scholarly journals Challenges Affecting Health Referral Systems in Low-And Middle-Income Countries: A Systematic Literature Review

2021 ◽  
Vol 6 (3) ◽  
pp. 33-44
Author(s):  
Mildred Nakayuki ◽  
Annabella Basaza ◽  
Hasifah Namatovu
Keyword(s):  
Health Service ◽  
Service Provision ◽  
Inclusion Criteria ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries ◽  
Emergency Units ◽  
Impaired Health ◽  
Referral Systems ◽  
Low And Middle Income

Aims: Low and middle-income countries are still facing challenges of dysfunctional referral systems which have impaired health service provision. This review aimed at investigating these challenges to understand their nature, cause, and the impacts they have on health service provision. Methods: Database search was made in Google scholar, ACM Library, PubMed health, and BMC public health, and a total of 123 papers were generated. Only 14 fitted the inclusion criteria. Inclusion criteria included studies that were both quantitative and qualitative addressing challenges facing referral systems or health referral systems, studies describing the barriers to effective referral systems, and studies describing factors that affect referral systems. The review only included studies conducted in LMICs and included literature between January 2010 and February 2021. Findings: Results revealed that human resource and financial constraints, non-compliance, and communication are the key challenges affecting referral systems in LMICs. Recommendation: Countries that are facing these challenges need to overhaul the system and improve end-to-end communication between hospitals, improve capacity specifically in referral and emergency units, and sensitizing patients on the adherence to emergency protocols.

scholarly journals Looking ahead in the COVID-19 pandemic: emerging lessons learned for sexual and reproductive health services in low- and middle-income countries

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Aduragbemi Banke-Thomas ◽  
Sanni Yaya
Keyword(s):  
Reproductive Health ◽  
Service Provision ◽  
Sexual And Reproductive Health ◽  
Lessons Learned ◽  
Safe Abortion ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries ◽  
Published Evidence ◽  
Low And Middle Income

AbstractThe COVID-19 pandemic has caused widespread disruption to essential health service provision globally, including in low- and middle-income countries (LMICs). Recognising the criticality of sexual and reproductive health (SRH) services, we review the actual reported impact of the COVID-19 pandemic on SRH service provision and evidence of adaptations that have been implemented to date. Across LMICs, the available data suggests that there was a reduction in access to SRH services, including family planning (FP) counselling and contraception access, and safe abortion during the early phase of the pandemic, especially when movement restrictions were in place. However, services were quickly restored, or alternatives to service provision (adaptations) were explored in many LMICs. Cases of gender-based violence (GBV) increased, with one in two women reporting that they have or know a woman who has experienced violence since the beginning of the pandemic. As per available evidence, many adaptations that have been implemented to date have been digitised, focused on getting SRH services closer to women. Through the pandemic, several LMIC governments have provided guidelines to support SRH service delivery. In addition, non-governmental organisations working in SRH programming have played significant roles in ensuring SRH services have been sustained by implementing several interventions at different levels of scale and to varying success. Most adaptations have focused on FP, with limited attention placed on GBV. Many adaptations have been implemented based on guidance and best practices and, in many cases, leveraged evidence-based interventions. However, some adaptations appear to have simply been the sensible thing to do. Where evaluations have been carried out, many have highlighted increased outputs and efficiency following the implementation of various adaptations. However, there is limited published evidence on their effectiveness, cost, value for money, acceptability, feasibility, and sustainability. In addition, the pandemic has been viewed as a homogenous event without recognising its troughs and waves or disentangling effects of response measures such as lockdowns from the pandemic itself. As the pandemic continues, neglected SRH services like those targeting GBV need to be urgently scaled up, and those being implemented with any adaptations should be rigorously tested.

scholarly journals Unpacking piped water consumption subsidies: Who benefits? New evidence from 10 countries

2020 ◽  
Vol 10 (4) ◽  
pp. 691-715 ◽  
Author(s):  
Laura Abramovsky ◽  
Luis Andrés ◽  
George Joseph ◽  
Juan Pablo Rud ◽  
Germán Sember ◽  
...  
Keyword(s):  
Water Consumption ◽  
Service Provision ◽  
Middle Income ◽  
Middle Income Countries ◽  
Piped Water ◽  
Poor Households ◽  
The World ◽  
Tariff Structures ◽  
New Evidence ◽  
Low And Middle Income

Abstract This paper provides new evidence on the recent performance of piped water consumption subsidies in terms of pro-poor targeting for 10 low- and middle-income countries around the world. Our results suggest that in these countries, existing tariff structures fall well short of recovering the costs of service provision, and that, moreover, the resulting subsidies largely fail to achieve the goal of improving the accessibility and affordability of piped water among the poor. Instead, the majority of subsidies in all 10 countries are captured by the richest households. On average, across the 10 low- and middle-income countries examined, 56% of subsidies end up in the pockets of the richest 20%, but only 6% of subsidies find their way to the poorest 20%. This is predominantly due to the most vulnerable segments of the population facing challenges in access and connection to piped water services. Shortcomings in the design of the subsidy, conditional on poor households being connected, exist but are less important.

scholarly journals Cost of maternal health services in low and middle-income countries: protocol for a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027822 ◽  
Author(s):  
Aduragbemi Banke-Thomas ◽  
Ibukun-Oluwa Omolade Abejirinde ◽  
Oluwasola Banke-Thomas ◽  
Adamu Maikano ◽  
Charles Anawo Ameh
Keyword(s):  
Systematic Review ◽  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Economic Evaluations ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries

IntroductionThere is substantial evidence that maternal health services across the continuum of care are effective in reducing morbidities and mortalities associated with pregnancy and childbirth. There is also consensus regarding the need to invest in the delivery of these services towards the global goal of achieving Universal Health Coverage in low/middle-income countries (LMICs). However, there is limited evidence on the costs of providing these services. This protocol describes the methods and analytical framework to be used in conducting a systematic review of costs of providing maternal health services in LMICs.MethodsAfrican Journal Online, CINAHL Plus, EconLit, Embase, Global Health Archive, Popline, PubMed and Scopus as well as grey literature databases will be searched for relevant articles which report primary cost data for maternal health service in LMICs published from January 2000 to June 2019. This search will be conducted without implementing any language restrictions. Two reviewers will independently search, screen and select articles that meet the inclusion criteria, with disagreements resolved by discussions with a third reviewer. Quality assessment of included articles will be conducted based on cost-focused criteria included in globally recommended checklists for economic evaluations. For comparability, where feasible, cost will be converted to international dollar equivalents using purchasing power parity conversion factors. Costs associated with providing each maternal health services will be systematically compared, using a subgroup analysis. Sensitivity analysis will also be conducted. Where heterogeneity is observed, a narrative synthesis will be used. Population contextual and intervention design characteristics that help achieve cost savings and improve efficiency of maternal health service provision in LMICs will be identified.Ethics and disseminationEthical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.PROSPERO registration numberCRD42018114124

scholarly journals The Impact of Trauma Care Systems in Low- and Middle-Income Countries

2017 ◽  
Vol 38 (1) ◽  
pp. 507-532 ◽  
Author(s):  
Teri A. Reynolds ◽  
Barclay Stewart ◽  
Isobel Drewett ◽  
Stacy Salerno ◽  
Hendry R. Sawe ◽  
...  
Keyword(s):  
Trauma Care ◽  
Resource Constraints ◽  
Inclusion Criteria ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Care Systems ◽  
Outcome Type ◽  
The Impact ◽  
Low And Middle Income

Injury is a leading cause of death globally, and organized trauma care systems have been shown to save lives. However, even though most injuries occur in low- and middle-income countries (LMICs), most trauma care research comes from high-income countries where systems have been implemented with few resource constraints. Little context-relevant guidance exists to help policy makers set priorities in LMICs, where resources are limited and where trauma care may be implemented in distinct ways. We have aimed to review the evidence on the impact of trauma care systems in LMICs through a systematic search of 11 databases. Reports were categorized by intervention and outcome type and summarized. Of 4,284 records retrieved, 71 reports from 32 countries met inclusion criteria. Training, prehospital systems, and overall system organization were the most commonly reported interventions. Quality-improvement, costing, rehabilitation, and legislation and governance were relatively neglected areas. Included reports may inform trauma care system planning in LMICs, and noted gaps may guide research and funding agendas.

scholarly journals mHealth Interventions in Low and Middle-Income Countries: A Systematic Review

2016 ◽  
Vol 8 (9) ◽  
pp. 183 ◽  
Author(s):  
Kathryn Hurt ◽  
Rebekah J. Walker ◽  
Jennifer A. Campbell ◽  
Leonard E. Egede
Keyword(s):  
Developing Countries ◽  
Randomized Trial ◽  
Clinical Outcomes ◽  
System Level ◽  
Expert Advice ◽  
Inclusion Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Significant Difference ◽  
Low And Middle Income

<p>The purpose of this review was to determine whether mHealth interventions were effective in low- and middle-income countries in order to create a baseline for the evidence to support mHealth in developing countries. Studies were identified by searching Medline on 02 October 2014 for articles published in the English language between January 2000 and September 2014. Inclusion criteria were: 1) written in English, 2) completion of an mHealth intervention in a low or middle-income country, 3) measurement of patient outcomes, and 4) participants 18 years of age or older. 7,920 titles were reviewed and 7 were determined eligible based on inclusion criteria. Interventions included a cluster randomized trial, mixed methods study, retrospective comparison of an opt-in text message program, a two-arm proof of concept, single arm trial, a randomized trial, and a single subject design. Five out of seven of the studies showed significant difference between the control and intervention. Currently there is little evidence on mHealth interventions in developing countries, and existing studies are very diverse; however initial studies show changes in clinical outcomes, adherence, and health communication, including improved communication with providers, decrease in travel time, ability to receive expert advice, changes in clinical outcomes, and new forms of cost-effective education.<em> </em>While this initial review is promising, more evidence is needed to support and direct system-level resource investment.</p>

scholarly journals The burden of non-TB lung disease presenting to TB clinics in The Gambia: preliminary data in the Xpert® MTB/Rif era

2019 ◽  
Vol 9 (4) ◽  
pp. 166-168
Author(s):  
S. Jayasooriya ◽  
A. Jobe ◽  
S. Badjie ◽  
O. Owolabi ◽  
A. Rachow ◽  
...  
Keyword(s):  
Health Service ◽  
The Gambia ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries ◽  
History Of ◽  
Negative Sputum ◽  
Lost To Follow Up ◽  
Hiv 1

In some low and middle-income countries, 10–20% of patients presenting with a persistent cough have tuberculosis (TB). Once TB is excluded, health service provision for alternative diagnoses is limited. We prospectively studied patients with two Xpert-negative sputum results presenting to a TB clinic in The Gambia. Of 239 patients, 108 did not have TB; 65/102 (6 were lost to follow-up) had alternative diagnoses, 24.6% of which were non-respiratory; 37/102 had no diagnosis, 27.0% of whom were HIV-1-positive; 37.8% had a history of TB and 24.3% smoked. We highlight the need for general health service integration with TB platforms and exploration of non-TB patients with chronic respiratory symptoms.

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