Systematic review of strategies to increase access to health services among children over five in low and middle income countries.

Bright, T; Felix, L; Kuper, H; Polack, S; (2018) Systematic review of strategies to increase access to health services among children over five in low and middle income countries. Tropical medicine & international health. ISSN 1360-2276 DOI:

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The populations of many low and middle-income countries (LMIC) are young. Despite progress made towards achieving Universal Health Coverage and remarkable health gains, evidence suggests that many children in LMIC are still not accessing needed health care services. Delayed or lack of access to health services can lead to a worsening of health, and can in turn negatively impact a child's ability to attend school, and future employment opportunities. We conducted a systematic review to assess the effectiveness of interventions aimed at increasing access to health services for children over five years in LMIC settings. Four electronic databases were searched in March 2017. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication/referral. Randomised controlled trials and non-randomised study designs were included in the review. Data extraction included: study characteristics, intervention type, and measures of access to health services for children over five. Studies outcomes classified as positive, negative, mixed or null in terms of their impact on access outcomes. Ten studies met the criteria for inclusion in the review. Interventions were evaluated in Nicaragua (1), Brazil (1), Turkey (1), India (1), China (1), Uganda (1), Ghana (1), Nigeria (1), South Africa (1), and Swaziland (1). Intervention types included education (2), incentives (1), outreach (1), SMS/phone call reminders (2), and multicomponent interventions (4). All evaluations reported positive findings on measured health access outcomes, however the quality and strength of evidence was mixed. This review provides evidence of the range of interventions that were used to increase health care access for children over five years old in LMIC. Nevertheless, further research is needed to examine each of the identified intervention types and the influence of contextual factors, with robust study designs. There is also a need to assess the cost-effectiveness of the interventions in order to inform decision makers on which are suitable for scale-up in their particular contexts. This article is protected by copyright. All rights reserved.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
Research Centre: International Centre for Eye Health
PubMed ID: 29473273


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