Skip to content


Health systems and services in low and middle income settings

Section edited by Dina Balabanova, Hengjin Dong, David Hotchkiss and Kaspar Wyss 

This section aims to publish research on health systems and services with a focus on research relevant to low and middle income settings as defined by The World Bank.

Page 1 of 17

  1. Content type: Research article

    The government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. However, no evidence is available on the physical presence of PHC services within health facilities. Thus, the pres...

    Authors: Altantuya Jigjidsuren, Tumurbat Byambaa, Enkhjargal Altangerel, Suvd Batbaatar, Yu Mon Saw, Tetsuyoshi Kariya, Eiko Yamamoto and Nobuyuki Hamajima

    Citation: BMC Health Services Research 2019 19:129

    Published on:

  2. Content type: Research article

    Standards represent benchmarks against which improvements can be measured. In 2016, the Federal Ministry of Health developed and endorsed a set of standards entitled the Ethiopian Health Center Reform Implemen...

    Authors: Mesele Damte Argaw, Binyam Fekadu Desta, Temesgen Ayehu Bele and Abebe Dagnew Ayne

    Citation: BMC Health Services Research 2019 19:127

    Published on:

  3. Content type: Research article

    The incidence of inappropriate admissions in China has become the shackle of its’ service supply system. This research aims to assess the level of children’s inappropriate admissions to county hospitals in rur...

    Authors: Shi-han Lei, Yan Zhang, Hao-miao Li, Dai Su, Jing-jing Chang, Xiao-mei Hu, Qing Ye, Di Jiang and Ying-chun Chen

    Citation: BMC Health Services Research 2019 19:126

    Published on:

  4. Content type: Research article

    Accurate measurement of CD4 cell counts remains an important tenet of clinical care for people living with HIV. We assessed an instrument-free point-of-care CD4 test (VISITECT® CD4) based on a lateral flow pri...

    Authors: Fiona Scorgie, Yasmin Mohamed, David Anderson, Suzanne M. Crowe, Stanley Luchters and Matthew F. Chersich

    Citation: BMC Health Services Research 2019 19:123

    Published on:

  5. Content type: Research article

    Data on nurses’ adherence to standard protocol on nasogastric (NG) tube feeding remain scanty in Ghana even though patients in critical medical conditions are routinely managed using this procedure. This study...

    Authors: Robert Kaba Alhassan, Richard Tsikata, Richard Naatu Tizaawaw, Prince Asante Tannor, Perpetual Praba Quaw, Cecilia Aba Ata Awortwi, Martin Amogre Ayanore, Agani Afaya, Solomon Mohammed Salia, Japiong Milipaak and Prudence Portia Mwini-Nyaledzigbor

    Citation: BMC Health Services Research 2019 19:119

    Published on:

  6. Content type: Research article

    The Integrated Disease Surveillance and Response (IDSR) strategy was adopted as the framework for implementation of International Health Regulation (2005) in the African region of World Health Organisation (WH...

    Authors: Lydia Nakiire, Ben Masiira, Christine Kihembo, Edson Katushabe, Nasan Natseri, Immaculate Nabukenya, Innocent Komakech, Issa Makumbi, Okot Charles, Francis Adatu, Miriam Nanyunja, Peter Nsubuga, Solomon Fisseha Woldetsadik, Patrick Tusiime, Ali Ahmed Yahaya, Ibrahima Socé Fall…

    Citation: BMC Health Services Research 2019 19:117

    Published on:

  7. Content type: Research article

    Evidence-based decision on drug list or formulary has been applied worldwide. Although the importance of scientific evidence was emphasized, the decision-making procedures for including medicines into the nati...

    Authors: Wenbin Liu, Lizheng Shi, Monika Sawhney, Xiaoli Gu and Yingyao Chen

    Citation: BMC Health Services Research 2019 19:112

    Published on:

  8. Content type: Research article

    The continuous migration of Human Resources for Health (HRH) compromises the quality of health services in the developing supplying countries. The ability to increase earnings potentially serves as a strong mo...

    Authors: Gavin George, Bruce Rhodes and Christine Laptiste

    Citation: BMC Health Services Research 2019 19:109

    Published on:

  9. Content type: Research article

    The appropriate use of the Partograph allows early identification of labour related complications and prevents deaths. We, therefore, sought to determine the level of Partograph completion and healthcare worke...

    Authors: John Mukisa, Isha Grant, Jonathan Magala, Andrew S. Ssemata, Patrick Z. Lumala and Josaphat Byamugisha

    Citation: BMC Health Services Research 2019 19:107

    Published on:

  10. Content type: Research article

    Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda.

    Authors: Katherine Albutt, Maria Punchak, Peter Kayima, Didacus B. Namanya and Mark G. Shrime

    Citation: BMC Health Services Research 2019 19:104

    Published on:

  11. Content type: Research article

    In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) set out a treatment target with the objective to help end the AIDS epidemic by 2030. This was supported by the UNAIDS ’90-90-90’ target that by 20...

    Authors: Vincent Adjetey, Dorcas Obiri-Yeboah and Bernard Dornoo

    Citation: BMC Health Services Research 2019 19:95

    Published on:

  12. Content type: Research article

    Tobacco use and alcohol abuse are associated with higher risk of tuberculosis (TB) infection, progression to active TB and adverse treatment outcomes among patients with TB. Revised National Tuberculosis Contr...

    Authors: Nagendra Navya, Kathiresan Jeyashree, Akshaya Kibballi Madhukeshwar, Tanu Anand, Abhay Subashrao Nirgude, Badarudeen Mohammad Nayarmoole and Petros Isaakidis

    Citation: BMC Health Services Research 2019 19:90

    Published on:

  13. Content type: Research article

    WhatsApp (WA) is the most recent and attractive applicative among Smartphone users. The use of WA in healthcare environment has been shown of multiple benefices. Mozambique team involved in 2017 bed nets unive...

    Authors: Jorge A. H. Arroz, Baltazar Neves Candrinho, Figueiredo Mussambala, Marta Chande, Chandana Mendis, Sónia Dias and Maria do Rosário O. Martins

    Citation: BMC Health Services Research 2019 19:86

    Published on:

  14. Content type: Research article

    The increasing cost on healthcare exposes China’s healthcare budgets and system to financial crisis. To control the excessive growth of healthcare expenditure, China’s healthcare reforms emphasize the control ...

    Authors: Jianzhou Yan, Hui-Heng Lin, Dan Zhao, Yuanjia Hu and Rong Shao

    Citation: BMC Health Services Research 2019 19:84

    Published on:

  15. Content type: Research article

    The South African National Mental Health Policy Framework and Strategic Plan 2013–2020 was adopted to address the country’s substantial burden and inadequate treatment of mental illness. It outlines measures t...

    Authors: Kathryn L. Lovero, Samantha L. Lammie, André van Zyl, Sharon N. Paul, Phuti Ngwepe, Jennifer J. Mootz, Catherine Carlson, Annika C. Sweetland, Rachel C. Shelton, Milton L. Wainberg and Andrew Medina-Marino

    Citation: BMC Health Services Research 2019 19:83

    Published on:

  16. Content type: Research article

    HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes in sub-Saharan Africa yet testing coverage for conditions other than HIV is low. Availing point-of-care tests (PO...

    Authors: Nicole Young, Florence Achieng, Meghna Desai, Penelope Phillips-Howard, Jenny Hill, George Aol, Godfrey Bigogo, Kayla Laserson, Feiko Ter Kuile and Miriam Taegtmeyer

    Citation: BMC Health Services Research 2019 19:74

    Published on:

  17. Content type: Research article

    Low- and middle-income countries (LMICs) are disproportionately impacted by interacting epidemics of tuberculosis (TB) and tobacco consumption. Research indicates behavioural support delivered by health worker...

    Authors: Sahil Warsi, Helen Elsey, Melanie Boeckmann, Maryam Noor, Amina Khan, Deepa Barua, Shammi Nasreen, Samina Huque, Rumana Huque, Sudeepa Khanal, Prabin Shrestha, James Newell, Omara Dogar and Kamran Siddiqi

    Citation: BMC Health Services Research 2019 19:71

    Published on:

  18. Content type: Research article

    Treatment of acute malnutrition in infants under 6 months is a relevant topic regarding the global problem of maternal and child malnutrition. While treatment for older age groups has shifted more towards an o...

    Authors: Tabitha D. van Immerzeel, Maty D. Camara, Indou Deme Ly and Rosemarijn J. de Jong

    Citation: BMC Health Services Research 2019 19:69

    Published on:

  19. Content type: Research article

    There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The ...

    Authors: Andrew Kintu, Sadiq Abdulla, Aggrey Lubikire, Mary T. Nabukenya, Elizabeth Igaga, Fred Bulamba, Daniel Semakula and Adeyemi J. Olufolabi

    Citation: BMC Health Services Research 2019 19:68

    Published on:

  20. Content type: Research article

    Although there are public policies for eradicating congenital syphilis, they do not seem to be a routine in most health services. The objective of this study was to evaluate the management of sexual partners o...

    Authors: Ana Fátima Braga Rocha, Maria Alix Leite Araújo, Angélica Espinosa Miranda, Rodolfo Gómez Ponce de Leon, Geraldo Bezerra da Silva Junior and Lea Dias Pimentel Gomes Vasconcelos

    Citation: BMC Health Services Research 2019 19:65

    Published on:

  21. Content type: Research article

    Substantial progress has been made in reducing child mortality over the last decades, however the magnitude of the problem is yet high globally Appropriate health care-seeking behavior of mothers/guardians for...

    Authors: Muluye Molla Simieneh, Mezgebu Yitayal Mengistu, Abebaw Addis Gelagay and Mulugeta Tesfa Gebeyehu

    Citation: BMC Health Services Research 2019 19:59

    Published on:

  22. Content type: Research article

    Progress in health service quality is vital to reach the target of Universal Health Coverage. However, in order to improve quality, it must be measured, and the assessment results must be actionable. We analyz...

    Authors: Sabine Renggli, Iddy Mayumana, Dominick Mboya, Christopher Charles, Christopher Mshana, Flora Kessy, Tracy R. Glass, Constanze Pfeiffer, Alexander Schulze, Ann Aerts and Christian Lengeler

    Citation: BMC Health Services Research 2019 19:55

    Published on:

  23. Content type: Research article

    Nursing care plays a prominent role in determining the overall satisfaction of patients’ hospitalization experience. Studies have shown that satisfaction with nursing care is the best indicator of patients’ sa...

    Authors: Ayele Semachew Kasa and Hayleyesus Gedamu

    Citation: BMC Health Services Research 2019 19:52

    Published on:

  24. Content type: Research article

    Hypertension self-care practice is essential for blood pressure control and reduction of hypertension complications. Nevertheless, we know little concerning hypertension self-care practice in Ethiopia. The pur...

    Authors: Sewunet Ademe, Fekadu Aga and Debela Gela

    Citation: BMC Health Services Research 2019 19:51

    Published on:

  25. Content type: Research article

    Tuberculosis patients often experience hospitalization. Inpatient services may result in high medical expenditures. It is important to explore the hospitalization rates of tuberculosis patients and the potenti...

    Authors: Yang Zhou, Cheng Chen, Hui Jiang, Hong-Qiu Pan, Li-Mei Zhu and Wei Lu

    Citation: BMC Health Services Research 2019 19:47

    Published on:

  26. Content type: Research article

    Despite progress towards achieving UNAIDS 90–90-90 goals, barriers persist in laboratory systems in sub-Saharan Africa (SSA) restricting scale up of early infant diagnosis (EID) and viral load (VL) test monito...

    Authors: Ritu Shrivastava, Peter N. Fonjungo, Yenew Kebede, Rajendra Bhimaraj, Shabnam Zavahir, Christina Mwangi, Renuka Gadde, Heather Alexander, Patricia L. Riley, Andrea Kim and John N. Nkengasong

    Citation: BMC Health Services Research 2019 19:46

    Published on:

  27. Content type: Research article

    Strategic purchasing can ensure that financial resources are used in a way that optimally enhances the attainment of health system goals. A number of low- and middle-income countries, including Kenya, have exp...

    Authors: Kenneth Munge, Stephen Mulupi, Edwine Barasa and Jane Chuma

    Citation: BMC Health Services Research 2019 19:45

    Published on:

  28. Content type: Research article

    Chronic diseases have emerged as the leading cause of death globally, and 20% of Indians are estimated to suffer from a chronic condition. Care for chronic diseases poses a major public health challenge, espec...

    Authors: Dorothy Lall, Nora Engel, Narayanan Devadasan, Klasien Horstman and Bart Criel

    Citation: BMC Health Services Research 2019 19:44

    Published on:

  29. Content type: Research article

    Prompt access to appropriate treatment reduces early onset of complications to chronic illnesses. Our objective was to document the health providers that patients with diabetes in rural areas seek treatment fr...

    Authors: Elizeus Rutebemberwa, James Bagonza and Raymond Tweheyo

    Citation: BMC Health Services Research 2019 19:33

    Published on:

  30. Content type: Research article

    The government of Ethiopia launched an innovative program called Urban Health Extension Program (UHEP) in 2009, aims to produce better health outcomes to the urban populations using urban health extension prof...

    Authors: Nebiyou Tafesse, Aregawi Gesessew and Ergataw Kidane

    Citation: BMC Health Services Research 2019 19:31

    Published on:

  31. Content type: Research article

    Given the documented benefits of Patient Own Drugs (PODs) in most developed countries and scanty data on PODs management in developing countries the aim of the study was to evaluate the assessment, quality and...

    Authors: Pauline Boachie-Ansah, Berko Panyin Anto and Afia Frimpomaa Asare Marfo

    Citation: BMC Health Services Research 2019 19:27

    Published on:

  32. Content type: Research article

    Tuberculosis (TB) remains the prime killer disease among infectious diseases. TB control depends on early case detection and treatment in a directly observed treatment short course (DOTS) programme. The succes...

    Authors: Bezawit Temesgen Sima, Tefera Belachew and Fekadu Abebe

    Citation: BMC Health Services Research 2019 19:19

    Published on:

  33. Content type: Research article

    The heart-breaking maternal and neonatal health indicators in Nigeria are not improving despite previous interventions, such as ‘Health for all’ and ‘Millennium Development Goals. The unattained health-related...

    Authors: Joel O. Aluko, Rhoda Anthea and R. R. Marie Modeste

    Citation: BMC Health Services Research 2019 19:10

    Published on:

  34. Content type: Research article

    This paper aims to demonstrate how systems modeling methodology of Group Model Building (GMD) can be applied for exploring and reaching consensus on non-communicable disease (NCD) management. This exercise was...

    Authors: John P. Ansah, Amina Mahmood Islam, Victoria Koh, Vanthy Ly, Hero Kol, David B. Matchar, Chhun Loun and Mondol Loun

    Citation: BMC Health Services Research 2019 19:2

    Published on:

  35. Content type: Research article

    In an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic ABR testing; one using a tele-medicine ap...

    Authors: Vidya Ramkumar, Roopa Nagarajan, Vanaja C. Shankarnarayan, Selvakumar Kumaravelu and James W. Hall

    Citation: BMC Health Services Research 2019 19:1

    Published on:

  36. Content type: Research article

    Integrated Management of Childhood Illness (IMCI) and Emergency Triage, Assessment and Treatment (ETAT) are guidelines developed by the World Health Organization to reach targets for reducing under-5 mortality...

    Authors: Sarah Kathryn Robertson, Kristina Manson and Evridiki Fioratou

    Citation: BMC Health Services Research 2018 18:1014

    Published on:

  37. Content type: Research article

    Whether the association between access to medical care and health outcomes differs by age and gender among older adults in China is unclear. We aimed to investigate the associations between self-reported inade...

    Authors: Xufan Zhang, Matthew E. Dupre, Li Qiu, Wei Zhou, Yuan Zhao and Danan Gu

    Citation: BMC Health Services Research 2018 18:1004

    Published on:

  38. Content type: Research article

    Off-patent pharmaceuticals (OPPs) hold vital importance in meeting public health objectives, especially in developing countries where resources are limited. OPPs are comprised of off-patent originals, branded ...

    Authors: Andras Inotai, Diana Brixner, Nikos Maniadakis, Iwan Dwiprahasto, Erna Kristin, Agus Prabowo, Alfi Yasmina, Sigit Priohutomo, Bertalan Németh, Kalman Wijaya and Zoltan Kalo

    Citation: BMC Health Services Research 2018 18:1003

    Published on:

  39. Content type: Research article

    Well organized and appropriately utilized pre-hospital emergency services play a critical role in augmenting emergency care systems. The primary objective of this study was to understand the demographic and cl...

    Authors: Menbeu Sultan, Yonas Abebe, Assefu Welde Tsadik, Catherine Ann Jennings and Nee-Kofi Mould-Millman

    Citation: BMC Health Services Research 2018 18:997

    Published on:

  40. Content type: Research article

    Single disease payment program based on clinical pathway (CP-based SDP) plays an increasingly important role in reducing health expenditure in china and there is a clear need to explore the scheme from differe...

    Authors: Jing Peng, Mengran Zhang, Pingfeng Yu and Nan Wang

    Citation: BMC Health Services Research 2018 18:990

    Published on:

  41. Content type: Research article

    Severe malarial anaemia is one of the leading causes of paediatric hospital admissions in Malawi. Post-discharge malaria chemoprevention (PMC) is the intermittent administration of full treatment courses of an...

    Authors: Thandile Nkosi-Gondwe, Bjarne Robberstad, Björn Blomberg, Kamija S. Phiri and Siri Lange

    Citation: BMC Health Services Research 2018 18:984

    Published on:

  42. Content type: Research article

    New HIV infections in Tanzania have been decreasing, however some populations remain at higher risk. Despite of that, evidence on the magnitude of HIV infection and the associated factors and HIV/AIDS services...

    Authors: Anthony Kapesa, Namanya Basinda, Elias C. Nyanza, Martha F. Mushi, Ola Jahanpour and Sospatro E. Ngallaba

    Citation: BMC Health Services Research 2018 18:980

    Published on:

  43. Content type: Research article

    In 2011, South Africa improved its ability to test for rifampicin-resistant TB (RR-TB) by introducing GeneXpert MTB/RIF. At the same time, the South African National TB program adopted a policy decentralized, ...

    Authors: Denise Evans, Tembeka Sineke, Kathryn Schnippel, Rebecca Berhanu, Caroline Govathson, Andrew Black, Lawrence Long and Sydney Rosen

    Citation: BMC Health Services Research 2018 18:973

    Published on:

  44. Content type: Research article

    Diabetes is one of the world’s most prevalent and serious non-communicable diseases (NCDs). It is a leading cause of death, disability and financial loss; moreover, it is identified as a major threat to global...

    Authors: Afsana Afroz, Mohammed J. Alramadan, Md Nassif Hossain, Lorena Romero, Khurshid Alam, Dianna J. Magliano and Baki Billah

    Citation: BMC Health Services Research 2018 18:972

    Published on:

  45. Content type: Research article

    Medication discrepancies are seen frequently in hospital setting upon admission or discharge. Medication Reconciliation service is a practice designed to ensure that patients’ medications are ordered in a corr...

    Authors: Rana Abu Farha, Khawla Abu Hammour, Sayida Al-Jamei, Raja AlQudah and Mohammed Zawiah

    Citation: BMC Health Services Research 2018 18:966

    Published on:

  46. Content type: Research article

    Clinical practice guidelines risk having little impact on healthcare if not effectively implemented. Theory informed, targeted implementation may maximise their impact. Our study explored barriers to and facil...

    Authors: Tamara Kredo, Sara Cooper, Amber Abrams, Jocelyn Muller, Jimmy Volmink and Salla Atkins

    Citation: BMC Health Services Research 2018 18:965

    Published on: