Is patient navigation a solution to the problem of "leaving no one behind"? A scoping review of evidence from low-income countries

Abstract

Patient navigation interventions, which are designed to enable patients excluded from health systems to overcome the barriers they face in accessing care, have multiplied in high-income countries since the 1990s. However, in low-income countries (LICs), indigents are generally excluded from health policies despite the international paradigm of universal health coverage (UHC). Fee exemption interventions have demonstrated their limits and it is now necessary to act on other dimensions of access to healthcare. However, there is a lack of knowledge about the interventions implemented in LICs to support the indigents throughout their care pathway. The aim of this paper is to synthesize what is known about patient navigation interventions to facilitate access to modern health systems for vulnerable populations in LICs. We therefore conducted a scoping review to identify all patient navigation interventions in LICs. We found 60 articles employing a total of 48 interventions. Most of these interventions targeted traditional beneficiaries such as people living with HIV, pregnant women and children. We utilized the framework developed by Levesque et al. (Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18) to analyse the interventions. All acted on the ability to perceive, 34 interventions on the ability to reach, 30 on the ability to engage, 8 on the ability to pay and 6 on the ability to seek. Evaluations of these interventions were encouraging, as they often appeared to lead to improved health indicators and service utilization rates and reduced attrition in care. However, no intervention specifically targeted indigents and very few evaluations differentiated the impact of the intervention on the poorest populations. It is therefore necessary to test navigation interventions to enable those who are worst off to overcome the barriers they face. It is a major ethical issue that health policies leave no one behind and that UHC does not benefit everyone except the poorest.

How could patient navigation help promote health equity in sub-Saharan Africa? A qualitative study among public health experts

“…The ability to seek is the ability on which the fewest interventions act (11). The experts emphasized that these are dimensions that are very difficult to act on because they require long-term, intersectoral action, designing projects with a participatory approach; and that they require ‘political courage’ (I.22).…”

“…All of the navigation interventions acted on the ability to perceive (11). Those interviewed said that acting on this ability is an essential prerequisite.…”

“…However, there is very little research on this type of intervention in low and middle income countries. This empirical article and a scoping review (11) provide guidelines to adapt these programs to the contexts of sub-Saharan African countries and to the situation of indigence in order to promote health equity.…”

“…The scoping review shows that there are no navigation interventions in LICs that specifically target the indigents (11). Since there is a lack of evidence, we decided to conduct the sixth stage of a scoping review: the consultation exercise (12).…”

Defining an action-research’s content to improve a policy supporting indigents’ health in Mali: a concept mapping

“…[11][12][13] This responds to the lack of evidence about interventions in favour of the poorest in Africa. 13,14 A workshop was organised in February 2019. It mobilized 27 experts from national and regional organisations, who had experiential knowledge to identify actions to be tested within this action-research.…”