The informal healthcare providers and universal health coverage in low and middle-income countries

Kumah, Emmanuel

doi:10.1186/s12992-022-00839-z

Cited by 20 publications

(25 citation statements)

References 19 publications

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“…Governments must sponsor studies to understand and measure the impact that IPs and other for profit systems have on rural health care practice and delivery. 55 …”

Section: Resultsmentioning

confidence: 99%

Informal Providers—Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review

Nayak

Oswal²,

Pramesh

et al. 2022

JCO Global Oncology

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PURPOSE South Asian Association for Regional Cooperation (SAARC) nations are a group of eight countries with low to medium Human Development Index values. They lack trained human resources in primary health care to achieve the WHO-stated goal of Universal Health Coverage. An unregulated service sector of informal health care providers (IPs) has been serving these underserved communities. The aim is to summarize the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socioeconomic milieu that sustains their existence. METHODS A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms Informal Health Care Provider/Informal Provider and Primary Health Care across databases such as Medline (PubMed), Google Scholar, and Cochrane database of systematic reviews, as well as World Bank, Center for Global Development, American Economic Review, Journal Storage, and Web of Science. In addition, citation lists from the primary articles, gray literature in English, and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC. RESULTS IPs across the rural landscape often comprise more than 75% of primary caregivers. They provide accessible and affordable, but often substandard quality of care. However, their network would be suitable for prompt cancer referrals. Care delivery and accountability correlate with prevalent standards of formal health care. CONCLUSION Acknowledgment and upskilling of IPs could be a cost-effective bridge toward universal health coverage and early cancer diagnosis in SAARC nations, whereas state capacity for training formal health care providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals who form the core of the rural public primary health care system.

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“…Governments must sponsor studies to understand and measure the impact that IPs and other for profit systems have on rural health care practice and delivery. 55 …”

Section: Resultsmentioning

confidence: 99%

Informal Providers—Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review

Nayak

Oswal²,

Pramesh

et al. 2022

JCO Global Oncology

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“…There was a low level of representativeness and therefore generalizability due to the use of convenience sampling, heterogenous illness characteristics, and concerns of non‐response bias (Downes et al, 2016). To add to this, these studies were conducted within the formal healthcare systems of the varying nations, meaning that harder‐to‐reach patients or those using informal health services may not have been included, likely representing a significant number of people in LMICs (Kumah, 2022). Moreover, the use of non‐validated instruments to measure factors and DUP compromised the validity, reliability, and comparability of the results (Downes et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

A systematic review of factors prolonging or reducing the duration of untreated psychosis for people with psychosis in low‐ and middle‐income countries

Paquin‐Goulet,

Krishnadas,

Beattie

2023

Early Intervention Psych

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AimThis review aims to identify factors that may prolong or reduce the duration of untreated psychosis for people with psychosis in low‐ and middle‐income countries.MethodsElectronic searches of six databases were conducted, to find studies from low‐ and middle‐income countries on people with psychotic disorders provided they statistically measured an association between factors that may prolong or reduce the duration of untreated psychosis. Studies were critically appraised and a narrative synthesis exploring differences between and within studies is presented. A socio‐ecological model is used to convey the main findings.ResultsThirty studies of 16 473 participants in total were included in this review. Taken together participants were 51.5% male and 48.5% female. Various factors potentially associated with longer duration of untreated psychosis for people with psychosis in low‐ and middle‐income countries were found. Examples of these factors are an insidious mode of onset, greater family stigma and low social class. Other factors, such as marital status, educational level, diagnostic type, predominant symptoms and employment status, yielded inconsistent results.ConclusionsThe methodological quality of the included studies limits the conclusions of this review. The results indicate an urgent need for further high‐quality research in these countries. The socio‐ecological model is a helpful framework for clinicians, scholars, and decision‐makers to conceptualize factors that may affect the duration of untreated psychosis, highlight gaps in the literature as well as reflect on potential prevention strategies that may ultimately support early intervention services for people with psychosis in developing countries.

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“…Work on informal healthcare providers does not consider the activities of these surplus health workers. 16 the lack of opportunity for formal employment within the health system is critical for three reasons. First, it can have grave consequences for quality within health systems.…”

Section: The Need For High Quality Mixed-methods Researchmentioning

confidence: 99%

“…Beyond these descriptions, however, we know little of what it is that these trained professionals do, how they make decisions, secure a living, or survive in harsh economic climates. Work on informal healthcare providers does not consider the activities of these surplus health workers 16 . Research on their individual and collective responses to the lack of opportunity for formal employment within the health system is critical for three reasons.…”

Section: The Need For High Quality Mixed‐methods Researchmentioning

confidence: 99%

The paradoxical surplus of health workers in Africa: The need for research and policy engagement

Hutchinson,

Kiwanuka,

Muhindo

et al. 2024

Health Planning & Management

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In many countries in Africa, there is a ‘paradoxical surplus’ of under and unemployed nurses, midwives, doctors and pharmacists which exists amidst a shortage of staff within the formal health system. By 2030, the World Health Organisation Africa Region may find itself with a shortage of 6.1 million health workers alongside 700,000 un‐ or underemployed health staff. The emphasis in policy debates about human resources for health at most national and global levels is on staff shortage and the need to train more health workers. In contrast, these ‘surplus’ health workers are both understudied and underacknowledged. Little time is given over to understand the economic, political and social factors that have driven their emergence; the ways in which they seek to make a living; the governance challenges that they raise; nor potential interventions that could be implemented to improve employment rates and leverage their expertise. This short communication reflects on current research findings and calls for improved quantitative and qualitative research to support policy engagement at national, regional and global levels.

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The informal healthcare providers and universal health coverage in low and middle-income countries

Cited by 20 publications

References 19 publications

Informal Providers—Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review

Informal Providers—Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review

A systematic review of factors prolonging or reducing the duration of untreated psychosis for people with psychosis in low‐ and middle‐income countries

The paradoxical surplus of health workers in Africa: The need for research and policy engagement

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