Primary care financing: a systematic assessment of research priorities in low- and middle-income countries

doi:10.1136/bmjgh-2019-001483

. 2019 Aug 16;4(Suppl 8):e001483.

doi: 10.1136/bmjgh-2019-001483. eCollection 2019.

Primary care financing: a systematic assessment of research priorities in low- and middle-income countries

Affiliations

¹ Department of General practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
² Robert Graham Center Policy Studies in Family Medicine & Primary Care, Washington, DC, USA.
³ Department of Primary Care, University of East Anglia Norwich Medical School, Norwich, Norfolk, UK.
⁴ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁵ Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia.
⁶ Research and Policy Department, the American Board of Family Medicine, Lexington, Kentucky, USA.
⁷ Radboud Institute of Health Research, Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.
⁸ Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia.

PMID: 31478025
PMCID: PMC6703294
DOI: 10.1136/bmjgh-2019-001483

Primary care financing: a systematic assessment of research priorities in low- and middle-income countries

Felicity Goodyear-Smith et al. BMJ Glob Health. 2019.

. 2019 Aug 16;4(Suppl 8):e001483.

doi: 10.1136/bmjgh-2019-001483. eCollection 2019.

Authors

Affiliations

¹ Department of General practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
² Robert Graham Center Policy Studies in Family Medicine & Primary Care, Washington, DC, USA.
³ Department of Primary Care, University of East Anglia Norwich Medical School, Norwich, Norfolk, UK.
⁴ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁵ Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia.
⁶ Research and Policy Department, the American Board of Family Medicine, Lexington, Kentucky, USA.
⁷ Radboud Institute of Health Research, Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.
⁸ Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia.

PMID: 31478025
PMCID: PMC6703294
DOI: 10.1136/bmjgh-2019-001483

Abstract

Introduction: Financing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC.

Methods: Three-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance.

Results: A diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as potentially critical to improving PHC financing. Round 2 provided 31 synthesised questions on financing for rating. The top 16 were ranked in Round 3e to produce four prioritised research questions.

Conclusions: This novel exercise created an expansive and prioritised list of critical knowledge gaps in PHC financing research questions. This offers valuable guidance to global supporters of primary care evaluation and implementation, including research funders and academics seeking research priorities. The source and context specificity of this research, informed by LMIC practitioners and academics on a global and local basis, should increase the likelihood of local relevance and eventual success in implementing the findings.

Keywords: delphi; developing countries; economics; financing healthcare: low-income and middlie-income; knowledge; organisation and administration; primary healthcare; research gaps.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Flowchart of literature reviews. LMIC, low- and middle-income country.

**Figure 2**
Number of studies from each LMIC. LMIC, low- and middle-income country.

**Figure 3**
Static copy of gap map. PHC, primary healthcare.

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References

1. International Conference on Primary Health Care Declaration of Alma-Ata. Alma-Ata, USSR: WHO, 1978.
1. Commonwealth Fund Primary care: our first line of defense. New York: Commonwealth Fund, 2013.
1. European Forum for Primary Care EFPC at a glance, 2017. Available: http://www.euprimarycare.org/about/efpc-glance
1. Goodwin N, Dixon A, Poole T, et al. Improving the quality of care in general practice Report of an independent inquiry commissioned by The King’s Fund. London: The King's fund, 2011.
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[1] International Conference on Primary Health Care Declaration of Alma-Ata. Alma-Ata, USSR: WHO, 1978.

[2] International Conference on Primary Health Care Declaration of Alma-Ata. Alma-Ata, USSR: WHO, 1978.

[3] Commonwealth Fund Primary care: our first line of defense. New York: Commonwealth Fund, 2013.

[4] Commonwealth Fund Primary care: our first line of defense. New York: Commonwealth Fund, 2013.

[5] European Forum for Primary Care EFPC at a glance, 2017. Available: http://www.euprimarycare.org/about/efpc-glance

[6] European Forum for Primary Care EFPC at a glance, 2017. Available: http://www.euprimarycare.org/about/efpc-glance

[7] Goodwin N, Dixon A, Poole T, et al. Improving the quality of care in general practice Report of an independent inquiry commissioned by The King’s Fund. London: The King's fund, 2011.

[8] Goodwin N, Dixon A, Poole T, et al. Improving the quality of care in general practice Report of an independent inquiry commissioned by The King’s Fund. London: The King's fund, 2011.

[9] Starfield B. Measuring the attainment of primary care. Academic Medicine 1979;54:361–9. 10.1097/00001888-197905000-00001 - DOI - PubMed

[10] Starfield B. Measuring the attainment of primary care. Academic Medicine 1979;54:361–9. 10.1097/00001888-197905000-00001 - DOI - PubMed

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Primary care financing: a systematic assessment of research priorities in low- and middle-income countries

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Primary care financing: a systematic assessment of research priorities in low- and middle-income countries

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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