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Research
Primary healthcare policy and governance in low-income and middle-income countries: an evidence gap map
  1. K M Saif-Ur-Rahman1,
  2. Razib Mamun1,
  3. Iffat Nowrin1,
  4. Shahed Hossain1,
  5. Khaleda Islam2,
  6. Tajkia Rumman3,
  7. Ehtesham Kabir4,
  8. Aminur Rahman1,
  9. Ngamindra Dahal5,
  10. Iqbal Anwar1
  1. 1 Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
  2. 2 Primary Health Care, Government of Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
  3. 3 Department of Public Health & Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  4. 4 Directorate General of Health Services, Dhaka, Bangladesh
  5. 5 South Asia Institute of Advanced Studies, Kathmandu, Nepal
  1. Correspondence to Dr K M Saif-Ur-Rahman; su.rahman{at}icddrb.org

Abstract

Introduction Governance is one of the most important aspects for strong primary healthcare (PHC) service delivery. To achieve the targets for the Sustainable Development Goals, good governance may play a prime role in low-income and middle-income countries (LMICs). This evidence gap map (EGM) explored the available evidence in LMICs to identify the knowledge gap concerning PHC policy and governance in these settings.

Methods We followed the standard 3ie EGM protocol, finalising the scope of the EGM through a stakeholder workshop. We searched a total of 32 bibliographic databases, systematic review databases, impact evaluation databases, and donor and bilateral agency databases using a comprehensive search strategy. Two reviewers screened retrieved studies, extracted data and performed quality assessment. We plotted the interventions and outcomes derived from the included studies in a dynamic platform to build the interactive EGM and conducted a stakeholder consultation with nominal group technique methods to prioritise the identified gaps.

Results The EGM included 24 systematic reviews and 7 impact evaluations focusing on PHC policy and governance in LMICs. Most of the sources emphasised workforce management and supervision. There were noticeable evidence gaps regarding accountability and social responsibility. The most highly prioritised themes were the role of accountability, the role of public–private partnerships and the role of user–provider communication in PHC governance.

Conclusions This EGM identified some important aspects of PHC policy and governance such as accountability, social responsibility, public–private partnership, user–provider communication through the methodological approaches of evidence synthesis and stakeholder consultation. Identified gaps will provide directions for an implementation research plan to improve the governance of PHC in LMICs.

  • primary health care
  • developing countries
  • policy
  • governance
  • evidence gap map
  • LMICs

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2019-001453

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors KMS-U-R: led the development of proposal, study design and research implementation. Conducted evidence synthesis, drafted initial paper and revised. RM: aided in the development of proposal, evidence synthesis and drafting the manuscript. IN: conducted evidence synthesis, contributed in narrative synthesis and drafting the manuscript. SH: guided the workshop, provided critical input all manuscript revisions. TR: conducted evidence synthesis, helped in drafting the manuscript. EK: contributed in workshops, helped in drafting the manuscript. AR: guided proposal development, involved in all manuscript revisions. ND: provided input to manuscript revisions KI: guided development of proposal, conducted workshop and revised manuscript. IA: guided development of proposal, conducted workshop and revised all versions of the manuscript.

    • Funding This publication is based on research funded by Ariadne Labs through Brigham and Women’s Hospital, who is the recipient of a Bill & Melinda Gates Foundation grant. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.