Optimizing patient-centeredness in the transitions of healthcare systems in low- and middle-income countries
نویسندگان
چکیده
BACKGROUND Patient-centeredness is necessary for quality of care. Wide-spread incorporation of patient-centered practices across the health system is challenging in low and middle income countries (LMICs) given the complexity of scarce resources, competing priorities and rapidly changing social, economic and political landscapes. Health service managers and policy makers in these settings would benefit from a framework that allows comprehension and anticipation of forthcoming challenges for optimizing patient-centeredness in healthcare delivery. We set out to formulate such a framework, based primarily on analysis of general patterns of healthcare system evolution in LMICs and the current literature. DISCUSSION We suggest that optimization of patient-centeredness in LMICs can be thought of as occurring in four phases, in accordance to particular patterns of macro transitions. Phase I is characterized by a deeply fragmented system based on conventional clinical approaches, dealing primarily with simple acute conditions. In phase II, the healthcare systems deal with increasing chronic cases and require redesign of existing acute-oriented services. In phase III, health services are increasingly confronted with multimorbid patients, requiring more coordinated and integrated care. Complex health care needs in individual patients are increasingly the norm in Phase IV, requiring the most optimal form of patient-centered care. This framework helps to identify and map the key challenges and implications for research, policy and practice, associated with the transitions ahead of time. SUMMARY We have developed a framework based on observed patterns of healthcare and related macro-transitions in LMICs. The framework provides insights into critical issues to be considered by health service managers and policy makers.
منابع مشابه
Universal Health Coverage and Primary Healthcare: Lessons From Japan; Comment on “Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries”
A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healt...
متن کاملStrategic Purchasing: The Neglected Health Financing Function for Pursuing Universal Health Coverage in Low- and Middle-Income Countries; Comment on “What’s Needed to Develop Strategic Purchasing in Healthcare? Policy Lessons from a Realist Review”
Sanderson et al’s realist review of strategic purchasing identifies insights from two strands of theory: the economics of organisation and inter-organisational relationships. Our findings from a programme of research conducted by the RESYST (Resilient and Responsive Health Systems) consortium in seven countries echo these results, and add to them the crucial area of org...
متن کاملCommunity Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries?
Background Community Health Workers (CHWs) are proven to be highly effective in low- and middle-income countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing disadvantage. This study is the first that examines the scope and...
متن کاملAchieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries
When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (S...
متن کامل