Embedded research to advance primary health care

Nursing engagement in research priorities focused on health systems and services in Latin America countries

BACKGROUND

A strong nursing research agenda in Latin America is fundamental to universal health coverage. Nursing science can make important contributions to the health of Latin American people through knowledge generation that directly informs nursing practice, professional education, and health policy.

METHODS

We used a cross-sectional survey design to assess nursing involvement in health systems and services research in Latin America in five priority areas: Policies and education related to nursing human resources; Structure, organization and dynamics of health systems and services; Science, technology, innovation, and information systems in public health; Health policies, governance, and social control; and Social studies in the health field.

RESULTS

Nursing and midwifery participants (N = 856) from Latin American countries completed the survey. Respondents who reported conducting research focused primarily on Policies and Education related to Nursing Human Resources and Structure, Organization, and Dynamics of Health Systems and Services. Across the five priority areas, more nurses reported using research findings and/or being aware of research than conducting research.

CONCLUSIONS

Survey results indicate that nursing research in Latin America is currently disproportionately focused on nursing education and practice. More research focused on information technology, nurse's impact on public health, and the threats posed by nurse migration is needed to better address health needs of Latin American populations.

Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context

Since the Alma Ata Declaration of 1978, countries have varied in their progress towards establishing and sustaining comprehensive primary health care (PHC) and realizing its associated vision of 'Health for All'. International health emergencies such as the coronavirus-19 (COVID-19) pandemic underscore the importance of PHC in underpinning health equity, including via access to routine essential services and emergency responsiveness. This review synthesizes the current state of knowledge about PHC impacts, implementation enablers and barriers, and knowledge gaps across the three main PHC components as conceptualized in the 2018 Astana Framework. A scoping review design was adopted to summarize evidence from a diverse body of literature with a modification to accommodate four discrete phases of searching, screening and eligibility assessment: a database search in PubMed for PHC-related literature reviews and multi-country analyses (Phase 1); a website search for key global PHC synthesis reports (Phase 2); targeted searches for peer-reviewed literature relating to specific components of PHC (Phase 3) and searches for emerging insights relating to PHC in the COVID-19 context (Phase 4). Evidence from 96 included papers were analysed across deductive themes corresponding to the three main components of PHC. Findings affirm that investments in PHC improve equity and access, healthcare performance, accountability of health systems and health outcomes. Key enablers of PHC implementation include equity-informed financing models, health system and governance frameworks that differentiate multi-sectoral PHC from more discrete service-focussed primary care, and governance mechanisms that strengthen linkages between policymakers, civil society, non-governmental organizations, community-based organizations and private sector entities. Although knowledge about, and experience in, PHC implementation continues to grow, critical knowledge gaps are evident, particularly relating to country-level, context-specific governance, financing, workforce, accountability and service coordination mechanisms. An agenda to guide future country-specific PHC research is outlined.

Designing the next generation of implementation research training for learners in low- and middle-income countries

Efficacious health interventions tested through controlled trials often fail to show desired impacts when implemented at scale. These challenges can be particularly pervasive in low- and middle-income settings where health systems often lack the capacity and mechanisms required for high-quality research and evidence translation. Implementation research is a powerful tool for identifying and addressing the bottlenecks impeding the success of proven health interventions. Implementation research training initiatives, although growing in number, remain out of reach for many investigators in low- and middle-income settings, who possess the knowledge required to contextualize challenges and potential solutions in light of interacting community- and system-level features. We propose a realigned implementation research training model that centers on team-based learning, tailored didactic opportunities, learning-by-doing, and mentorship.