How to assess and prepare health systems in low- and middle-income countries for integration of services—a systematic review

Topp, Stephanie M.; Abimbola, Seye; Joshi, Rohina; Negin, Joel

doi:10.1093/heapol/czx169

Cited by 50 publications

(60 citation statements)

References 58 publications

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“…Another prioritised question, on the impact on NPHWs of integrating new programmes into their work routines , also reflected stakeholder interest in determining effective workforce development strategies to optimise team-based PHC functioning. This knowledge gap converged with the findings of the evidence mapping process and has been highlighted elsewhere as a key enabler to successful integration of front-line health services 26…”

Section: Convergence and Differences In Identified Evidence Gapsmentioning

confidence: 53%

“…Lack of evidence on the impact of front-line health service integration, as well as the necessary preconditions for achieving it, continues to impair the ability of decision makers and planners to assess integration preparedness in their setting, and limits knowledge of effective strategies to achieve sustainable integration 26. In the Asia-Pacific, there is a particular need for knowledge of how to effectively consolidate existing vertically funded programmes and operationalise the delivery of an integrated package of PHC services, including care for chronic NCDs.…”

Section: A Future Research Agendamentioning

confidence: 99%

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Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda

et al. 2019

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Health system planners in low- and middle-income countries (LMIC) of the Asia-Pacific region seeking to reorient primary health care (PHC) systems to achieve universal health coverage may be hindered by lack of knowledge of what works in their setting. With limited resources for research available, it is important to identify evidence-based strategies for reorganising PHC delivery, determine where relevant evidence gaps exist and prioritise these for future study. This paper describes an approach for doing this using the best available evidence combined with consultation to establish evidence priorities. We first reviewed PHC organisational interventions in Asia-Pacific LMICs and ascertained evidence gaps. The largest gaps related to interventions to promote access to essential medicines, patient management tools, effective health promotion strategies and service planning and accountability. Evidence from Pacific Island countries was particularly scant. We then engaged an expert panel of 22 PHC stakeholders from seven Asia-Pacific LMICs in a Delphi exercise to identify priority questions for future research. Research priorities were: (1) identifying effective PHC service delivery models for chronic diseases; (2) devising sustainable models of disease integration; (3) optimising task shifting; (4) understanding barriers to care continuity; (5) projecting future PHC needs; and (6) designing appropriate PHC service packages. Notably, stakeholder-determined priorities reflected large, context-dependent system issues, while evidence gaps centred on discrete interventions. Future research on the organisation of PHC services in Asia-Pacific LMICs should incorporate codesign principles to engage researchers and national PHC system stakeholders, and innovative methods that build on existing evidence and account for system complexity.

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Section: Convergence and Differences In Identified Evidence Gapsmentioning

confidence: 53%

Section: A Future Research Agendamentioning

confidence: 99%

Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda

et al. 2019

Self Cite

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“…Attention was paid to upskilling of both hospital and primary healthcare staff, although orientation of new staff was initially not as well managed. As with other integration programs [41] our respondents described contributing additional effort beyond their usual work roles to establish the program. Interviewees were concerned about ongoing funding and security of employment after the program's trial period.…”

Section: Discussionmentioning

confidence: 90%

Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis

Trankle

Usherwood

Abbott

et al. 2020

BMC Health Serv Res

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Background In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally. Methods We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts. Results Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. Conclusions Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.

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“…This review also identified facilitators and barriers to the integration of PC—also similar to those suggested in broader integration literature. For example, the creation of partnerships, supportive organizational culture and placement of the client and families as central to integration also promote broader integration and, conversely, a lack of the skilled health workers and resources can inhibit integration ( Watt et al , 2017 ; Topp et al , 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Approaches to integrating palliative care into African health systems: a qualitative systematic review

Court

Olivier

2020

Health Policy and Planning

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Africa is characterized by a high burden of disease and health system deficits, with an overwhelming and increasing demand for palliative care (PC). Yet only one African country is currently considered to have advanced integration of palliative care into medical services and generalized PC is said to be available in only a handful of others. The integration of PC into all levels of a health system has been called for to increase access to PC and to strengthen health systems. Contextually appropriate evidence to guide integration is vital yet limited. This qualitative systematic review analyses interventions to integrate PC into African health systems to provide insight into the ‘how’ of PC integration. Forty articles were identified, describing 51 different interventions. This study found that a variety of integration models are being applied, with limited best practices being evaluated and repeated in other contexts. Interventions typically focused on integrating specialized PC services into individual or multiple health facilities, with only a few examples of PC integrated at a population level. Four identified issues could either promote integration (by being present) or block integration (by their absence). These include the provision of PC at all levels of the health system alongside curative care; the development and presence of sustainable partnerships; health systems and workers that can support integration; and lastly, placing the client, their family and community at the centre of integration. These echo the broader literature on integration of health services generally. There is currently a strong suggestion that the integration of PC contributes to health system strengthening; however, this is not well evidenced in the literature and future interventions would benefit from placing health systems strengthening at the forefront, as well as situating their work within the context of integration of health services more generally.

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How to assess and prepare health systems in low- and middle-income countries for integration of services—a systematic review

Cited by 50 publications

References 58 publications

Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda

Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda

Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis

Approaches to integrating palliative care into African health systems: a qualitative systematic review

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