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Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach
  1. Felicity Goodyear-Smith1,
  2. Andrew Bazemore2,
  3. Megan Coffman2,
  4. Richard D W Fortier1,3,
  5. Amanda Howe4,
  6. Michael Kidd5,6,
  7. Robert Phillips7,
  8. Katherine Rouleau5,
  9. Chris van Weel8,9
  1. 1 Department of General Practice and Primary Health Care, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
  2. 2 Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington, District of Columbia, USA
  3. 3 McGill University, Montreal, Quebec, Canada
  4. 4 Primary Care, University of East Anglia Norwich Medical School, Norwich, UK
  5. 5 Department of Family and Community Medicine, University of Toronto and Southgate Institute for Health, Toronto, Ontario, Canada
  6. 6 Flinders University, Adelaide, South Australia, Australia
  7. 7 Research and Policy of the American Board of Family Medicine, Lexington, Kentucky, USA
  8. 8 Radboud Institute of Health Research, Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
  9. 9 Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia
  1. Correspondence to Professor Felicity Goodyear-Smith; f.goodyear-smith{at}auckland.ac.nz

Abstract

Introduction Since the Alma-Ata Declaration 40 years ago, primary healthcare (PHC) has made great advances, but there is insufficient research on models of care and outcomes—particularly for low-income and middle-income countries (LMICs). Systematic efforts to identify these gaps and develop evidence-based strategies for improvement in LMICs has been lacking. We report on a global effort to identify and prioritise the knowledge needs of PHC practitioners and researchers in LMICs about PHC organisation.

Methods Three-round modified Delphi using web-based surveys. PHC practitioners and academics and policy-makers from LMICs sampled from global networks. First round (pre-Delphi survey) collated possible research questions to address knowledge gaps about organisation. Responses were independently coded, collapsed and synthesised. Round 2 (Delphi round 1) invited panellists to rate importance of each question. In round 3 (Delphi round 2), panellists ranked questions into final order of importance. Literature review conducted on 36 questions and gap map generated.

Results Diverse range of practitioners and academics in LMICs from all global regions generated 744 questions for PHC organisation. In round 2, 36 synthesised questions on organisation were rated. In round 3, the top 16 questions were ranked to yield four prioritised questions in each area. Literature reviews confirmed gap in evidence on prioritised questions in LMICs.

Conclusion In line with the 2018 Astana Declaration, this mixed-methods study has produced a unique list of essential gaps in our knowledge of how best to organise PHC, priority-ordered by LMIC expert informants capable of shaping their mitigation. Research teams in LMIC have developed implementation plans to answer the top four ranked research questions.

  • primary health care
  • developing countries
  • knowledge
  • research gaps
  • financing healthcare: low and middle income countries
  • delphi
  • models of care

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/.

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Footnotes

  • Handling editor Seye Abimbola

  • Contributors FG-S: led the proposal, study design and research implementation; conducted qualitative analysis, oversaw other analyses, drafted initial paper and revised. AB: involved in developing the proposal on which this article is based, is on the core project team, helped advise on methods development and contributed to consecutive versions of the article. MC: conducted qualitative data analysis, refined qualitative coding process and edited publication documents. RDWF: made substantial contributions to study design, data collection, qualitative and quantitative data analyses, and to the draft and critical revision of the manuscript. AH: involved in the bid for the work on which this article is based, is on the core project team, had input to methods development and commented on consecutive versions of the article. MK: involved in the bid for the work on which this article is based, is on the core project team and had input to all versions of the article. RP: involved in developing the proposal on which this article is based, is on the core project team, helped advise on methods development and contributed to consecutive versions of the article. KR: participated in initial discussions about the project and in two teleconferences, and provided input into the documents. CvW: involved in the bid for the work on which this article is based, is on the core project team and had input to all versions of the article.

  • Disclaimer This publication is based on research funded by Ariadne Labs through Brigham and Women’s Hospital, which is the recipient of a Bill and 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 and Melinda Gates Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval University of Auckland Human Participants Ethics Committee (ref. 020630).

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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