Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada.
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
Nephrology (Carlton). 2021 Dec;26(12):948-960. doi: 10.1111/nep.13935. Epub 2021 Jul 27.
Healthcare systems in low-income and lower-middle income countries (LLMICs) face significant challenges in the provision of health services, for example, kidney care to the population. Although this is linked to several high-level factors such as poor infrastructure, socio-demographic and political factors, healthcare funding has often been cited as the major reason for the wide gap in availability, accessibility and quality of care between LLMICs and rich countries. With the steady rising incidence and prevalence of kidney diseases globally, as well as cost of care, LLMICs are likely to suffer more consequences of these increases than rich countries and may be unable to meet targets of universal health coverage (UHC) for kidney diseases. As health systems in LLMICs continue to adapt in finding ways to provide access to affordable kidney care, various empirical and evidence-based strategies can be applied to assist them. This review uses a framework for healthcare strengthening developed by the World Health Organization (WHO) to assess various challenges that health systems in LLMICs confront in providing optimal kidney care to their population. We also suggest ways to overcome these barriers and strengthen health systems to improve kidney care in LLMICs.
低收入和中低收入国家（LMICs）的医疗体系在提供医疗服务方面面临着重大挑战，例如为民众提供肾脏护理。尽管这与基础设施差、社会人口和政治因素等几个高级别因素有关，但医疗保健资金经常被认为是造成 LMICs 与富裕国家之间在可及性、可及性和护理质量方面存在巨大差距的主要原因。随着全球肾脏疾病的发病率和患病率不断上升，以及治疗成本的上升，LMICs 可能比富裕国家遭受更多的影响，并且可能无法实现肾脏疾病全民健康覆盖（UHC）的目标。随着 LLMICs 的医疗体系继续适应寻找提供负担得起的肾脏护理的方法，各种经验和基于证据的策略可以应用于帮助它们。本综述使用世界卫生组织（WHO）制定的医疗体系加强框架来评估 LLMICs 的医疗体系在为其民众提供最佳肾脏护理方面面临的各种挑战。我们还提出了克服这些障碍和加强医疗体系以改善 LLMICs 肾脏护理的方法。
