Mobile clinics in humanitarian emergencies: a systematic review

Abstract

Background: Despite the widespread reliance on mobile clinics for delivering health services in humanitarian emergencies there is little empirical evidence to support their use. We report a narrative systematic review of the empirical evidence evaluating the use of mobile clinics in humanitarian settings. Methods: We searched MEDLINE, EMBASE, Global Health, Health Management Information Consortium, and The Cochrane Library for manuscripts published between 2000 and 2019. We also conducted a grey literature search via Global Health, Open Grey, and the WHO publication database. Empirical studies were included if they reported on at least one of the following evaluation criteria: relevance/appropriateness, connectedness, coherence, coverage, efficiency, effectiveness, and impact.Findings: Five studies met the inclusion criteria: all supported the use of mobile clinics in the particular setting under study. Three studies included controls. Two studies were assessed as good quality. The studies reported on mobile clinics providing non-communicable disease interventions, mental health services, sexual and reproductive health services, and multiple primary health care services in Afghanistan, the Democratic Republic of the Congo , Haiti, and the Occupied Palestinian Territories. Studies assessed one or more of the following evaluation domains: relevance/appropriateness, coverage, efficiency, and effectiveness. Four studies made recommendations including: i) ensure that mobile clinics are designed to complement clinic-based services; ii) improve technological tools to support patient follow-up, improve record-keeping, communication, and coordination; iii) avoid labelling services in a way that might stigmatise attendees; iv) strengthen referral to psychosocial and mental health services; v) partner with local providers to leverage resources; and vi) ensure strong coordination to optimise the continuum of care. Recommendations regarding the evaluation of mobile clinics include carrying out comparative studies of various modalities (including fixed facilities and community health workers) in order to isolate the effects of the mobile clinics. In the absence of a sound evidence base informing the use of mobile clinics in humanitarian crises, we encourage the integration of: i) WASH services, ii) nutrition services, iii) epidemic surveillance, and iv) systems to ensure the quality and safety of patient care. We recommend that future evaluations report against an established evaluation framework. Conclusion: Evidence supporting the use of mobile clinics in humanitarian emergencies is limited. We encourage more studies of the use of mobile clinics in emergency settings.

Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review

“…This review locates evidence of mobile clinics that have been implemented specifically for Indigenous populations (with the exception of New Zealand), and highlights the potential for mobile clinics to improve the accessibility of primary health care services. These findings are a valuable contribution to the growing body of international literature around the use of mobile clinics [ 28 , 29 , 32 , 33 , 36 , 38 ]. Before discussing the implications of these findings, it is important to reiterate that Indigenous populations are diverse, have different languages, cultural identities, customs, lore and spiritual beliefs [ 16 ].…”

“…The support for mobile clinics in providing flexible and safe health care to vulnerable people has gained traction with the recent COVID-19 pandemic [ 33 ]. In other countries, mobile clinics have also been implemented with the purpose of screening for communicable and non-communicable diseases [ 34 – 36 ] and providing disaster relief [ 37 , 38 ]. Some research supports the potential for mobile clinics to be a cost-effective model of health care and improve the management of chronic disease [ 29 , 39 ].…”

Reproductive, maternal, newborn and child health service delivery during conflict in Yemen: a case study

“…The bulk of these services are provided by female health workers, who are in short supply in many areas and face exacerbated inequities and risks in conflict-affected settings [39,40]. Mobile clinics and outreach strategies may be suitable for preventive services and outpatient case management of chronic conditions, but are unlikely to be able to deliver a comprehensive package of preventative and curative care, [41] meaning that gaps in availability of care for women during pregnancy, childbirth and the postpartum period will persist until community-based midwifery programs are expanded and access to quality, facilitybased services are restored.…”

Sexual Abuse and Mental Health in Humanitarian Disasters

“…Depression is also a consequence of sexual violence experienced during a humanitarian disaster and also a symptom of PTSD and trauma. Depression is generally treatable, however left alone without support it can easily worsen and even increase the probability of depression symptoms in children or other dependents in a household [1,19,20].…”