Choice of primary healthcare providers among population in urban areas of low- and middle-income countries: a systematic review of literature

Background

Strengthening urban primary healthcare (PHC) systems in low- and middle-income countries (LMICs) is essential to effectively serve the growing urban poor. Such reforms should incorporate patient opinions to ensure accessible and affordable services. However, there is limited evidence on patient preferences for PHC providers in these settings. We aimed to conduct a systematic review of the evidence on the attributes reported by patients when choosing PHC providers in urban LMICs.

Methods

A search was performed across MEDLINE, Embase, Global Health, Web of Science, PsycINFO, and Scopus bibliographic databases, as well as grey literature sources, from their earliest entries until March 30, 2024. Studies examining the revealed or stated preferences of populations for PHC providers in urban LMIC settings were included. We descriptively analysed and compared these studies, assessing their methodological quality using checklists for Conjoint Analysis studies and the Mixed Methods Appraisal Tool.

Results

Our findings are reported according to PRISMA guidelines. The search yielded 5,089 citations, of which 28 met the eligibility criteria for this review. We identified 203 attributes across selected studies. The most frequently reported attributes were cost of services (n = 25) and distance/proximity (n = 24), followed by provider behaviour/attitude (n = 19) and quality of care (n = 17). Most studies identified the availability of medicine/equipment, distance/proximity, healthcare provider type, and quality of care as the most valued attributes. Eighteen studies examined preference heterogeneity, considering socioeconomic factors such as education, gender, age, severity of illness, and income, with severity of illness being the most significant factor.

Conclusions

Prioritising patient preferences in health system reforms is essential for equitable and sustainable healthcare in rapidly urbanising LMICs. Our review highlights the most valued attributes in preference studies, which will help policymakers and researchers tailor better PHC interventions to meet urban community needs and guide future studies on PHC preferences in similar settings.