First Referral Hospitals in low resource settings: a narrative review of expectations for clinical service provision.

Abstract

First referral hospitals (FRH) have an important role to play in helping many countries achieve 'Health for All'. However, their specific role and the clinical services they are expected to provide to achieve this are evolving. To explore this issue further we undertook a narrative review to examine the clinical service expectations of FRH outlined in academic and policy literature, which identified a total of 404 FRH service expectations. At a global level, some categories of services provide extensive specific service recommendations, likely resulting from historical priorities and the influence of vertical programming and professional interests. However, in several important areas we identified few or no recommendations. At the level of individual country case-studies undertaken through this review, FRH clinical service recommendations within available policy documents vary considerably. Our findings suggest a disconnect between the ambition for FRH and the difficult, context-specific decision making needed at national level on the role of FRH as a service delivery platform within integrated health systems helping countries achieve universal health coverage (UHC).