The medication method can be offered by clinicians without surgical skills thus potentially increasing access for women while also reducing hospital costs and freeing up the time of over-burdened higher level providers [ 10, 11].
New models of care provision are needed to improve efficiency of existing health services that provide HIV care and treatment including those which rationalize the use of the limited higher level providers through the maximum delegation of tasks within the formal health care team.
Most of the studies included in the review were conducted in high-income countries and focused on treatments performed by high-level providers under colposcopic guidance.
Although innovative models of referral and management services are being tested in resource-limited settings [ 19], it must be noted that LEEP is still typically performed by high-level providers in district or provincial facilities.
We conclude that EBM may not be effective as a stand-alone program targeting a family planning method with a high level of provider and consumer bias.
As a result, HIV care was resource intense and required a high level of provider expertise; as such, services tended to be concentrated in specialized clinics in large urban centres.
Despite a high level of provider awareness, use of national resources to implement the program and reported high rates of electronic notification of administered doses to the ACIR, uptake of the 13vPCV supplementary dose was lower than for other comparable PCV catch-up vaccination programs.
Our finding suggests that even with high levels of provider knowledge, benefits of integrated service delivery are limited if providers are unable to deliver elements of integrated care.
Patients are only sampled from the public healthcare sector, and, therefore, the study cannot comment on individuals who receive care only in the private sector, though other research shows high levels of provider switching in the private sector [ 39, 46] and low levels of effective medication use [ 25- 27].
The poorest usually contact lower public providers like community health station (CHS) only when they get sick, whilst the richest typically contact higher level public providers, such as district health central (DHC) or province/centre hospital (P/CH).
