, 553 were selected to primary screening, 390 were excluded, and 163 were selected for full text reading. Finally, 151 articles were excluded, and 12 matched with the inclusion and exclusion criteria were included in the study.Conclusion:Health reforms in low and middle-income countries have faced different challenges in financing, human resources, drugs and medicine, infrastructures, and governance, which can be influenced the delivery of qualified services. Thus, in order to design and implement any health care reforms in these countries, it is recommended for policymakers to take appropriate decisions about agenda setting, regulations and guidelines, sustainability of financing resources, collaborations, accountabilities and responsibilities, as well as the way of providing human resources, infrastructures, needed drugs, and medicine. In addition, the way of accessing services in rural and remote areas should be clarified. Finally, the reforms should be made very intelligently to direct the funds for the right needs and priorities in the countries where the donors’ interests may be affected.
Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses