Building optimal and sustainable kidney care in low resource settings: The role of healthcare systems

Abstract

Healthcare systems in low-income and lower-middle income countries (LLMICs) face significant challenges in the provision of health services, for example, kidney care to the population. Although this is linked to several high-level factors such as poor infrastructure, socio-demographic and political factors, healthcare funding has often been cited as the major reason for the wide gap in availability, accessibility and quality of care between LLMICs and rich countries. With the steady rising incidence and prevalence of kidney diseases globally, as well as cost of care, LLMICs are likely to suffer more consequences of these increases than rich countries and may be unable to meet targets of universal health coverage (UHC) for kidney diseases. As health systems in LLMICs continue to adapt in finding ways to provide access to affordable kidney care, various empirical and evidence-based strategies can be applied to assist them. This review uses a framework for healthcare strengthening developed by the World Health Organization (WHO) to assess various challenges that health systems in LLMICs confront in providing optimal kidney care to their population. We also suggest ways to overcome these barriers and strengthen health systems to improve kidney care in LLMICs.

The case for increased peritoneal dialysis utilization in low‐ and lower‐middle‐income countries

“…These data strongly support the case for increased utilization of PD in LLMICs, even though major changes to health systems and practice patterns may be required to support improved PD use 30 . In arguing for increased PD use in these settings, we do not imply that our suggested strategies will be applicable or feasible across all countries.…”

“…27 These data strongly support the case for increased utilization of PD in LLMICs, even though major changes to health systems and practice patterns may be required to support improved PD use. 30 In arguing for increased PD use in these settings, we do not imply that our suggested strategies will be applicable or feasible across all countries. Rather, we discuss these strategies to interrogate existing models of kidney care in LLMICs and base our arguments on adaptations that can be made to turn barriers into opportunities.…”

“…Despite the enormous cost implications, measures for addressing the PD cost barrier in LLMICs are feasible and include (Figure 1): Increased public funding for healthcare and KRT, 8,30 Reduced cost of dialysis fluids produced by companies, 36 Local production of dialysate fluids, 24,37 Enhanced procurement methods (e.g., strategic purchasing including bulk procurement, waiving customs duties and taxes) for imported fluids, 30 Policy initiatives that use a PD‐first policy, 27,28,38 Reducing complications rate for PD thereby reducing added costs of hospitalization 36 and Using incremental dialysis approaches 36 …”

Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review

“…Furthermore, Africa has the highest gaps in the proportion of people with kidney failure needing dialysis but unable to receive it[ 66 ] and an extremely high mortality rate in adults and children with kidney failure [ 67 ]. Although cost plays a pivotal role in the care disparities and outcomes of kidney failure patients [ 3 ], very low nephrologist density has been linked to poor outcomes in the region [ 4 , 68 ]. Early NCD identification with appropriate interventions (e.g., education, counselling, pharmacotherapies, etc.)…”

Early Identification of CKD—A Scoping Review of the Global Populations

“…Real-world differences in health systems, 12 reimbursement, 13 and availability, accessibility, and affordability of kidney care 2 also drive this debate. The discussions on early identification programs often converge on the following 2 key points 14 , 15 , 16 , 17 : (i) the usefulness of the exercise (Is screening useful in asymptomatic individuals?…”