Mid-level health providers for primary healthcare: a rapid evidence synthesis.

Sandeep Moola,Soumyadeep Bhaumik,Devaki Nambiar

doi:10.12688/f1000research.24279.1

Abstract

Background: Health care services, in many countries, are increasingly being provided by cadres not trained as physicians, but capable of performing several diagnostic and clinical functions. These substitute health workers are referred to as mid-level health providers (MLHPs). The health and wellness centres under India's Comprehensive Primary Health Care programme have teams led by MLHPs who can aid doctors. The objective of this study was to rapidly synthesise evidence on the effectiveness of MLHPs for primary health care. Methods: The review team undertook a rapid overview of systematic reviews that compared MLHPs with doctors and different types of MLHPs involved in the delivery of health care were included, with a perspective on low- and middle-income countries, including India. Results: Seven systematic reviews were included in the final report. Mortality outcomes in relation to pregnancy and childbirth care services showed no significant differences in care provided by MLHPs when compared with doctors. Pregnancy care provided by midwives was found to slightly improve quality of care when compared to care delivered by doctors. The risk of failure or incomplete abortion for surgical abortion procedures provided by MLHPs was twice when compared to the procedures provided by doctors. Moderate to high certainty evidence showed that initiation and maintenance of antiretroviral therapy for HIV-infected patients by a nurse or clinical officer slightly reduced mortality. High certainty evidence showed that chronic disease management by non-medical prescribers reduced some important physiological measures when compared to medical prescribing by doctors. Conclusions: To date, this is the first rapid overview of evidence on MLHPs. Evidence suggests that MLHPs might be suitable to deliver quality care in certain areas of health and they may be relevant and feasible in countries like India. However, the roles and subsequent training and regulation of MLHPs might be different for different care domains.

Highlights

There is a growing momentum worldwide to improve access to healthcare and provide efficient and cost-effective primary health care (PHC)[1]
Approach for rapid evidence synthesis (RES) We conducted a rapid overview of systematic reviews (SRs) of evidence on the effectiveness of mid-level health providers (MLHPs) within a span of about eight weeks and in all domains corresponding to the comprehensive primary health care (CPHC) package in Ayushman Bharat
MLHPs for emergency medical services. In this rapid overview of SRs, we examined the evidence on the effectiveness of care provided by MLHPs in low- and middleincome countries (LMICs) for various healthcare domains of India’s CPHC package[3], and contextualised the certainty using GRADE approach[7]

Summary

Introduction

There is a growing momentum worldwide to improve access to healthcare and provide efficient and cost-effective primary health care (PHC)[1]. Ayushman Bharat’s HWC sub-strategy, the comprehensive primary health care (CPHC), conceives of MLHPs as a key focal point for service organisation and delivery, performing a range of screening, diagnostic and clinical functions and improve health systems at the frontline. In many countries, are increasingly being provided by cadres not trained as physicians, but capable of performing several diagnostic and clinical functions. These substitute health workers are referred to as mid-level health providers (MLHPs). Methods: The review team undertook a rapid overview of systematic reviews that compared MLHPs with doctors and different types of MLHPs involved in the delivery of health care were included, with a perspective on low- and middle-income countries, including India. The roles and subsequent training and regulation of MLHPs might be different for different care version 2 (revision)

Objectives

Methods

Results

Discussion

Conclusion