scholarly journals Protocol for a realist synthesis of health systems responsiveness in low-income and middle-income countries

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046992
Author(s):  
Tolib Mirzoev ◽  
Anna Cronin de Chavez ◽  
Ana Manzano ◽  
Irene Akua Agyepong ◽  
Mary Eyram Ashinyo ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Empirical Studies ◽  
Grey Literature ◽  
Realist Synthesis ◽  
Vulnerable Groups ◽  
Primary Data ◽  
London School ◽  
Middle Income ◽  
Middle Income Countries

IntroductionHealth systems responsiveness is a key objective of any health system, yet it is the least studied of all objectives particularly in low-income and middle-income countries. Research on health systems responsiveness highlights its multiple elements, for example, dignity and confidentiality. Little is known, however, about underlying theories of health systems responsiveness, and the mechanisms through which responsiveness works. This realist synthesis contributes to bridging these two knowledge gaps.Methods and analysisIn this realist synthesis, we will use a four-step process, comprising: mapping of theoretical bases, formulation of programme theories, theory refinement and testing of programme theories using literature and empirical data from Ghana and Vietnam. We will include theoretical and conceptual pieces, reviews, empirical studies and grey literature, alongside the primary data. We will explore responsiveness as entailing external and internal interactions within health systems. The search strategy will be purposive and iterative, with continuous screening and refinement of theories. Data extraction will be combined with quality appraisal, using appropriate tools. Each fragment of evidence will be appraised as it is being extracted, for its relevance to the emerging programme theories and methodological rigour. The extracted data pertaining to contexts, mechanisms and outcomes will be synthesised to identify patterns and contradictions. Results will be reported using narrative explanations, following established guidance on realist syntheses.Ethics and disseminationEthics approvals for the wider RESPONSE (Improving health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam) study, of which this review is one part, were obtained from the ethics committees of the following institutions: London School of Hygiene and Tropical Medicine (ref: 22981), University of Leeds, School of Medicine (ref: MREC19-051), Ghana Health Service (ref: GHS-ERC 012/03/20) and Hanoi University of Public Health (ref: 020-149/DD-YTCC).We will disseminate results through academic papers, conference presentations and stakeholder workshops in Ghana and Vietnam.PROSPERO registration numberCRD42020200353. Full record: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200353.

scholarly journals Foreign aid on economic growth in Africa: A comparison of low and middle-income countries

2015 ◽  
Vol 18 (4) ◽  
pp. 449-462 ◽  
Author(s):  
Aye Mengistu Alemu ◽  
Jin-Sang Lee
Keyword(s):  
Economic Growth ◽  
Foreign Aid ◽  
Low Income ◽  
Empirical Studies ◽  
Critical Role ◽  
Generalized Method Of Moments ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Theoretical Hypothesis

Previous empirical studies on the effects of foreign aid on economic growth have generated mixed results that make it difficult to draw policy recommendations. The main reason for such mixed results is the choice of a single aggregate list of countries, regardless of the disparities in levels of development. This study therefore fills the development gap by disaggregating the African data into a panel of 20 middle- income and 19 low- income African countries over a period of 15 years between 1995 and 2010, and employing a dynamic generalized method of moments (GMM) model to address the dynamic nature of economic growth as well as the problems of endogeneity. The results of this study support the theoretical hypothesis that a positive relationship between aid and GDP growth exists, but only for low-income African countries, not middle-income ones. On the other hand, the study reveals that middle- income African countries tend to experience a greater impact on their economic growth from foreign direct investment (FDI) and natural resources revenues, mainly oil exports. This implies that the frequent criticism that foreign aid has not contributed to economic growth is flawed, at least in the case of low-income African countries. In fact, foreign aid has played a critical role in stimulating economic growth in such countries through supplementing domestic sources of finance such as savings, thus increasing the amount of investment and capital stock in them.

scholarly journals Advancing research on emergency care systems in low-income and middle-income countries: ensuring high-quality care delivery systems

2019 ◽  
Vol 4 (Suppl 6) ◽  
pp. e001265 ◽  
Author(s):  
Rachel T Moresky ◽  
Junaid Razzak ◽  
Teri Reynolds ◽  
Lee A Wallis ◽  
Benjamin W Wachira ◽  
...  
Keyword(s):  
Health Systems ◽  
Emergency Care ◽  
Low Income ◽  
Communicable Diseases ◽  
Middle Income ◽  
Care Research ◽  
Middle Income Countries ◽  
Emergency Care Systems ◽  
Care Systems ◽  
Research Questions

Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.

scholarly journals Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018193 ◽  
Author(s):  
Grace Kathryn Ryan ◽  
Andreas Bauer ◽  
Judith K Bass ◽  
Julian Eaton
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Low Income ◽  
Tertiary Education ◽  
Grey Literature ◽  
Theory Of Change ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries ◽  
Humanitarian Crises

IntroductionThere is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC).Methods and analysisQualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis.Ethics and disseminationFindings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users.PROSPERO registration numberCRD42017058287.

scholarly journals Job morale of physicians in low-income and middle-income countries: a systematic literature review of qualitative studies

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e028657 ◽  
Author(s):  
Alina Sabitova ◽  
Sana Zehra Sajun ◽  
Sandra Nicholson ◽  
Franziska Mosler ◽  
Stefan Priebe
Keyword(s):  
Low Income ◽  
Grey Literature ◽  
Well Being ◽  
Analytical Framework ◽  
Working Environment ◽  
Reference List ◽  
Middle Income ◽  
Staff Shortage ◽  
Middle Income Countries ◽  
Context Specific

ObjectivesTo systematically review the available literature on physicians’ and dentists’ experiences influencing job motivation, job satisfaction, burnout, well-being and symptoms of depression as indicators of job morale in low-income and middle-income countries.DesignThe review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies evaluating outcomes of interest using qualitative methods. The framework method was used to analyse and integrate review findings.Data sourcesA primary search of electronic databases was performed by using a combination of search terms related to the following areas of interest: ‘morale’, ‘physicians and dentists’ and ‘low-income and middle-income countries’. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers.ResultsTen papers representing 10 different studies and involving 581 participants across seven low-income and middle-income countries met the inclusion criteria for the review. However, none of the studies focused on dentists’ experiences was included. An analytical framework including four main categories was developed: work environment (physical and social), rewards (financial, non-financial and social respect), work content (workload, nature of work, job security/stability and safety), managerial context (staffing levels, protocols and guidelines consistency and political interference). The job morale of physicians working in low-income and middle-income countries was mainly influenced by negative experiences. Increasing salaries, offering opportunities for career and professional development, improving the physical and social working environment, implementing clear professional guidelines and protocols and tackling healthcare staff shortage may influence physicians’ job morale positively.ConclusionsThere were a limited number of studies and a great degree of heterogeneity of evidence. Further research is recommended to assist in scrutinising context-specific issues and ways of addressing them to maximise their utility.PROSPERO registration numberCRD42017082579.

scholarly journals Health of transgender men in low-income and middle-income countries: a scoping review

2020 ◽  
Vol 5 (11) ◽  
pp. e003471
Author(s):  
Ayden Scheim ◽  
Vibhuti Kacholia ◽  
Carmen Logie ◽  
Venkatesan Chakrapani ◽  
Ketki Ranade ◽  
...  
Keyword(s):  
Scoping Review ◽  
Low Income ◽  
Grey Literature ◽  
Men’S Health ◽  
Men's Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Trans Men ◽  
Gender Based ◽  
And Gender

IntroductionDespite the rapid growth of research on transgender (trans) health globally, the extent of research on trans men and other transmasculine persons assigned the female sex at birth remains unclear. We, therefore, conducted a scoping review on trans men’s health in low-income and middle-income countries (LMICs).MethodsThe review included peer-reviewed articles and conference abstracts, and grey literature published from 1 January 1999 to 5 July 2019 in English, French, Hindi or Spanish and reporting original quantitative and/or qualitative data on the health of trans men or transmasculine persons living in LMIC. Studies were excluded if they did not disaggregate data for trans men or if they only described surgical techniques or laboratory values.ResultsWe included 53 studies (42 peer-reviewed and 11 grey literature) from 19 LMIC. Most were conducted in higher-middle-income countries (n=12) and in Latin America (n=16, 30.2%), the Middle East (n=14, 26.4%) or Sub-Saharan Africa (n=12, 22.6%) and published in 2014 or later (n=44, 83.0%). Approximately half of studies used quantitative methods (52.8%, n=28), of which 64.3% (n=18) had fewer than 50 participants and 14.2% (n=4) had over 150. Across study designs, social determinants of health and gender-affirming care were the most commonly represented domains (49.1% and 47.1% of studies respectively), with common themes including gender-based violence, coercion and discrimination as well as unprescribed hormone use. Other domains represented included mental health (32.1%), sexual and reproductive health (24.5%), general healthcare access (18.9%), physical health (9.4%) and substance use (9.4%).ConclusionGreater inclusion and disaggregation of trans men and transmasculine persons in global health research is needed to support sex- and gender-based analyses of trans health. Community-based research approaches and theoretically driven research may help to increase the relevance and rigour of such research. Funders should invest in research on trans men’s health in LMIC.

scholarly journals Evaluating health systems strengthening interventions in low-income and middle-income countries: are we asking the right questions?

2012 ◽  
Vol 27 (suppl 4) ◽  
pp. iv9-iv19 ◽  
Author(s):  
T. Adam ◽  
J. Hsu ◽  
D. de Savigny ◽  
J. N. Lavis ◽  
J.-A. Rottingen ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Health Systems Strengthening ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Right

scholarly journals Maternal and neonatal data collection systems in low- and middle-income countries: scoping review protocol

2020 ◽  
Vol 4 ◽  
pp. 18 ◽  
Author(s):  
Mabel Berrueta ◽  
Ariel Bardach ◽  
Agustin Ciaponni ◽  
Xu Xiong ◽  
Andy Stergachis ◽  
...  
Keyword(s):  
Data Collection ◽  
Scoping Review ◽  
Care Delivery ◽  
Grey Literature ◽  
Adverse Event Reporting ◽  
Vulnerable Groups ◽  
Recent Analysis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Background: Pregnant women and neonates represent one of the most vulnerable groups, especially in low- and middle-income countries (LMICs). A recent analysis reported that most vaccine pharmacovigilance systems in LMICs consist of spontaneous (passive) adverse event reporting. Thus, LMICs need effective active surveillance approaches, such as pregnancy registries. We intend to identify currently active maternal and neonatal data collection systems in LMICs, with the potential to inform active safety electronic surveillance for novel vaccines using standardized definitions. Methods: A scoping review will be conducted based on established methodology. Multiple databases of indexed and grey literature will be searched with a specific focus on existing electronic and paper-electronic systems in LMICs that collect continuous, prospective, and individual-level data from antenatal care, delivery, neonatal care (up to 28 days), and postpartum (up to 42 days) at the facility and community level, at the national and district level, and at large hospitals. Also, experts will be contacted to identify unpublished information on relevant data collection systems. General and specific descriptions of Health Information Systems (HIS) extracted from the different sources will be combined and duplicated HIS will be removed, producing a list of unique statements. We will present a final list of Maternal, Newborn, and Child Health systems considered flexible enough to be updated with necessary improvements to detect, assess and respond to safety concerns during the introduction of vaccines and other maternal health interventions. Selected experts will participate in an in-person consultation meeting to select up to three systems to be further explored in situ. Results and knowledge gaps will be synthesized after expert consultation.

scholarly journals Voices from low-income and middle-income countries: a systematic review protocol of primary healthcare interventions within public health systems addressing intimate partner violence against women

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019266 ◽  
Author(s):  
Marcos Claudio Signorelli ◽  
Stav Hillel ◽  
Daniel Canavese de Oliveira ◽  
Beatriz Paulina Ayala Quintanilla ◽  
Kelsey Hegarty ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Health Systems ◽  
Low Income ◽  
Partner Violence ◽  
Intimate Partner ◽  
Risk Of Bias ◽  
Middle Income ◽  
Public Health Systems ◽  
Middle Income Countries

IntroductionIntimate partner violence (IPV) considerably harms the health, safety and well-being of women. In response, public health systems around the globe have been gradually implementing strategies. In particular, low-income and middle-income countries (LMIC) have been developing innovative interventions in primary healthcare (PHC) addressing the problem. This paper describes a protocol for a systematic review of studies addressing the impacts and outcomes of PHC centre interventions addressing IPV against women from LMIC.Methods and analysisA systematic search for studies will be conducted in African Index Medicus, Africa Portal Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Index Medicus for the Southeast Asia Region, IndMed, Latin American and Caribbean Health Science Literature Database (LILACS), Medecins Sans Frontieres, MEDLINE, Minority Health and Health Equity Archive, ProQuest, PsycINFO, Scientific Electronic Library Online, (SciELO) and Social Policy and Practice. Studies will be in English, Spanish and Portuguese, published between 2007 and 2017, addressing IPV against women from LMIC, whose data quantitatively report on the impacts and outcomes for survivors and/or workers and/or public health systems preintervention and postintervention. Two trilingual reviewers will independently screen for study eligibility and data extraction, and a librarian will cross-check for compliance. Risk of bias and quality assessment of studies will be measured according to: (1) the Cochrane Collaboration’s tool for assessing risk of bias for randomised controlled trials and (2) the Methodological Index for Non-Randomised Studies (MINORS). Data will be analysed and summarised using meta-analysis and narrative description of the evidence across studies. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols(PRISMA P) guidelines.Ethics and disseminationThis systematic review will be based on published studies, thus not requiring ethical approval. Findings will be presented in conferences and published in a peer-reviewed journal.PROSPERO registration numberCRD42017069261.

scholarly journals Barriers to the implementation of sexual and reproductive health education programmes in low-income and middle-income countries: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030814
Author(s):  
Moreblessing Chipo Mashora ◽  
Tafadzwa Dzinamarira ◽  
Claude Mambo Muvunyi
Keyword(s):  
Health Education ◽  
Reproductive Health ◽  
Scoping Review ◽  
Low Income ◽  
Sexual And Reproductive Health ◽  
Emotional Health ◽  
Grey Literature ◽  
Middle Income ◽  
Middle Income Countries ◽  
Effective Implementation

IntroductionHealth education programmes (HEPs) have been associated with a number of benefits. These include providing individuals with information on matters related to their mental, social, physical as well as emotional health. HEPs also play a major role in preventing diseases and reducing the level of engagement of individuals in risky behaviours. While this is the case, there are barriers to the effective implementation of HEPs, especially in low-income and middle-income countries (LMICs) where resources are scarce. Available evidence has revealed socioeconomic challenges ranging from literacy issues, discomfort about issues of sexuality, and cultural barriers to financial constraints as key barriers to the implementation of sexual and reproductive health HEPs in LMICs. We will focus on HEPs related to sexual and reproductive health; all age groups will be considered with no restrictions on geographical setting nor model of HEP delivery. This review will map literature on the barriers to the effective implementation of HEPs in LMICs to guide future implementation research.MethodsArksey and O’Malley’s 2005 scoping methodological framework will act as the guide for this review. We will search the following electronic databases: EBSCOhost (Academic search complete, PsycINFO, Health Sources, CINAHL and MEDLINE with full text), Google Scholar, PubMed, SCOPUS, Science Direct and Web of Science. Grey literature from Mount Kenya University theses and dissertations, governments’ as well as international organisations’ reports, such as WHO, and reference lists of included studies will be searched for eligible studies. We will limit our search to publications from 1 January 2000 to 30 September 2019. Using thematic content analysis, we will employ NVivo V.12 to extract the relevant outcomes from the included articles. We will conduct a quality appraisal of the included articles using the mixed methods appraisal tool (MMAT) version 2018.Ethics and disseminationNo ethical approval is needed for the study as it will not include animal nor human participants. The results of the proposed scoping review will be disseminated electronically, in print and through conference presentation as well as at key stakeholder meetings.

scholarly journals Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries

2020 ◽  
Vol 5 (6) ◽  
pp. e002375 ◽  
Author(s):  
Ché L Reddy ◽  
Alexander W Peters ◽  
Desmond Tanko Jumbam ◽  
Luke Caddell ◽  
Blake C Alkire ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Critical Role ◽  
Scale Up ◽  
Surgical Care ◽  
Healthcare Intervention ◽  
Strengthen Health System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Fiscal Space

Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.

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