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Primary care financing: a systematic assessment of research priorities in low- and middle-income countries
  1. Felicity Goodyear-Smith1,
  2. Andrew Bazemore2,
  3. Megan Coffman2,
  4. Richard Fortier1,
  5. Amanda Howe3,
  6. Michael Kidd4,5,
  7. Robert Phillips6,
  8. Katherine Rouleau4,
  9. Chris van Weel7,8
  1. 1 Department of General practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  2. 2 Robert Graham Center Policy Studies in Family Medicine & Primary Care, Washington, DC, USA
  3. 3 Department of Primary Care, University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
  4. 4 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
  6. 6 Research and Policy Department, the American Board of Family Medicine, Lexington, Kentucky, USA
  7. 7 Radboud Institute of Health Research, Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
  8. 8 Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia
  1. Correspondence to Felicity Goodyear-Smith; f.goodyear-smith{at}auckland.ac.nz

Abstract

Introduction Financing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC.

Methods Three-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance.

Results A diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as potentially critical to improving PHC financing. Round 2 provided 31 synthesised questions on financing for rating. The top 16 were ranked in Round 3e to produce four prioritised research questions.

Conclusions This novel exercise created an expansive and prioritised list of critical knowledge gaps in PHC financing research questions. This offers valuable guidance to global supporters of primary care evaluation and implementation, including research funders and academics seeking research priorities. The source and context specificity of this research, informed by LMIC practitioners and academics on a global and local basis, should increase the likelihood of local relevance and eventual success in implementing the findings.

  • primary healthcare
  • developing countries
  • economics
  • organisation and administration
  • knowledge
  • research gaps
  • financing healthcare: low-income and middlie-income
  • delphi

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 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. RF 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, on the core project team, 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, 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, provided input into the documents. CvW Involved in the bid for the work on which this article is based, on the core project team, had input to all versions of the article.

  • Funding This publication is based on research funded by Ariadne Labs through Brigham and Women’s Hospital, which 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.

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

  • Data sharing statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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