Task Sharing to Support Paediatric Service Delivery in Low- and Middle-income Countries: Current Practice and a Scoping Review of Emerging Opportunities

2021 ◽  
Author(s):  
Yingxi Zhao ◽  
Christiane Hagel ◽  
Raymond Tweheyo ◽  
Nathanael Sirili ◽  
David Gathara ◽  
...  
Keyword(s):  
Child Health ◽  
Service Delivery ◽  
Scoping Review ◽  
Chronic Conditions ◽  
Current Practice ◽  
Task Sharing ◽  
Middle Income ◽  
Middle Income Countries ◽  
Paediatric Service ◽  
Training Opportunities

Abstract BackgroundDemographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0-19 years (paediatric) age range. The general and skilled paediatric workforce shortage especially in low- and middle-income countries (LMICs) will impede the provision of additional paediatric services. This paper examines experiences with task sharing as part of the solution to this human resources challenge in LMICs and specifically looks beyond the provision of care for acute infectious diseases and malnutrition that are widely and historically shifted. MethodsWe (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritised; (2) investigated training opportunities and national policies related to task sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarised reported experience of task sharing and paediatric service delivery through a scoping review of research literature in LMICs published between 1990-2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library. ResultsWe found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found there is some evidence available for task sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health). ConclusionAs child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for mid-level cadres to support safe, accessible and high-quality care.

scholarly journals Task-sharing to support paediatric and child health service delivery in low- and middle-income countries: current practice and a scoping review of emerging opportunities

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yingxi Zhao ◽  
Christiane Hagel ◽  
Raymond Tweheyo ◽  
Nathanael Sirili ◽  
David Gathara ◽  
...  
Keyword(s):  
Child Health ◽  
Chronic Conditions ◽  
Current Practice ◽  
Health Service Delivery ◽  
Child Health Service ◽  
Task Sharing ◽  
Middle Income ◽  
Middle Income Countries ◽  
Training Opportunities ◽  
And Child Health

Abstract Background Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0–19 years (paediatric) age range. Providing such services will be undermined by general and skilled paediatric workforce shortages especially in low- and middle-income countries (LMICs). In this paper, we aim to understand existing, sanctioned forms of task-sharing to support the delivery of care for more complex and chronic paediatric and child health conditions in LMICs and emerging opportunities for task-sharing. We specifically focus on conditions other than acute infectious diseases and malnutrition that are historically shifted. Methods We (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritized; (2) investigated training opportunities and national policies related to task-sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarized reported experience of task-sharing and paediatric and child health service delivery through a scoping review of research literature in LMICs published between 1990 and 2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library. Results We found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found some evidence examining task-sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health). Conclusion As child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for non-physician cadres to support safe, accessible and high-quality care.

scholarly journals Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001551 ◽  
Author(s):  
Asaf Bitton ◽  
Jocelyn Fifield ◽  
Hannah Ratcliffe ◽  
Ami Karlage ◽  
Hong Wang ◽  
...  
Keyword(s):  
Service Delivery ◽  
Scoping Review ◽  
Low Income ◽  
Primary Healthcare ◽  
Recent Literature ◽  
Future Research ◽  
Topic Area ◽  
Middle Income ◽  
Ample Evidence ◽  
Middle Income Countries

IntroductionThe 2018 Astana Declaration reaffirmed global commitment to primary healthcare (PHC) as a core strategy to achieve universal health coverage. To meet this potential, PHC in low-income and middle-income countries (LMIC) needs to be strengthened, but research is lacking and fragmented. We conducted a scoping review of the recent literature to assess the state of research on PHC in LMIC and understand where future research is most needed.MethodsGuided by the Primary Healthcare Performance Initiative (PHCPI) conceptual framework, we conducted searches of the peer-reviewed literature on PHC in LMIC published between 2010 (the publication year of the last major review of PHC in LMIC) and 2017. We also conducted country-specific searches to understand performance trajectories in 14 high-performing countries identified in the previous review. Evidence highlights and gaps for each topic area of the PHCPI framework were extracted and summarised.ResultsWe retrieved 5219 articles, 207 of which met final inclusion criteria. Many PHC system inputs such as payment and workforce are well-studied. A number of emerging service delivery innovations have early evidence of success but lack evidence for how to scale more broadly. Community-based PHC systems with supportive governmental policies and financing structures (public and private) consistently promote better outcomes and equity. Among the 14 highlighted countries, most maintained or improved progress in the scope of services, quality, access and financial coverage of PHC during the review time period.ConclusionOur findings revealed a heterogeneous focus of recent literature, with ample evidence for effective PHC policies, payment and other system inputs. More variability was seen in key areas of service delivery, underscoring a need for greater emphasis on implementation science and intervention testing. Future evaluations are needed on PHC system capacities and orientation toward social accountability, innovation, management and population health in order to achieve the promise of PHC.

scholarly journals Evidence of integrated health service delivery during COVID-19 in low- and middle-income countries: protocol for a scoping review

2020 ◽  
Author(s):  
Rachel Neill ◽  
Md Zabir Hasan ◽  
Priyanka Das ◽  
Vasuki Venugopal ◽  
Nishant Jain ◽  
...  
Keyword(s):  
Health Service ◽  
Service Delivery ◽  
Health Systems ◽  
Scoping Review ◽  
Health Service Delivery ◽  
World Health ◽  
Research Database ◽  
Middle Income ◽  
Middle Income Countries ◽  
Integrated Health

Introduction The importance of integrated, people-centered health systems has been recognized as a central component of achieving Universal Health Coverage. Integration has also been highlighted as a critical element for building resilient health systems that can stand the shock of health emergencies. However, there is dearth of research and systematic synthesis of evidence on the synergistic relationship between integrated health services and pandemic preparedness in low- and low-middle income countries (LMICs). Thus, the authors are organizing a scoping review aiming to explore application of integrated health service delivery approaches during the emerging COVID-19 pandemic in LMICs. Methods and analysis This scoping review adheres to the six steps for scoping reviews from Arksey and OMalley (2005). Peer reviewed scientific literature will be systematically assembled utilizing a standardized and replicable search strategy from seven electronic databases, including PubMed, Embase, Scopus, Web of Science, CINAHL Plus, the World Health Organization Global Research Database on COVID-19, and LitCovid. Initially, the title and abstract of the collected literature, published in English from December 2019 to June 2020, will be screened for inclusion which will be followed by a full text review by two independent reviewers. Data will be charted using a data extraction form and reported in narrative format with accompanying data matrices. Ethics and dissemination No ethical approval is required for the review. The study will be conducted from June to December 2020. Results from this study will provide a snapshot of the evidence currently being generated related to integrated health service delivery in response to the COVID-19 pandemic. The findings will be developed into reports and a peer-reviewed articles and will assist policy makers in making pragmatic and evidence-based decisions for current and future pandemic response.

scholarly journals Evidence of integrated health service delivery during COVID-19 in low and lower-middle-income countries: protocol for a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042872
Author(s):  
Rachel Neill ◽  
Md Zabir Hasan ◽  
Priyanka Das ◽  
Vasuki Venugopal ◽  
Nishant Jain ◽  
...  
Keyword(s):  
Health Service ◽  
Service Delivery ◽  
Health Systems ◽  
Scoping Review ◽  
Health Service Delivery ◽  
Data Matrix ◽  
Research Database ◽  
Middle Income ◽  
Middle Income Countries ◽  
Integrated Health

IntroductionThe importance of integrated, people-centred health systems has been recognised as a central component of Universal Health Coverage. Integration has also been highlighted as a critical element for building resilient health systems that can withstand the shock of health emergencies. However, there is a dearth of research and systematic synthesis of evidence on the synergistic relationship between integrated health services and pandemic preparedness, response, and recovery in low-income and lower-middle-income countries (LMICs). Thus, the authors are organising a scoping review aiming to explore the application of integrated health service delivery approaches during the emerging COVID-19 pandemic in LMICs.Methods and analysisThis scoping review adheres to the six steps for scoping reviews from Arksey and O’Malley. Peer-reviewed scientific literature will be systematically assembled using a standardised and replicable search strategy from seven electronic databases, including PubMed, Embase, Scopus, Web of Science, CINAHL Plus, the WHO’s Global Research Database on COVID-19 and LitCovid. Initially, the title and abstract of the collected literature, published in English from December 2019 to June 2020, will be screened for inclusion which will be followed by a full-text review by two independent reviewers. Data will be charted using a data extraction form and reported in narrative format with accompanying data matrix.Ethics and disseminationNo ethical approval is required for the review. The study will be conducted from June 2020 to May 2021. Results from this scoping review will provide a snapshot of the evidence currently being generated related to integrated health service delivery in response to the COVID-19 pandemic in LMICs. The findings will be developed into reports and a peer-reviewed article and will assist policy-makers in making pragmatic and evidence-based decisions for current and future pandemic responses.

Problems and Practice of Management on Menstruation by Adolescents Girls of Basic Schools of Chitwan, Nepal

2020 ◽  
Vol 8 ◽  
pp. 85-94
Author(s):  
Sudha Ghimire
Keyword(s):  
Current Practice ◽  
Quantitative Information ◽  
Community Schools ◽  
Mixed Method Research ◽  
Participatory Action ◽  
Group Discussions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Field Notes ◽  
Sanitary Pads

Managing menstruation in a hygienic way is a challenge in most of the low and middle-income countries (LMIC) including Nepal, where normal and natural physiological process of menstruation is considered as girls’ problem which is viewed as sinful, unholy and matter of shame. This paper explores the current practice and existing difficulties that adolescents girls encounter hygienic management of menstruation (MHM) especially during school days. The study was conducted on five purposively selected community schools of Chitwan district. The study adopted Participatory Action Research (PAR) as an approach, that is encapsulated with mixed method research design. For qualitative information observation, focus group discussions (FGD) and field notes were used, whereas for quantitative data self-administrative questionnaires were used. Quantitative information was collected from 205 girls students who were present at schools on the day of data collection. The finding shows that majority of the girls (93.7%) who encounter hygienic management of menstruation were of 10-14 years old age, whereas nearly one third of them were (29%) from grade eight. Similarly, among the total 205 girls, only 79 girls have already started their menstruation; among those who have started menstruation majority (78%) had heard about menstruation form their mothers. Likewise, 35% girls used homemade cotton pads and 40.5% of them changed pad three times a day. During FGD, adolescents girls shared that lack of water and soap in toilets, stress and lack of concentration during menstruation are the major difficulties which they encounter during days of menstruation. They suggested the concerned authorities to manage pad bank, make soap and water available, and develop skills for proper disposing of used sanitary pads for MHM at schools. 

scholarly journals Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045005
Author(s):  
Fadia Gamieldien ◽  
Roshan Galvaan ◽  
Bronwyn Myers ◽  
Zarina Syed ◽  
Katherine Sorsdahl
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Scoping Review ◽  
Data Extraction ◽  
Flow Diagram ◽  
Personal Recovery ◽  
Middle Income ◽  
Middle Income Countries ◽  
Provider Perspectives ◽  
Low Middle Income Countries

ObjectiveTo examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery.DesignScoping review.Data sources and eligibilityWe searched 14 electronic databases, hand searched citations and consulted with experts during the period May–December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer.Data extraction and synthesisAll bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data.ResultsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists.ConclusionAlthough there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.

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