RT Journal Article
SR Electronic
T1 Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001487
DO 10.1136/bmjgh-2019-001487
VO 4
IS Suppl 8
A1 Rebecca Dodd
A1 Anna Palagyi
A1 Stephen Jan
A1 Marwa Abdel-All
A1 Devaki Nambiar
A1 Pavitra Madhira
A1 Christine Balane
A1 Maoyi Tian
A1 Rohina Joshi
A1 Seye Abimbola
A1 David Peiris
YR 2019
UL http://gh.bmj.com/content/4/Suppl_8/e001487.abstract
AB Introduction This paper synthesises evidence on the organisation of primary health care (PHC) service delivery in low-income and middle-income countries (LMICs) in the Asia Pacific and identifies evidence of effective approaches and pathways of impact in this region.Methods We developed a conceptual framework describing key inputs and outcomes of PHC as the basis of a systematic review. We searched exclusively for intervention studies from LMICs of the Asia-Pacific region in an effort to identify ‘what works’ to improve the coverage, quality, efficiency, equity and responsiveness of PHC. We conducted a narrative synthesis to identify key characteristics of successful interventions.Results From an initial list of 3001 articles, we selected 153 for full-text review and included 111. We found evidence on the impact of non-physician health workers (NPHWs) on coverage and quality of care, though better integration with other PHC services is needed. Community-based services are most effective when well integrated through functional referral systems and supportive supervision arrangements, and have a reliable supply of medicines. Many studies point to the importance of community engagement in improving service demand. Few studies adopted a ‘systems’ lens or adequately considered long-term costs or implementation challenges.Conclusion Based on our findings, we suggest five areas where more practical knowledge and guidance is needed to support PHC systems strengthening: (1) NPHW workforce development; (2) integrating non-communicable disease prevention and control into the basic package of care; (3) building managerial capacity; (4) institutionalising community engagement; (5) modernising PHC information systems.