Dodd Rebecca, Palagyi Anna, Jan Stephen, Abdel-All Marwa, Nambiar Devaki, Madhira Pavitra, Balane Christine, Tian Maoyi, Joshi Rohina, Abimbola Seye, Peiris David
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia.
BMJ Glob Health. 2019 Aug 16;4(Suppl 8):e001487. doi: 10.1136/bmjgh-2019-001487. eCollection 2019.
This 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.
We 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.
From 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.
Based 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.
本文综合了亚太地区低收入和中等收入国家（LMICs）初级卫生保健（PHC）服务提供组织方面的证据，并确定了该地区有效方法及影响途径的证据。
我们制定了一个概念框架，将初级卫生保健的关键投入和成果描述为系统评价的基础。我们专门搜索了亚太地区低收入和中等收入国家的干预研究，以确定“什么有效”来提高初级卫生保健的覆盖范围、质量、效率、公平性和响应性。我们进行了叙述性综合分析，以确定成功干预措施的关键特征。
从最初的3001篇文章列表中，我们选择了153篇进行全文审查，其中111篇被纳入。我们发现了非医师卫生工作者（NPHWs）对护理覆盖范围和质量影响的证据，不过需要更好地与其他初级卫生保健服务相结合。通过功能转诊系统和支持性监督安排以及可靠的药品供应进行良好整合时，基于社区的服务最为有效。许多研究指出社区参与在改善服务需求方面的重要性。很少有研究采用“系统”视角或充分考虑长期成本或实施挑战。
基于我们的研究结果，我们建议在五个领域需要更多实用知识和指导来支持初级卫生保健系统的加强：（1）非医师卫生工作者劳动力发展；（2）将非传染性疾病预防和控制纳入基本护理包；（3）建设管理能力；（4）使社区参与制度化；（5）使初级卫生保健信息系统现代化。
