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Cited by 205Healthcare Systems and ReformsPrimary Care and Health OutcomesHealthcare Systems and Practices

Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017

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Bitton, Asaf, Fifield, Jocelyn, Ratcliffe, Hannah, Karlage, Ami, Wang, Hong, Veillard, Jeremy H, Schwarz, Dan, Hirschhorn, Lisa R·2019·BMJ Global Health
DOI 10.1136/bmjgh-2019-001551PMC PMC6703296
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Abstract

Introduction: The 2018 Astana Declaration reaffirmed global commitment to primary healthcare (PHC) as a core strategy to achieve universal health coverage. To meet this potential, PHC in low-income and middle-income countries (LMIC) needs to be strengthened, but research is lacking and fragmented. We conducted a scoping review of the recent literature to assess the state of research on PHC in LMIC and understand where future research is most needed. Methods: Guided by the Primary Healthcare Performance Initiative (PHCPI) conceptual framework, we conducted searches of the peer-reviewed literature on PHC in LMIC published between 2010 (the publication year of the last major review of PHC in LMIC) and 2017. We also conducted country-specific searches to understand performance trajectories in 14 high-performing countries identified in the previous review. Evidence highlights and gaps for each topic area of the PHCPI framework were extracted and summarised. Results: We retrieved 5219 articles, 207 of which met final inclusion criteria. Many PHC system inputs such as payment and workforce are well-studied. A number of emerging service delivery innovations have early evidence of success but lack evidence for how to scale more broadly. Community-based PHC systems with supportive governmental policies and financing structures (public and private) consistently promote better outcomes and equity. Among the 14 highlighted countries, most maintained or improved progress in the scope of services, quality, access and financial coverage of PHC during the review time period. Conclusion: Our findings revealed a heterogeneous focus of recent literature, with ample evidence for effective PHC policies, payment and other system inputs. More variability was seen in key areas of service delivery, underscoring a need for greater emphasis on implementation science and intervention testing. Future evaluations are needed on PHC system capacities and orientation toward social accountability, innovation, management and population health in order to achieve the promise of PHC.

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  • Delivering quality PHC services requires an enduring infrastructure, essential medicines, commodities, adequately staffed and skilled health workers and effective, safe, people-centred care that is timely, equitable, integrated and efficient.

    “There is a growing acknowledgment that delivering quality PHC services requires an enduring infrastructure, essential medicines, commodities, adequately staffed and skilled health workers and effective, safe, people-centred care that is timely, equitable, integrated and efficient [1, 17, 54–56].”

    From Assessment of the compliance with minimum quality standards by public primary healthcare facilities in Nigeria (2024) · cites this paper as [56]

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  • While multiple reasons underlie good country performance, a common element seems to be investment in robust, community-based primary healthcare infrastructure.

    “While multiple reasons underly good country performance, a common element seems to be investment in robust, community-based primary healthcare infrastructure.16”

    From Global health 2050: the path to halving premature death by mid-century (2024) · cites this paper as [16]

  • Substantial gaps exist in most primary healthcare systems, particularly in LMICs, including limited human resources and capacity, shortages in medicines and equipment, and suboptimal quality of care.

    “The literature, however, has shown that substantial gaps exist in most primary healthcare systems, particularly in low-and middle-income countries (LMICs), including limited human resources and capacity, shortages in medicines and equipment, and suboptimal quality of care11–13.”

    From Digital health interventions for non-communicable disease management in primary health care in low-and middle-income countries (2023) · cites this paper as [12]

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Authors
Bitton, A., Fifield, J., Ratcliffe, H., Karlage, A., Wang, H., Veillard, J. H., Schwarz, D., & Hirschhorn, L. R.
Affiliations
  • Brigham and Women's Hospital (US)
  • Ariadne Labs (US)
  • Gates Foundation (US)
  • University of Toronto (CA)
  • Northwestern University (US)
Corresponding author
Bitton, Asaf
ORCID
Venue
BMJ Global Health
Publisher
BMJ
Published
2019-08
Volume
4
Issue
Suppl 8
Pages
e001551
ISSN
2059-7908 (ISSN-L)
DOI
10.1136/bmjgh-2019-001551
PMC
PMC6703296
OpenAlex
W2968458690
Cited by
205
References
78
Citations by year
2026: 25 · 2025: 35 · 2024: 37 · 2023: 35 · 2022: 37 · 2021: 21 · 2020: 11 · 2019: 3 · 2018: 1
Type
conference abstract
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Global Health (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Bill and Melinda Gates Foundation
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
Keywords
primary care, low- and middle-income countries, universal health coverage, community-based primary care, health care financing, healthcare workers, health equity, health care access, quality of care, implementation science, research gaps

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