Models of community-based primary care for epilepsy in low- and middle-income countries

Neurology ◽  
2020 ◽  
Vol 94 (4) ◽  
pp. 165-175 ◽  
Author(s):  
Gagandeep Singh ◽  
Meenakshi Sharma ◽  
Anand Krishnan ◽  
Tarun Dua ◽  
Francesco d'Aniello ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Treatment Adherence ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Community Awareness ◽  
Primary Health ◽  
Low And Middle Income

ObjectiveTo review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries.MethodsA systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles.ResultsThe 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans.ConclusionsCost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.

scholarly journals Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs

2020 ◽  
Author(s):  
Lutfi Lokman ◽  
Teresa Chahine
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Business Models ◽  
Social Enterprises ◽  
Social Entrepreneurs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Low And Middle Income

Abstract Background Social entrepreneurship can help increase access to primary health care in low resource settings. Research on social enterprises in health have focused either on developing countries, or on secondary and tertiary care in low and middle income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low and middle income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area. Methods We identify social entrepreneurs working to deliver primary care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurs. Through in-depth interviews, we collect information on medical processes, business processes, social impact and organizational impact according to the Battacharyya et al framework. We then conducted qualitative analysis to identify common patterns and themes emerging within these four categories. Results Distinguishing characteristics in the business models of primary care social enterprises include flat rate rather than differential pricing; cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under ten years old. Conclusions Social enterprise has been demonstrated as a feasible model for providing primary care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

Strengthening Primary Health Care in Low- and Middle-Income Countries

2013 ◽  
Vol 26 (4) ◽  
pp. 339-348 ◽  
Author(s):  
John Rule ◽  
Duc Anh Ngo ◽  
Tran Thi Mai Oanh ◽  
Augustine Asante ◽  
Jennifer Doyle ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Low And Middle Income

scholarly journals Business models for primary health care delivery in low and middle income countries: a scoping study of nine social entrepreneurs

2020 ◽  
Author(s):  
Lutfi Lokman ◽  
Teresa Chahine
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Business Models ◽  
Tertiary Care ◽  
Social Enterprises ◽  
Social Entrepreneurs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Low And Middle Income

Abstract Background: Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area.Methods: We identify social entrepreneurs working to deliver primary care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories.Results: Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing; cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under ten years old.Conclusions: Social enterprise has been demonstrated as a feasible model for providing primary care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

scholarly journals A primary health care model for managing pre-eclampsia and eclampsia in low- and middle- income countries

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Charlotte E. Warren ◽  
Sharif Mohammed Ismail Hossain ◽  
Salisu Ishaku ◽  
Deborah Armbruster ◽  
Emily Hillman
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Care Model ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Health Care Model ◽  
Low And Middle Income

scholarly journals Business models for primary health care delivery in low- and middle-income countries: a scoping study of nine social entrepreneurs

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lutfi Lokman ◽  
Teresa Chahine
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Business Models ◽  
Tertiary Care ◽  
Social Enterprises ◽  
Social Entrepreneurs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Low And Middle Income

Abstract Background Social enterprises are organizations created to address social problems that use business models to sustain themselves financially. Social enterprises can help increase access to primary health care in low resource settings. Research on social enterprises in health care have focused either on high-income countries, or on secondary and tertiary care in low- and middle-income countries, where common business models include differential pricing to cross-subsidize low income populations. This is the first study to examine social enterprises providing primary health care in low- and middle-income countries using primary data. The purpose is to determine whether social enterprise is a viable model in this setting and to identify common patterns and characteristics that could inform the work of social entrepreneurs, funders, and researchers in this area. Methods We identify social entrepreneurs working to deliver primary health care in low- and middle-income countries who have been vetted by international organizations dedicated to supporting social entrepreneurship. Through in-depth interviews, we collect information on medical processes, business processes, social impact, and organizational impact according to the Battacharyya et al. framework. We then conducted qualitative analysis to identify common patterns emerging within these four categories. Results Common characteristics in the business models of primary health care social enterprises include flat rate rather than differential pricing and cross-subsidizing across services rather than patients. Subscription packages and in-house IT systems were utilized to generate revenue and increase reach through telemedicine, franchising, and mobile units. In some cases, alternate revenue streams are employed to help break even. About half of the social enterprises interviewed were for-profit, and about half non-profit. The majority faced challenges in engaging with the public sector. This is still a nascent field, with most organizations being under 10 years old. Conclusions Social enterprise has been demonstrated as a feasible model for providing primary health care in low resource settings, with key characteristics differing from the previously commonly studied social enterprises in tertiary care. There are opportunities to complement existing public health systems, but most organizations face challenges in doing so. More research and attention is needed by researchers, governments and funders to support social entrepreneurs and avoid parallel systems.

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