Abstract
BackgroundUniversal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented.MethodsWe conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results.ResultsFifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies.ConclusionsThis review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution.Systematic review registrationPROSPERO CRD420160334200
Highlights
Universal Health Coverage is widely endorsed as the pivotal goal in global health, substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist
In 2015, the World Health Organisation (WHO) estimated that 5.9 million deaths occurred in children under 5 years of age, with a disproportionate concentration of deaths occurring in LMICs [1]
Since the 1978 Alma Ata declaration expressed the need for action to ensure “Health for All” by the year 2000, many resolutions and goals have been endorsed with the ultimate objective of achieving what is known as Universal Health Coverage (UHC) [5,6,7,8,9]
Summary
Universal Health Coverage is widely endorsed as the pivotal goal in global health, substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. The problem, condition, or issue The substantial gap between the need for health care and the level of access in Low and Middle Income Countries (LMIC) is well established. Since the 1978 Alma Ata declaration expressed the need for action to ensure “Health for All” by the year 2000, many resolutions and goals have been endorsed with the ultimate objective of achieving what is known as Universal Health Coverage (UHC) [5,6,7,8,9]. Despite progress made towards achieving UHC and remarkable health gains, evidence suggests that many children in LMIC are still not accessing needed health care services [3, 6]
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