scholarly journals Barriers and enablers to pulmonary rehabilitation in low- and middle-income countries: a qualitative study of healthcare professionals

2021 ◽  
Author(s):  
Fanuel Bickton ◽  
Harriet Shannon
Keyword(s):  
Qualitative Study ◽  
Pulmonary Rehabilitation ◽  
Respiratory Diseases ◽  
Healthcare Professionals ◽  
Successful Implementation ◽  
Middle Income ◽  
Chronic Respiratory Diseases ◽  
Middle Income Countries ◽  
Barriers And Enablers ◽  
Low And Middle Income

Abstract Low- and middle-income countries bear a disproportionately high burden of global morbidity and mortality caused by chronic respiratory diseases. Pulmonary rehabilitation is recommended as a core intervention in the management of people with chronic respiratory diseases. However, the intervention remains poorly accessed/utilised globally, especially in low- and middle-income countries. This qualitative study explored barriers and enablers to pulmonary rehabilitation in low- and middle-income countries from the perspective of healthcare professionals with pulmonary rehabilitation experience in these settings. Online-based semi-structured in-depth interviews with healthcare professionals were undertaken to data saturation, exploring lived barriers and enablers to pulmonary rehabilitation in their low- or middle-income country. Anonymised Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. A total of seven healthcare professionals from seven low- and middle-income countries representing Africa, Asia, and South America, were interviewed. They included five physiotherapists (four females), one family physician (male), and one pulmonologist (female). Themes for barriers to pulmonary rehabilitation included limited resources, low awareness, Coronavirus Disease 2019, and patient access-related costs. Themes for enablers included local adaptation, motivated patients, Coronavirus Disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Successful implementation of these enablers will require engagement with multiple stakeholders. The findings of this study are a necessary step towards developing strategies that can overcome the existing pulmonary rehabilitation evidence-practice gap in low- and middle-income countries and alleviating the burden of chronic respiratory diseases in these countries.

scholarly journals Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

2021 ◽  
pp. 004947552199818
Author(s):  
Ellen Wilkinson ◽  
Noel Aruparayil ◽  
J Gnanaraj ◽  
Julia Brown ◽  
David Jayne
Keyword(s):  
Laparoscopic Surgery ◽  
Low Cost ◽  
Surgical Care ◽  
Successful Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Technological Advances ◽  
Local Access ◽  
And Training ◽  
Low And Middle Income

Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.

scholarly journals How does performance-based financing affect the availability of essential medicines in Cameroon? A qualitative study

2019 ◽  
Vol 34 (Supplement_3) ◽  
pp. iii4-iii19 ◽  
Author(s):  
Isidore Sieleunou ◽  
Anne-Marie Turcotte-Tremblay ◽  
Manuela De Allegri ◽  
Jean-Claude Taptué Fotso ◽  
Habakkuk Azinyui Yumo ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health Services ◽  
Healthcare Providers ◽  
Study Data ◽  
Essential Medicines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Performance Based Financing ◽  
Low And Middle Income

Abstract Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced the availability of EMs, and to understand the pathways leading to the experiential dimension related with the observed changes. The design was an exploratory qualitative study. Data were collected through in-depth interviews, using semi-structured questionnaires. Key informants were selected using purposive sampling. The respondents (n = 55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. All interviews were recorded, transcribed and analysed using qualitative data analysis software. Thematic analysis was performed. Our findings suggest that the PBF programme improved the perceived availability of EMs in three regions in Cameroon. The change in availability of EMs experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. However, a sequence of challenges, including delays in PBF payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. The participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. The study highlights that some specific dimensions of PBF, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels.

scholarly journals Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249638
Author(s):  
Obidimma Ezezika ◽  
Apira Ragunathan ◽  
Yasmine El-Bakri ◽  
Kathryn Barrett
Keyword(s):  
Systematic Review ◽  
Implementation Research ◽  
Oral Rehydration Therapy ◽  
Barriers And Facilitators ◽  
World Health ◽  
Successful Implementation ◽  
Middle Income ◽  
Oral Rehydration ◽  
Middle Income Countries ◽  
Low And Middle Income

Background Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries. Methods A comprehensive search strategy comprised of relevant subject headings and keywords was executed in 5 databases including OVID Medline, OVID Embase, OVID HealthStar, Web of Science and Scopus. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results The search identified 1570 citations and following removal of duplicates as well as screening according to our inclusion/exclusion criteria, 55 articles were eligible for inclusion in the review. Twenty-three countries were represented in this review, with India, Bangladesh, Egypt, Nigeria, and South Africa having the most representation of available studies. Study dates ranged from 1981 to 2020. Overarching thematic areas spanning the barriers and facilitators that were identified included: availability and accessibility, knowledge, partnership engagement, and design and acceptability. Conclusion A systematic review of studies on implementation of ORT in low- and middle-income countries (LMICs) highlights key activities that facilitate the development of successful implementation that include: (1) availability and accessibility of ORT, (2) awareness and education among communities, (3) strong partnership engagement strategies, and (4) adaptable design to enhance acceptability. The barriers and facilitators identified under the CIFR domains can be used to build knowledge on how to adapt ORT to national and local settings and contribute to a better understanding on the implementation and use of ORT in LMICs. The prospects for scaling and sustaining ORT (after years of low use) will increase if implementation research informs local applications, and implementers engage appropriate stakeholders and test assumptions around localized theories of change from interventions to expected outcomes. Registration A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD420201695).

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