40 years after Alma-Ata, is building new hospitals in low-income and lower-middle-income countries beneficial?

Abstract

Public hospitals in low-income and lower-middle-income countries face acute material and financial constraints, and there is a trend towards building new hospitals to contend with growing population health needs. Three cases of new hospital construction are used to explore issues in relation to their funding, maintenance and sustainability. While hospitals are recognised as a key component of healthcare systems, their role, organisation, funding and other aspects have been largely neglected in health policies and debates since the Alma Ata Declaration. Building new hospitals is politically more attractive for both national decision-makers and donors because they symbolise progress, better services and nation-building. To avoid the ‘white elephant’ syndrome, the deepening of within-country socioeconomic and geographical inequalities (especially urban–rural), and the exacerbation of hospital-centrism, there is an urgent need to investigate in greater depth how these hospitals are integrated into health systems and to discuss their long-term economic, social and environmental sustainability.

Current realities versus theoretical optima: quantifying efficiency and sociospatial equity of travel time to hospitals in low-income and middle-income countries

“…Potential policy approaches to increase access may involve building better road networks and strengthening interfacility communication and transportation services. Building new hospitals is also an attractive project for governments and international funders40; and strategies to ensure their integration with the existing system and overall functioning are essential 40. In LMICs, where the physical and human resources needed to sustain the structure of a comprehensive healthcare system are limited, decision-makers may be interested in the spatial decision mechanism developed here as it provides insights into where a hospital might be added/upgraded to improve existing levels of efficiency and equity.…”

“…The efficiency-equity balance might be particularly pertinent to emergency health services planning due to the critical role of travel time. Some solutions also extend to a hierarchy of health facilities of varying levels,41 and are suitable for ensuring the population’s accessibility to a whole network of both primary healthcare and the wider range of other health services 40…”

Learning from Public Health and Hospital Resilience to the SARS-CoV-2 Pandemic: Protocol for a Multiple Case Study (Brazil, Canada, China, France, Japan, and Mali).

“…[9,18] The need to integrate social sciences, health staff, and system resilience into the pandemic response was also identi ed as one of the priorities. [19,20] How different hospitals in different countries respond during this pandemic in their preparation and implementation is essential to study and understand [21]. Regarding public health measures, it is vital to understand how social were (or not) taken into account in planning COVID-19 interventions.…”

The experience of tertiary care public hospital in Oman: Lean performance improvement to enhance universal health coverage

“…However, in the celebration of the 40th anniversary of the Alma Ata Declaration in 2018, there was a call to reconsider the role of public hospitals and specialized care in the primary healthcare system. [7] More focus is needed to understand hospital reform integration into the broader health system reform, especially in the context of global prioritization of quality and equity in access to UHC. [7] Harnessing innovation in healthcare (e.g., in pharmaceuticals, diagnostics, devices) judiciously, and in information and communication technologies could substantially change health service provision.…”

“…[7] More focus is needed to understand hospital reform integration into the broader health system reform, especially in the context of global prioritization of quality and equity in access to UHC. [7] Harnessing innovation in healthcare (e.g., in pharmaceuticals, diagnostics, devices) judiciously, and in information and communication technologies could substantially change health service provision. [8] The experience of the Royal Hospital (RH) in performance improvement augments the recent report shared by the WHO, about hospitals being powerful with influential impact as institutions that have political, economic and social weight to make change happen.…”