What improves access to primary healthcare services in rural communities? A systematic review

Abstract

Background To compile key strategies from the international experiences to improve access to primary healthcare (PHC) services in rural communities. Different innovative approaches have been practiced in different parts of the world to improve access to essential healthcare services in rural communities. Systematically collecting and combining best experiences all over the world is important to suggest effective strategies to improve access to healthcare in developing countries. Accordingly, this systematic review of literature was undertaken to identify key approaches from international experiences to enhance access to PHC services in rural communities. Methods All published and unpublished qualitative and/or mixed method studies conducted to improvement access to PHC services were searched from MEDLINE, Scopus, Web of Science, WHO Global Health Library, and Google Scholar. Articles published other than English language, citations with no abstracts and/or full texts, and duplicate studies were excluded. We included all articles available in different electronic databases regardless of their publication years. We assessed the methodological quality of the included studies using mixed methods appraisal tool (MMAT) version 2018 to minimize the risk of bias. Data were extracted using JBI mixed methods data extraction form. Data were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes. Results Our analysis of 110 full-text articles resulted in ten key strategies to improve access to PHC services. Community health programs or community-directed interventions, school-based healthcare services, student-led healthcare services, outreach services or mobile clinics, family health program, empanelment, community health funding schemes, telemedicine, working with traditional healers, working with non-profit private sectors and non-governmental organizations including faith-based organizations are the key strategies identified from international experiences. Conclusion This review identified key strategies from international experiences to improve access to PHC services in rural communities. These strategies can play roles in achieving universal health coverage and reducing disparities in health outcomes among rural communities and enabling them to get healthcare when and where they want.

The development and evaluation of a short-term international student research and educational program

“…Further, the visiting student described her engagement with our School of Nursing faith-based community program (taught by two research program team members) as a unique and valuable experience related to her goals of working with older adults in rural communities. Studies report that faith-based programs are effective in improving global health outcomes [ [35] , [36] , [37] ] and increasing older adults’ participation in healthy behaviors [ 38 ]. Also, the international student expressed a keen interest in our research team’s implementation of rural nursing care.…”

Rural and Urban patients’ Requirements and Experiences of Out-of-hours medical care after cancer (RUREO): a questionnaire study

“…Digital interventions could add value in addressing inequality of healthcare service access in rural populations63–66 by reducing the need for travel to services. Similarly, strategic use of resources close to patients such as community hospitals, patient navigators64 or community and family healthcare programmes in rural communities,66 could also improve equitable access to OOH services.…”

“…61 Patients value access to knowledgeable human operators with good communication skills. 62 Digital interventions could add value in addressing inequality of healthcare service access in rural populations [63][64][65][66] by reducing the need for travel to services.…”

“…Similarly, strategic use of resources close to patients such as community hospitals, patient navigators 64 or community and family healthcare programmes in rural communities, 66 could also improve equitable access to OOH services.…”

Real-World Performance of Large Language Models in Emergency Department Chest Pain Triage

“…Globally, especially in remote areas of developing and developed countries, there is a severe shortage of primary healthcare resources, characterized by insufficient facilities, lack of professional personnel, and financial constraints 22,23 . Trained medical providers, including doctors, nurses, and other community health workers, are scarce, making it difficult to provide high-quality primary healthcare services, further exacerbating the imbalance of medical human resources between urban and rural areas 24 . Traditional clinical prediction models based on machine learning or deep learning, despite having theoretical application prospects, are rarely deployed in actual clinical practice.…”