Health interventions among mobile pastoralists: a systematic review to guide health service design

Abstract

Objective Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap. Methods We conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records. Results Our search yielded 4884 non‐duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub‐Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11). Conclusion Without adaptations to account for mobile pastoralists’ unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist‐specific delivery strategies, such as combinations of mobile and ‘temporary fixed’ services informed by transhumance patterns, culturally acceptable waiting homes, community‐directed interventions and combined joint human‐animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.

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“…Health system leaders, in response to the emergency, successfully implemented a combined community level and fixed health service delivery points to reach the pastoralist community. This finding aligns with previous research highlighting the importance of flexible service delivery models such as mixed mobile and temporary fixed options, that cater to the sociocultural context and ensure service acceptability within pastoralist communities 24. Moreover, a study from Ethiopia found that mobile health team played a vital role in delivering health and nutrition services to mobile community 25.…”

“…This finding aligns with previous research highlighting the importance of flexible service delivery models such as mixed mobile and temporary fixed options, that cater to the sociocultural context and ensure service acceptability within pastoralist communities. 24 Moreover, a study from Ethiopia found that mobile health team played a vital role in delivering health and nutrition services to mobile community. 25 These findings consistent with this study, where the combined approach of community-based outreach and fixed health service delivery points effectively extended health service during drought and food insecurity emergency.…”

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“…Migration changes the distance to markets and services, already suboptimal in origin villages. A 2005 survey of nomadic Fulani found that 99 percent of children had not received routine childhood immunisations due to their mobility and remote locations (Wild et al, 2020).…”

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