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Barriers And Facilitators To Implementation Of Essential Health Benefits Package Within Primary Health Care Settings In Low‐income And Middle‐income Countries: A Systematic Review

F. El-Jardali, Racha Fadlallah, Aref Daouk, R. Rizk, N. Hemadi, Ola El Kebbi, Aida Farha, E. Akl
Published 2019 · Medicine

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BACKGROUND One of the key requirements for achieving universal health coverage is the proper design and implementation of essential health benefits package (EHPs). We systematically reviewed the evidence on barriers and facilitators to the implementation of EHPs within primary health care settings in low-income and middle-income countries. METHODS We searched multiple databases and the gray literature. Two reviewers completed independently and in duplicate data selection, data extraction, and quality assessment. We synthesized the findings according to the following health systems arrangement levels: governance, financial, and delivery arrangements. RESULTS Ten studies met the eligibility criteria. At the governance level, key reported barriers were insufficient policymaker-implementer interactions, limited involvement of consumers and stakeholders, sub-optimal primary health care network arrangement, poor marketing and promotion of package, and insufficient coordination with community network. The key reported facilitator was the presence of a legal policy framework for package implementation. At the financial level, barriers included delays and inadequate remunerations to health care providers while facilitators included government and donor commitments to financing of package and flexibility in exploring new funding mechanisms. At the delivery level, barriers included inadequate supervision, poor facility infrastructure, limited availability of equipment and supplies, and shortages of workers. Facilitators included proper training and management of workforce, availability of female health workers, presence of clearly defined packages, and continuum of care, including referrals to promote comprehensive service delivery. CONCLUSION We identified a set of barriers and facilitators that need to be addressed to ensure proper implementation of EHPs within primary health care settings.
This paper references
10.1186/1472-6963-14-359
Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study
N. Howard (2014)
10.1136/bmj.332.7543.718
Contracting out health services in fragile states
N. Palmer (2006)
Costing resource gaps for the delivery of minimum essential health services package in the Coast Province, Kenya.
Mercy G. Mugo (2009)
London: EPPI‐Centre, Social Science Research Unit, Institute of Education, University of London
A Acharya (2012)
10.2471/BLT.12.102301
The impact of health insurance in Africa and Asia: a systematic review.
E. Spaan (2012)
10.1016/S0140-6736(03)13861-5
Household catastrophic health expenditure: a multicountry analysis
K. Xu (2003)
10.1093/HEAPOL/CZH031
Community-based health insurance in low-income countries: a systematic review of the evidence.
Björn Ekman (2004)
10.1080/23288604.2016.1124171
Defining a Health Benefits Package: What Are the Necessary Processes?
A. Glassman (2016)
10.1016/S0140-6736(14)61419-7
Universal health coverage and the post-2015 agenda
Marisol Touraine (2014)
http://www.worldbank.org/en/news/ press‐release/2015/07/01/new‐world‐bank‐update‐shows‐bangladesh‐kenya‐myanmar‐and‐tajikistan‐as‐middle‐income‐ while‐south‐sudan‐falls‐back‐to‐low‐income
R Fadlallah (2015)
Assessment of the implementation of the primary health care package at selected sites in South Africa.
J. C. Heunis (2006)
10.3402/gha.v7.23693
The missing link - the role of primary care in global health.
Mala Narasappaya Rao (2014)
10.1016/j.socscimed.2012.11.026
Implementing a Basic Package of Health Services in post-conflict Liberia: perceptions of key stakeholders.
D. Petit (2013)
The political economy of universal health coverage. Background paper for the global symposium on health systems research
D. Stuckler (2010)
Assessment of the implementation of the primary health care package at selected sites in South Africa.
Heunis Jc (2006)
10.1016/S0140-6736(05)67140-1
Buying results? Contracting for health service delivery in developing countries
Benjamin P. Loevinsohn (2005)
10.1056/NEJMp1508807
Politics and Universal Health Coverage--The Post-2015 Global Health Agenda.
Vin Gupta (2015)
10.1097/JAC.0b013e31819941bb
Governance and the Effectiveness of the Buenos Aires Public Health Insurance Implementation Process
E. Báscolo (2009)
10.1136/bmj.i244
Role of priority setting in implementing universal health coverage
Y. Teerawattananon (2016)
Uganda's minimum health package for health care: rationing within the minimum?
F. Ssengooba (2004)
10.1186/s12914-016-0106-y
Assessing the universal health coverage target in the Sustainable Development Goals from a human rights perspective
A. Chapman (2016)
10.1016/j.socscimed.2010.02.029
International involvement and national health governance: the basic benefit package in Tajikistan.
Bernd Rechel (2010)
10.1371/journal.pone.0160479
What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis
D. Dror (2016)
10.4102/PHCFM.V2I1.246
Affordable primary health care in low-income countries: can it be achieved?
Dorothy E Logie (2010)
10.1590/S0102-311X2007001200003
Access to health care in developing countries: breaking down demand side barriers.
O. O'Donnell (2007)
10.1111/1468-0009.00005
Examining the role of health services research in public policymaking.
J. Lavis (2002)
10.1016/S0140-6736(08)61403-8
Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews
S. Lewin (2008)
10.1080/17441692.2014.916735
Afghanistan's Basic Package of Health Services: Its development and effects on rebuilding the health system
W. Newbrander (2014)
10.1177/135581960501000110
Synthesising qualitative and quantitative evidence: A review of possible methods
M. Dixon-Woods (2005)
10.2471/BLT.08.053108
Contracting for health services: effects of utilization and quality on the costs of the Basic Package of Health Services in Afghanistan.
O. Ameli (2008)
10.1371/journal.pone.0020741
Constraints to Implementing the Essential Health Package in Malawi
D. H. Mueller (2011)
Essential health packages: What are they for
C. Waddington (2013)
10.3736/JCIM20090918
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
D. Moher (2009)
10.1136/bmjopen-2014-004880
Legislative, educational, policy and other interventions targeting physicians’ interaction with pharmaceutical companies: a systematic review
Lina Alkhaled (2014)
10.1196/ANNALS.1425.011
Poverty and access to health care in developing countries.
D. Peters (2008)
Prince Mahidol Award Conference S . Role of priority setting in implementing universal health coverage
A Beattie (2016)
10.1016/j.healthpol.2010.09.013
The role of institutional design and organizational practice for health financing performance and universal coverage.
I. Mathauer (2011)
10.1080/17441692.2013.829862
A cost and technical efficiency analysis of two alternative models for implementing the basic package of health services in Afghanistan
Aaron Philip Blaakman (2014)
10.1186/1471-2296-13-67
Primary health services at district level in South Africa: a critique of the primary health care approach
S. Dookie (2012)
10.1136/bmjgh-2016-000190
Accelerating progress towards universal health coverage in Asia and Pacific: improving the future for women and children
A. Beattie (2016)
10.1016/j.ijsu.2010.02.007
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
D. Moher (2010)
Impact of national health insurance for the poor and the informal sector in low- andmiddle-income countries: a systematic review.
A. Acharya (2012)
10.1177/1049732305276687
Three Approaches to Qualitative Content Analysis
Hsiu-Fang Hsieh (2005)
10.1093/intqhc/mzn039
Determinants of primary care service quality in Afghanistan.
P. Hansen (2008)
10.1186/s12913-015-1179-3
A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries
E. Adebayo (2015)
10.15171/ijhpm.2016.22
Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries
Naoki Ikegami (2016)
The cost-effectiveness of primary care services in developing countries: a review of the international literature.
J. Doherty (2004)



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