Evidence map›Paper›PMID 31478026›Full record

ArticleBMJ global health2019

Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region.

Rebecca Dodd, Anna Palagyi, Stephen Jan, Marwa Abdel-All, Devaki Nambiar, Pavitra Madhira, Christine Balane, Maoyi Tian, Rohina Joshi, Seye Abimbola and 1 more

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In one paragraph

Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  20. Reorienting health systems towards Primary Health Care in South Asia.The Lancet regional health. Southeast Asia · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Rebecca DoddThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.ORCID 0000-0003-3469-8999
Anna PalagyiThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.ORCID 0000-0002-8127-9351
Stephen JanThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Marwa Abdel-AllThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.ORCID 0000-0001-8103-1498
Devaki NambiarThe George Institute for Global Health, New Delhi, India.
Pavitra MadhiraThe George Institute for Global Health, New Delhi, India.
Christine BalaneThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Maoyi TianThe George Institute for Global Health, Beijing, China.
Rohina JoshiThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Seye AbimbolaThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
David PeirisThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.ORCID 0000-0002-6898-3870

Funding

Medical Research Council MR/P013996/1
6 · The paper itself

Abstract

introductionThis paper synthesises evidence on the organisation of primary health care (PHC) service delivery in low-income and middle-income countries (LMICs) in the Asia Pacific and identifies evidence of effective approaches and pathways of impact in this region.

methodsWe developed a conceptual framework describing key inputs and outcomes of PHC as the basis of a systematic review. We searched exclusively for intervention studies from LMICs of the Asia-Pacific region in an effort to identify 'what works' to improve the coverage, quality, efficiency, equity and responsiveness of PHC. We conducted a narrative synthesis to identify key characteristics of successful interventions.

resultsFrom an initial list of 3001 articles, we selected 153 for full-text review and included 111. We found evidence on the impact of non-physician health workers (NPHWs) on coverage and quality of care, though better integration with other PHC services is needed. Community-based services are most effective when well integrated through functional referral systems and supportive supervision arrangements, and have a reliable supply of medicines. Many studies point to the importance of community engagement in improving service demand. Few studies adopted a 'systems' lens or adequately considered long-term costs or implementation challenges.

conclusionBased on our findings, we suggest five areas where more practical knowledge and guidance is needed to support PHC systems strengthening: (1) NPHW workforce development; (2) integrating non-communicable disease prevention and control into the basic package of care; (3) building managerial capacity; (4) institutionalising community engagement; (5) modernising PHC information systems.

Indexed as

asiaintervention effectivenesslow- and middle-income countriespacificprimaryhealthcare

Identifiers

PMID31478026
PMCPMC6703302

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.