Primary healthcare delivery models in African conflict-affected settings: a systematic review

Abstract

Background In conflict-affected settings, access to primary healthcare for displaced populations is constrained by multiple challenges. These include geographical, cultural, communication, logistical and financial barriers, as well as risks posed to health workers and the population by insecurity. Different models of care are used to provide primary healthcare to affected communities. However, there is a paucity of evidence on how these models are selected and implemented by organisations working in conflict and displacement-affected settings. Our aim was to explore the different primary healthcare delivery models used in conflict-affected settings to understand gaps in existing healthcare delivery models. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The review protocol was registered with the International Prospective Register of Systematic Reviews. We searched six databases for manuscripts published from January 1992 to December 2020. Publications were included if they reported primary healthcare models of care in conflict-affected settings of Africa. Data was analyzed descriptively and thematically using tables, charts and text. Results Forty-eight primary research articles were included for analysis from which thirty-three were rated as “high” quality. The results showed that the models of care in place in these conflict-affected settings include health facility-based, community-based, mobile clinics, outreach and home visits. Primary healthcare for internally displaced persons and refugees is provided by a wide range of actors including national and international organisations. A range of services is offered, most commonly nutrition, mental health and sexual/reproductive health. Some organisations offer vertical (stand-alone) services, while others use an integrated service delivery model. Multiple cadres of healthcare workers provide services, frequently lay healthcare workers such as Community Health Workers. Conclusion Understanding the different modalities of primary healthcare delivery in conflict-affected settings is important to identify existing practices and gaps in service delivery. Service delivery using community health workers in conflict-affected settings is a low-cost primary care delivery strategy that may help optimize contributions of existing personnel through task shifting.

Leaving no one behind in armed conflict-affected settings of Africa: is universal health coverage a possibility or mirage?

“…In the face of compromised government institutional capacity for public health governance and weak policy environments, infrastructures, and systems, services are mainly provided by national or international non-governmental organisations contracted by multilateral partners. The service delivery models are mainly health facility-based with pockets of community-based health initiatives, mobile clinics, outreaches, and home visits, which are essential in reaching the last mile [ 19 ]. The coordination mechanisms for health in these settings are predominantly humanitarian-based and led by the health cluster that has limited mandate and capacity for coordinating health system recovery and resilience building [ 20 ].…”