Improving the delivery of safe and effective healthcare in low and middle income countries

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e981 (Published 14 February 2012)
Cite this as: BMJ 2012;344:e981

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Indeed. What is equally, if not more important, and complementary to what the authors propose, is to support transdisciplinary communication frameworks, thereby promoting collective understanding of healthcare providers needs and ways of meeting those needs, and advocacy among all stakeholders with an interest in the progressive realisation of universal access to evidence-based health care. The strongest and most sustainable change is that emerging from all those working in the system, rather than that which is devised and imposed by researchers and policymakers.

Competing interests: I facilitate a global virtual network called Healthcare Information For All by 2015 www.hifa2015.org

Neil Pakenham-Walsh, Global Health Professional

Global Healthcare Information Network, Corner House, Charlbury, OX7 3PN

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Massoud et al argue eloquently for a renewed focus on improving the delivery of healthcare in low and middle-income countries through quality programmes to improve systems. They correctly identify the need for involving healthcare practitioners at all levels in initiating and implementing these changes.

However, to drive changes in the quality of healthcare, it is also important to engage two important groups who potentially can play an important role- the media and lay users of health services, to drive the demand side. This is especially important with health where historical hierarchies of access to knowledge persist in many low and middle-income settings leading to significant information asymmetry on health issues.

Providing more information about evidence based healthcare interventions, in an easily understood and accessible format to lay people and the media could help promote accountability and provide an external impetus from outside the healthcare professions to drive changes that improve the quality of healthcare in low and middle income countries.

With the expansion in sources of information and communication produced by advances in mobile telecommunications and internet technology, the opportunities for doing this are greater than ever before. In many middle and low-income countries, a growing number of citizens are engaging in public debate through these platforms. While people have used social media in seeking political and social reform, health issues have not featured sufficiently on the advocacy agenda.

The enthusiastic response from the Nigerian media and members of the public to our blog Nigeria Health Watch (www.nigeriahealthwatch.com), which we started publishing in 2007, indicates that there is an appetite among people outside the health professions for engagement on these issues.

Competing interests: None declared

Ike Anya, Consultant in Public Health Medicine

Chikwe Ihekweazu

Inner North West London PCTs, 15 Marylebone Road

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