A systematic review of global health capacity building initiatives in low-to middle-income countries in the Middle East and North Africa region

Abstract

Introduction Low-and Middle-Income Countries (LMICs) in the Middle East and North Africa (MENA) region are facing increasing global health challenges with a reduced ability to manage them. Global Health Capacity Building (GHCB) initiatives have the potential to improve health workforce performance and health outcomes, however little is known about the GHCB topics and approaches implemented in this region. This is the first systematic review of GHCB initiatives among LMICs in the MENA region. Methods An academic database search of Medline (OVID), PubMed, Scopus, Embase.com, and Open Grey was conducted for articles published between January 2009 and September 2019 in English. Next, a grey literature search following a recommended search framework was conducted. Reviewed records addressed a global health topic, had a capacity building component, looked at specific learning outcomes, and reflected an LMIC in the MENA. Primary outcomes included country, topic, modality, pedagogy, and population. Results Reports of GHCB initiatives were retrieved from grey sources (73.2%) and academic sources (26.8%). Most GHCB initiatives were mainly conducted face-to-face (94.4%) to professional personnel (57.5%) through a theoretical pedagogical approach (44.3%). Dominant global health themes were non-communicable diseases (29.2%), sexual and reproductive health (18.4%), and mental health (14.5%). When matched against the Global Burden of Disease data, important gaps were found regarding the topics of GHCB initiatives in relation to the region’s health needs. There were limited reports of GHCB initiatives addressing conflict and emergency topics, and those addressing non-communicable disease topics were primarily reported from Egypt and Iran. Conclusion Innovative and practicum-based approaches are needed for GHCB initiatives among LMICs in the MENA region, with a focus on training community workers. Regional and country-specific analyses of GHCB initiatives relative to their health needs are discussed in the manuscript based on the results of this review.

Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon

“…In light of this, an increase in screening efforts and referral mechanisms to PHCs and other health facilities is highly needed to improve access to mental health services and to reduce depression symptoms. One recommended way to do that is through task shifting, by conducting more capacity building initiatives that train non-specialized community health workers to deliver basic mental health services to their communities and to conduct referrals [55,56]. According to a recent national facility assessment, almost 32% of PHCs in Lebanon are currently delivering mental health services following the mhGAP training, and almost 50% of them cover rural areas [57], where most refugees reside.…”

Evaluating a capacity building program on women’s health for displaced community health workers in fragile settings in Lebanon

“…While evidence suggests that global health capacity building initiatives are beneficial, little is known about their success in the MENA region and especially regarding women's health in refugee populations, given the scarcity of case studies on this issue [13]. In fact, based on a recent systematic review, there is an increasing need for data on the effectiveness of capacity building programs that target CHWs, given their potential to provide non-specialized and essential services in low-resource settings [15].…”

Health research capacity building of health workers in fragile and conflict-affected settings: a scoping review of challenges, strengths, and recommendations

“…With regard to the weaknesses, most of the reviewed papers reflected short-term and generic descriptions of a given intervention with little to no report on short- or long-term evaluations or impact assessments. Although the political and social instability throughout FCASs prompts the implementation of short-term interventions, a follow-up strategy for assessing the feasibility, benefits, and impacts of such interventions is crucial as it informs future directions and contributes to the sustainability of capacity building projects [ 92 , 93 ]. The problem of sustainability for research in FCASs is primarily a matter of resources, as demonstrated by the major disparity in spending on research between HIC and LMICs.…”