IntroductionGovernance 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.MethodsWe 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.ResultsThe 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.ConclusionsThis 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.
Introduction In Bangladesh, to address the challenges of ensuring adequate human resources for health (HRH), the government began implementing a digital tool for HRH management in 2017. However, evidence suggests institutionalizing such tools in low-and-middle-income countries is impeded by policy aspects like implementation strategy and poor regulatory framework. Therefore, we aimed to explore factors in the current policy landscape that might facilitate and challenge the implementation of the tool in Bangladesh. Methods We conducted a review of policies related to ICT implementation and human resources management in the health sector in Bangladesh using qualitative content analysis method. Ten policies have been identified, and extensive reading was done to ascertain common themes and patterns. A document analysis matrix was developed to synthesize and help interpret the findings. Results Regarding facilitators, strong upstream level commitments were reflected in the content of policies in terms of setting out specific objectives, targets, timelines, and budget allocation. However, the lack of explicit monitoring strategy and extent of stakeholders’ engagement was not well-defined, ultimately creating chances for impeding downstream implementation. In addition, effective coordination among stakeholders and different HRH and ICT policies could be strengthened. Discussion Findings support the current discourse that national commitment plays a vital role in the integration of ICTs in health services. However, well-defined monitoring strategy and inter-ministry and intra-ministry policy coordination are crucial.
IntroductionStroke is the second leading cause of death and morbidity across the globe. In low-income and middle-income countries (LMICs), it has become an overwhelming burden over the past few decades. This burden is escalating at a much greater pace compared with that of high-income countries. It is considered the most frequent cause of adult disability that affects the quality of life. ‘Prevention’ is one of the key components to combating stroke. In this regard, community-based interventions can play a vital role in improving population-level health and well-being. Considering the escalating trend of stroke in LMICs, this systematic review aims to map the available community-based interventions in preventing stroke and to conduct further analysis regarding the effectiveness of the identified interventions.Methods and analysisWe have searched Medline, Web of Science and Scopus using a comprehensive search strategy in October 2021. Two reviewers will independently perform screening, data extraction and risk of bias (ROB) assessment. The ROB assessment and applicability of results of eligible studies will be performed using the Cochrane ROB tool for assessing randomised controlled trials and the ROBANS (Risk Of Bias Assessment tool for Non-randomised Studies) to assess non-randomised studies. A random-effect model meta-analysis will be used to calculate pooled results and to obtain weighted OR and risk ratio of incidence of stroke along with corresponding 95% CI.Ethics and disseminationThe results will be disseminated through publishing in a peer-reviewed journal and public presentations at relevant national and international conferences. Ethical approval is not required as this is a systematic review of publicly available data.PROSPERO registration numberCRD42021283670.
Introduction Identifying and ensuring the Essential Public Health Functions (EPHFs) is one of the core agendas of the World Health Organization to strengthen the health system of a country. The definition of EPHFs varies widely, considering country needs. In Bangladesh, the physician cadres are in the leadership position to oversee the EPHFs at the district and sub-district levels. However, there is a dearth of contextual information regarding the purview of essential EPHFs in the country. The purpose of this study was to document the perception of key stakeholders on what constitute the EPHFs at district and sub-district level and identify the challenges they face in providing the services. Methods We carried out a qualitative exploratory study consisting of document review and Key Informant Interviews (KIIs). The desk review included the organograms of the government district and sub-district level health facilities and the job description of Civil Surgeons (CSs) and Upazila Health and Family Planning Officers (UHFPOs). In addition, 15 KIIs with relevant professionals and stakeholders from the Directorate of General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW) were conducted. Collected data were analyzed thematically. Results Three major categories of EPHFs were identified: i) population-oriented preventive functions, ii) clinical preventive functions, and iii) administrative/management functions. The CSs and UHFPOs need to ensure these wide range of EPHFs at the district level and below. However, at peripheral level, the leadership positions’ clinical and public health roles often get amalgamated. Therefore, ensuring public health functions are hampered. Besides, these positions need training and adequate support staff to perform the EPHFs effectively. Conclusion Recognizing the EPHFs in the Bangladesh context is crucial. Revisiting the job descriptions and strengthening appropriate public health services at different tiers in the country health system should be prioritized to achieve health-related Sustainable Development Goals.
Background The impact of rapid urbanization taking place across the world is posing variegated challenge. Especially in terms of communicable disease, the risk is more concentrated in urban poor areas where basic amenities are inadequate. In this context, the aim of this study was to carry out an evidence synthesis on the state-of the art effective community-based interventions in tackling infectious diseases among the urban poor in the LMICs across the globe. Methods This review has been registered in PROPSPERO (CRD42021278689). A total of 18,260 published articles were primarily selected; after applying the inclusion and exclusion criteria 115 studies were considered for full-text screening. Among them, 17 articles were included. Afterwards, reference check was done and finally total of 21 articles were considered for the systematic review. Narrative synthesis was done. Results The pathway to identifying and addressing the SDOH through community-based intervention in the urban poor setting was complex. For effectiveness of a community-based intervention, the socio-cultural context is found extremely important. From this review, the effective community-based interventions were- community-based screening and socio-economic support, community-based vector control, behaviour change communication, capacity building of the Community Health Workers, health education and e-health interventions. Interventions need to be delivered considering the day-to-day realities of the urban poor. While some studies considered the outcome of specific diseases through vertical intervention approach, scarcity of evidence was found in terms of taking an intersectional approach. Discussion The effectiveness of an intervention are inextricable linked with social context, stakeholder dimensions and macro level social issues. The review results thus suggestive of an intervention package that considers a systems approach. Conclusion Considering this complex reality of an intervention to be effective, this evidence-synthesis therefore advocates for designing the intervention package with multiple components related to prevention and control of communicable diseases in poor urban areas. PROSPERO registration number: This review has been registered in PROPSPERO (CRD42021278689).
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