Palliative care in low- and medium-resource countries

Abstract: Low- and medium-resource countries are facing a significant increase in the incidence of noncommunicable diseases such as cancer. Unfortunately, the majority of patients with cancer present with advanced disease, and disease-directed treatment may be unlikely to be effective and/or not available. Globally, there will be a growing need for palliative care services. There has been significant progress in the provision and integration of palliative care into the health care policy and systems. Nonetheless, palliative care services vary significantly between regions of the world and also between countries in the same region. Some common barriers to care include the lack of a trained workforce to provide palliative care, lack of availability of opioids or the restriction of their use, cultural attitudes of physicians and patients, and also funding. Despite these challenges, there are examples of low- and medium-resource countries that are providing excellent palliative care that is being integrated ...

A scoping review of mentorship of health personnel to improve the quality of health care in low and middle-income countries

Most Low and Middle-Income Countries are facing a crisis in human resources for health which compromises their ability to meet health related targets outline by the Sustainable Development Goals. The crisis is not limited to the availability of health personnel but also the quality of care and the training and development of the workforce. To address these challenges evidence based education strategies are urgently required. 

Integrated care: learning between high-income, and low- and middle-income country health systems

Integration is a challenging concept to define, in part because of its multiple dimensions and varied scope: from integrated clinical care for individual patients to broader systems integration- or linkage-involving wide range of interconnected services. This commentary compares integrated care in high-and lower- income countries. Although contexts may differ significantly between these settings, there are many common features of how integration has been understood and common challenges in its implementation

How to assess and prepare health systems in low- and middle-income countries for integration of services—a systematic review

Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle- income countries (LMICs). This article adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for capacity to implement integrated services. 

Managing In- and Out-Migration of Health Workforce in Selected Countries in South East Asia Region

There is an increasing trend of international migration of health professionals from low -and middle- income countries to high-income countries as well as across middle- income countries. The WHO Global Code of Practice on the International Recruitment of Health Personnel was created better address health workforce development and the ethical coduct of international recruitment. This study assessed policies and practices in 4 countries in South East Asia on managing the in -and out- migration of doctors and nurses to see whether the managementet has been in line with the WHO Global Code and has fostered health workforce development in the region; and draws lessons from these countries. 

A Critical Analysis of Purchasing Arrangements in Kenya: The Case of the National Hospital Insurance Fund

Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low-and middle- income countries, and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospitals Insurance Fund as a case study. 

Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation

Policy analysis on why women and children in low- and middle- income settings are still disadvantaged by access to appropiate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street- level bureaucracy theory, this article explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana´s community-based PHC implementation to the disadvantage of women and children accessing and using health services. 

Health system innovations: adapting to rapid change

A fundamental challenge for health systems is the need to adapt to changes in the patterns of health service need, scientific and technological developments, and the economic and institutional contexts within which providers of health services are embedded. This is especially true of many low and middle-income countries, where the pace of multiple and interconnected changes is breath-taking. 

Best practices in scaling digital health in low and middle income countries

Healthcare challenges in low and middle income countries (LMICs) have been the focus of many digital initiatives that have aimed to improve both access to healthcare and the quality of healthcare delivery. Moving beyond the initial phase of piloting and experimentation, these initiatives are now more clearly focused on the need for effective scaling and integration to provide sustainable benefit to healthcare systems.

Strengthening performance-based financing as a health system approach for quality improvement

Over the last decade, a significant reduction of maternal and child mortality has been achieved in low- and middle-income countries (LMICs). This is largely attributable to the substantial improvement in access to essential reproductive, maternal and child health services. However, in some countries, expansion of health services has not resulted in the expected mortality reduction. Low quality of care (QoC) is an important cause of this discrepancy, and it calls for putting quality improvement on the global health agenda. As an approach to enhance QoC in LMICs, performance-based financing (PBF), which incentivizes health providers based on predetermined indicators, has been piloted or implemented in more than 30 countries. More importantly, PBF has been used as an important vehicle to catalyze health system reforms to enhance service delivery, including quality improvement (QI), in many countries.

This paper takes a system perspective to examine the current practice of PBF in strengthening health ...

The Governance of National Community Health Worker Programmes in Low- and Middle-Income Countries: An Empirically Based Framework of Governance Principles, Purposes and Tasks

National community health worker (CHW) programmes are increasingly regarded as an integral component of primary healthcare (PHC) in low- and middle-income countries (LMICs). At the interface of the formal health system and communities, CHW programmes evolve in context specific ways, with unique cadres and a variety of vertical and horizontal relationships. These programmes need to be appropriately governed if they are to succeed, yet there is little evidence or guidance on what this entails in practice. Based on empirical observations of South Africa’s community-based health sector and informed by theoretical insights on governance, this paper proposes a practical framework for the design and strengthening of CHW programme governance at scale.

Determinants of enrollment decision in the community-based health insurance, North West Ethiopia: a case-control study

Health security is increasingly being recognized as an integral part of poverty reduction effort. Many lower and middle-income countries (LMICs) have not been able to fulfill equitable healthcare needs of their citizens.
The aim of this study was to identify the determinants for enrollment decision in the community-based health insurance program among informal economic sector-engaged societies, North West Ethiopia.