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. 2019 Aug 16;4(Suppl 8):e001453.
doi: 10.1136/bmjgh-2019-001453. eCollection 2019.

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

K M Saif-Ur-Rahman  1 , Razib Mamun  1 , Iffat Nowrin  1 , Shahed Hossain  1 , Khaleda Islam  2 , Tajkia Rumman  3 , Ehtesham Kabir  4 , Aminur Rahman  1 , Ngamindra Dahal  5 , Iqbal Anwar  1
Affiliations

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

K M Saif-Ur-Rahman et al. BMJ Glob Health. .

Abstract

Introduction: Governance 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.

Methods: We 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.

Results: The 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.

Conclusions: This 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.

Keywords: LMICs; developing countries; evidence gap map; governance; policy; primary health care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of EGM methodology and prioritisation of identified gaps. EGM, evidence gap map.
Figure 2
Figure 2
Flow diagram of included articles using ROSES. LMIC, low-income and middle-income country; PHC, primary healthcare; ROSES, Reporting Standards for Systematic Evidence Syntheses.
Figure 3
Figure 3
Distribution of systematic reviews by major quality-assessment criteria.
Figure 4
Figure 4
Geographical distribution of articles (IE: Impact Evaluations and SR: Systematic Reviews) by world bank region.
Figure 5
Figure 5
An illustration of the interactive evidence gap map on PHC policy and governance. PHC, primary healthcare.
See this image and copyright information in PMC

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