Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach

doi:10.1136/bmjgh-2019-001482

. 2019 Aug 16;4(Suppl 8):e001482.

doi: 10.1136/bmjgh-2019-001482. eCollection 2019.

Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach

Felicity Goodyear-Smith¹, Andrew Bazemore², Megan Coffman², Richard D W Fortier^{1

3}, Amanda Howe⁴, Michael Kidd^{5

6}, Robert Phillips⁷, Katherine Rouleau⁵, Chris van Weel^{8

9}

Affiliations

¹ Department of General Practice and Primary Health Care, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.
² Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington, District of Columbia, USA.
³ McGill University, Montreal, Quebec, Canada.
⁴ Primary Care, University of East Anglia Norwich Medical School, Norwich, UK.
⁵ Department of Family and Community Medicine, University of Toronto and Southgate Institute for Health, Toronto, Ontario, Canada.
⁶ Flinders University, Adelaide, South Australia, Australia.
⁷ Research and Policy of the American Board of Family Medicine, Lexington, Kentucky, USA.
⁸ Radboud Institute of Health Research, Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.
⁹ Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia.

PMID: 31497316
PMCID: PMC6703507
DOI: 10.1136/bmjgh-2019-001482

Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach

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

. 2019 Aug 16;4(Suppl 8):e001482.

doi: 10.1136/bmjgh-2019-001482. eCollection 2019.

Authors

Felicity Goodyear-Smith¹, Andrew Bazemore², Megan Coffman², Richard D W Fortier^{1

3}, Amanda Howe⁴, Michael Kidd^{5

6}, Robert Phillips⁷, Katherine Rouleau⁵, Chris van Weel^{8

9}

Affiliations

¹ Department of General Practice and Primary Health Care, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.
² Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington, District of Columbia, USA.
³ McGill University, Montreal, Quebec, Canada.
⁴ Primary Care, University of East Anglia Norwich Medical School, Norwich, UK.
⁵ Department of Family and Community Medicine, University of Toronto and Southgate Institute for Health, Toronto, Ontario, Canada.
⁶ Flinders University, Adelaide, South Australia, Australia.
⁷ Research and Policy of the American Board of Family Medicine, Lexington, Kentucky, USA.
⁸ Radboud Institute of Health Research, Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.
⁹ Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia.

PMID: 31497316
PMCID: PMC6703507
DOI: 10.1136/bmjgh-2019-001482

Abstract

Introduction: Since the Alma-Ata Declaration 40 years ago, primary healthcare (PHC) has made great advances, but there is insufficient research on models of care and outcomes-particularly for low-income and middle-income countries (LMICs). Systematic efforts to identify these gaps and develop evidence-based strategies for improvement in LMICs has been lacking. We report on a global effort to identify and prioritise the knowledge needs of PHC practitioners and researchers in LMICs about PHC organisation.

Methods: Three-round modified Delphi using web-based surveys. PHC practitioners and academics and policy-makers from LMICs sampled from global networks. First round (pre-Delphi survey) collated possible research questions to address knowledge gaps about organisation. Responses were independently coded, collapsed and synthesised. Round 2 (Delphi round 1) invited panellists to rate importance of each question. In round 3 (Delphi round 2), panellists ranked questions into final order of importance. Literature review conducted on 36 questions and gap map generated.

Results: Diverse range of practitioners and academics in LMICs from all global regions generated 744 questions for PHC organisation. In round 2, 36 synthesised questions on organisation were rated. In round 3, the top 16 questions were ranked to yield four prioritised questions in each area. Literature reviews confirmed gap in evidence on prioritised questions in LMICs.

Conclusion: In line with the 2018 Astana Declaration, this mixed-methods study has produced a unique list of essential gaps in our knowledge of how best to organise PHC, priority-ordered by LMIC expert informants capable of shaping their mitigation. Research teams in LMIC have developed implementation plans to answer the top four ranked research questions.

Keywords: delphi; developing countries; financing healthcare: low and middle income countries; knowledge; models of care; primary health care; research gaps.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Flowchart for search on primary healthcare organisation in low-income and middle-income countries (LMICs).

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

**Figure 3**
Static version of gap map of studies for model of care.

See this image and copyright information in PMC

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References

1. International Conference on Primary Health Care Declaration of Alma-Ata. Alma-Ata: USSR: WHO, 1978.
1. Labonté R, Pooyak S, Baum F, et al. . Implementation, effectiveness and political context of comprehensive primary health care: preliminary findings of a global literature review. Aust J Prim Health 2008;14:58–67. 10.1071/PY08037 - DOI
1. Tarimo E, Webster E, World Health Organization . Primary health care concepts and challenges in a changing world: Alma-Ata revisited. Geneva: WHO, 1994.
1. World Health Assembly Primary health care, including health system strengthening WHA6212. Geneva: 22nd World Health Assembly, WHO, 2009: 3.
1. Starfield B. Measuring the attainment of primary care. J Med Educ 1979;54:361–9. 10.1097/00001888-197905000-00001 - DOI - PubMed

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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] Labonté R, Pooyak S, Baum F, et al. . Implementation, effectiveness and political context of comprehensive primary health care: preliminary findings of a global literature review. Aust J Prim Health 2008;14:58–67. 10.1071/PY08037 - DOI

[4] Labonté R, Pooyak S, Baum F, et al. . Implementation, effectiveness and political context of comprehensive primary health care: preliminary findings of a global literature review. Aust J Prim Health 2008;14:58–67. 10.1071/PY08037 - DOI

[5] Tarimo E, Webster E, World Health Organization . Primary health care concepts and challenges in a changing world: Alma-Ata revisited. Geneva: WHO, 1994.

[6] Tarimo E, Webster E, World Health Organization . Primary health care concepts and challenges in a changing world: Alma-Ata revisited. Geneva: WHO, 1994.

[7] World Health Assembly Primary health care, including health system strengthening WHA6212. Geneva: 22nd World Health Assembly, WHO, 2009: 3.

[8] World Health Assembly Primary health care, including health system strengthening WHA6212. Geneva: 22nd World Health Assembly, WHO, 2009: 3.

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

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

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Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach

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Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach

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