Bypassing primary health care for maternal and child healthcare in low-and middle-income countries

Abstract

Evidence of bypassing primary healthcare in low-and middle-income countries (LMICs) is lacking. This study aims to review the extent of bypassing primary healthcare for maternal and child health (MCH) services in LMICs. PubMed, Google scholar and CINAHL databases from January, 2009 to 2020 search was conducted and only English language was used. Critical appraisal tool was used to assess quality of studies. Egger’s test and I² statistical analysis were used to check publication bias and heterogeneity of studies, respectively. Sub-group analysis across regions and services was also conducted. Sensitivity test was also conducted. All analysis was done using STATA v-14 software. International Prospective Register of Systematic Reviews (PROSPERO) registered this study with registry number CRD420212356380.A total of 40 studies were qualified for the extensive review and finally 25 studies were included in the meta-analysis. Nineteen studies were from Africa and six studies were from Asia. Eight of the included studies were from East-Africa, of these; 3 from Kenya, 2 studies from Uganda, and 3 from Ethiopia. In this review, a total of 19,178 clients were included ranges from 240 in Kenya to 3,517 in India. Almost all the included studies design were a cross-sectional study design. Bypassing primary health care for overall MCH and child-birth was 61%( 95% CI: 52% to 68%) and 57 %( 95% CI: 47% to 68%) in LMICs, respectively. Overall bypassing for MCH shows difference across regions with 55%(95% CI: 45% to 65%) and 62 %( 95% CI: 52% to 68%) in Asia & Africa, respectively. Clinical competency and quality of care were the most important reasons associated with bypassing. Participants resides in 5km radius and married were less likely to bypass primary healthcare for MCH services. Nevertheless, education, ante-partum care visits, and age factors had no role on the extent of bypassing. Extent of bypassing primary health care for MCH services was significant. Expanding financial investments and introducing suitable policies to address bypassing and retention of clients is essential. As policy options, additionally to pay for free or affordable cost services, there should be a functional referral linkage and feedback system, capacity building and deploying health work force, availing drugs, transportation, training, education opportunities, strengthening financing, health insurance, basic obstetric services, and providing companion & respectful care should be designed, integrated & implemented.