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

• Published in: BMJ global health Vol. 4; no. Suppl 8; p. e001482
• Main Authors: Goodyear-Smith, Felicity, Bazemore, Andrew, Coffman, Megan, Fortier, Richard D W, Howe, Amanda, Kidd, Michael, Phillips, Robert, Rouleau, Katherine, van Weel, Chris
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 2019; BMJ Publishing Group
• Subjects: Global health; Health care; Health promotion; Income; Literature reviews; Low income groups; Medicine; Mixed methods research; Workforce; delphi; financing healthcare: low and middle income countries; models of care; developing countries; primary health care; knowledge; research gaps
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2019-001482

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.
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.
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.
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.