Another important policy paper titled “First referral hospitals in low-resource settings: a narrative review ofexpectations for clinical service provision ”, published in an esteemed journal HPPJournal LSHTM and co-authored by GlohMed investigator, with in-depth review of 126 academic papers and 7 country case studies, where primary care in LMICs and ‘ideal or expected clinical services’ in the First Referral Hospitals (FRH) have been extensively discussed (probably for the first time).
Primary care is the backbone of national health systems. Success of nation’s UHC agenda and health insurance schemes rely on the functionality and strength of primary care and referral mechanism. The study found big differences in how seven countries across continents organize, how they define services at FRHs and how FRHs fit into the overall health system.
In most LMICs including Nepal, tertiary care hospitals (both public & private) are often overcrowded leading to downgrading of clinical services (to primary level) and underutilization of already existing specialty services. In absence of clear and standard definitions of ‘primary care’, ‘first service point’ or ‘first referral hospitals’ (in both cities & rural regions), clinical services have been messy and unregulated, affecting the poor and vulnerable populations.
It is the right time to re-design and re-define our health service delivery systems, categorize primary vs specialty clinical services, and specify the first service point and first referral point for each clinical service. The emerging concept of ‘primary care strengthening’ and ‘FRH clinical services’ must get attention of government units, health development partners, clinicians, policymakers, public health practitioners and HPSR researchers. It should be reflected in health planning, financing and HRH strategies.
GlohMed is keen to join discussion and initiatives around ‘primary care and referral systems’ at national and global levels.
Citation:
Tamara Mulenga Willows, Rosanna Mazhar, Suraj Bhattarai, Chit-Su Tinn, Nadine Misago, Jean Jacque Roger Ikuzwe, Mike English, First referral hospitals in low-resource settings: a narrative review of expectations for clinical service provision, Health Policy and Planning, Volume 40, Issue 6, July 2025, Pages 652–660, https://doi.org/10.1093/heapol/czaf021