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Identifying gaps in primary healthcare policy and governance in low-income and middle-income countries: protocol for an evidence gap map
  1. K M Saif-Ur-Rahman,
  2. Razib Mamun,
  3. Iqbal Anwar
  1. Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
  1. Correspondence to Dr K M Saif-Ur-Rahman; su.rahman{at}


Introduction There are gaps in the primary healthcare (PHC) delivery in majority of low-income and middle-income countries (LMICs) due to epidemiological transition, emergence of outbreaks or war, and often lack of governance. In LMICs, governance is always a less focused aspect, and often limited to the role of the authority despite potential contribution of other actors. It is evident that community engagement and social mobilisation of health service delivery result in better health outcomes. Even in case of systems failure, the need for PHC services is satisfied by individuals and communities in LMICs. Available evidence including systematic reviews on PHC governance is mostly from high-income countries and there is limited work in LMICs. This evidence gap map (EGM) is a systematic exploration to identify evidence gaps in PHC policy and governance in this region.

Methods and analysis Different bibliographic databases were explored to retrieve available studies considering the time period between 1980 and 2017, and these were independently screened by two reviewers. Screened articles will be considered for full-text extraction based on prespecified criteria for inclusion and exclusion. A modified SURE (Supporting the Use of Research Evidence) checklist will be used to assess the quality of included systematic reviews. Overview of the findings will be provided in synthesised form. Identified interventions and outcomes will be plotted in a dynamic platform to develop a gap map.

Ethics and dissemination Findings of the EGM will be published in a peer-reviewed journal in a separate manuscript. This EGM aims to explore the evidence gaps in PHC policy and governance in LMICs. Findings from the EGM will highlight the gaps in PHC to guide policy makers and researchers for future research planning and development of national strategies.

PROSPERO registration number CRD42018096883.

  • evidence gap map
  • primary health care
  • policy
  • governance
  • lmics

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  • Contributors KMSUR and RM conceptualised the EGM in consultation with the coauthors. KMSUR wrote the first draft of this protocol with substantial inputs from all authors. KMSUR and RM contributed to the planning for literature search. Plan for screening, collection and analysis of data for all the included systematic reviews and impact evaluations are conducted by KMSUR and RM with close consultation from IA. All authors provided input, reviewed and finalised the paper before dissemination. The corresponding author is the guarantor of this EGM. All authors read and approved the final manuscript.

  • Funding This publication is based on research of icddr,b funded by Ariadne Labs through Brigham and Women’s Hospital, which is a recipient of a Bill & Melinda Gates Foundation grant. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.

  • Competing interests None declared.

  • Ethics approval As this EGM is based on published articles, formal ethical assessment and informed consent are not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Any updates or amendments to this protocol will be described, including the date of each amendment, description of the change and rationale for the change. The PROSPERO register will remain updated with the protocol and amendments.

  • Patient consent for publication Not required.

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