Primary healthcare policy and governance in low-income and middle-income countries: an evidence gap map

Abstract

IntroductionGovernance is one of the most important aspects for strong primary healthcare (PHC) service delivery. To achieve the targets for the Sustainable Development Goals, good governance may play a prime role in low-income and middle-income countries (LMICs). This evidence gap map (EGM) explored the available evidence in LMICs to identify the knowledge gap concerning PHC policy and governance in these settings.MethodsWe followed the standard 3ie EGM protocol, finalising the scope of the EGM through a stakeholder workshop. We searched a total of 32 bibliographic databases, systematic review databases, impact evaluation databases, and donor and bilateral agency databases using a comprehensive search strategy. Two reviewers screened retrieved studies, extracted data and performed quality assessment. We plotted the interventions and outcomes derived from the included studies in a dynamic platform to build the interactive EGM and conducted a stakeholder consultation with nominal group technique methods to prioritise the identified gaps.ResultsThe EGM included 24 systematic reviews and 7 impact evaluations focusing on PHC policy and governance in LMICs. Most of the sources emphasised workforce management and supervision. There were noticeable evidence gaps regarding accountability and social responsibility. The most highly prioritised themes were the role of accountability, the role of public–private partnerships and the role of user–provider communication in PHC governance.ConclusionsThis EGM identified some important aspects of PHC policy and governance such as accountability, social responsibility, public–private partnership, user–provider communication through the methodological approaches of evidence synthesis and stakeholder consultation. Identified gaps will provide directions for an implementation research plan to improve the governance of PHC in LMICs.

<p>Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries</p>

“…139,140 Multiple studies reported that intersectoral collaboration combined with community engagement among all health care stakeholders of LMICs improves healthcare indices and access to healthcare in these countries. [141][142][143] PHC Enhances Community Participation Community participation or engagement, another principal strength of PHC, has been reported as being highly influential on the prevention and control of NCDs. 144 Community participation is described as a method and practice by which ordinary people and societies are empowered to be involved dynamically and meaningfully in identifying and describing the health-issues concerning themselves.…”

Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context

“…, 2019 ). In an ‘evidence gap map’ exploring the available evidence in LMICs concerning PHC policy and governance, Saif-Ur-Rahman et al. (2019) demonstrate that among the highest priority research areas are better governance in PHC, public–private partnerships for community leadership and accountability, and improved user–provider communication.…”

Exploring access to government-led support for children with disabilities in Bangladesh

“…However, it is challenging to reach the most marginalized groups particularly in a context of low coverage of social protection schemes like Bangladesh. Low coverage increases competition among applicants and thus holds greater risk for inequitable allocation of coverage based on nepotism, bribery, patronage and political gain [10,56]. Thus, there is a need for strong monitoring and supervision systems, and also strong political commitment to achieve the goal of each social protection scheme [10].…”