Hrev_master [Healthcare in Low-resource Settings 2013; 1:e1] [page 1] Introducing Healthcare in Low-resource Settings Chandrakant Lahariya Public Health Specialist, New Delhi, India Healthcare resources are often referred to as the means available in a health system to deliver services to the population. Healthcare or health resources, like any other system, can be grouped into three broad categories of infrastructure, material or supplies or consu- mable, and human resources. Health outcome or status of a population is interplay of all 3 categories of resources, working in tandem to deliver services. There are population-based global norms for resources in a functioning health system. A health system which does not meet the accepted norms can be called as low-resource setting (LRS) for healthcare. The resources for health are allocated by national governments and the economic con- dition of the country is a major determinant in health budget allocation. Political instabili- ty, public unrest, war, conflicts and natural calamities, all play a major role in the deter- mining the resources for health system. As a rule of thumb, low and middle income coun- tries (LMICs) have at least some form of imbalance in either health infrastructure or supply or in human resources. Thus, LMICs not always but generally equates with low- resource healthcare settings. The historically low resource allocation for healthcare in LMICs leads to increased disea- se burden and health service requirement, worsening the situation. Healthcare in LRSs is different from other countries in many aspects: lower investments by the gover- nments, poor infrastructure, limited equip- ments and medicines, scarce human resour- ces with high turn-over, limited service provi- sion, and large out-of-pocket expenditure. The situation becomes even more complex when discussion moves from simple inputs (infrastructure, materials and human resour- ces) to distribution of health services, frag- mentation of services (rural-urban, preventi- ve-curative, major city-small town, mother- child, young-old) in-equities and also on ser- vice provision for various health issues, etc. Low resource settings are the reality and have the highest all-cause mortality, inclu- ding child and maternal mortalities, thus hampering the overall achievement of Millennium Development Goals. The quantity and quality of healthcare services in LRS is not supposed to be different than any other situation; however, till the resources are increased, the available resources should be effectively and efficiently utilized. The solu- tions of the local challenges need to be found by research, which is often not conducted due to the low resources/funding. The emic health data is needed rather than the widely availa- ble etic data. Though, both of these approa- ches could be complementary. The view often presented by external observers (in etic) is often colored by the experience in their own settings and has less acceptability by the country program managers. There is emer- ging need for emic data from LRSs to bring transformational health changes. The suffi- cient etic data exist and the time for emic to supplement this information is ripe. Low-resource settings need additional attention as there are higher expectations from these to perform and deliver. The cultu- ral context needs to be understood and addressed and the political leadership in these settings need to be brought on the board. People often get overwhelmed by the absolute number of challenges and the efforts become non-starter because of failure to identify a point to start with. People in LRSs need as good services as in any other settings and they cannot wait indefinitely. The chal- lenges should be addressed immediately and can probably be solved by recognizing heal- thcare in low-resource settings (HLS) as a separate field of work: that is what this Journal aims at. I have written in the past that scientific journals have a bigger role to play in healthca- re delivery. A reputed and well-focused journal can draw a lot of attention on the part of all stakeholders to bring right changes and beco- me a societal catalyst.1 This trend has become increasingly common where journals publish research theme issues, start discussion and debates among stakeholders and changes happen. The lack of availability of local evi- dence is often cited as a major hurdle in improving health status and introducing new interventions in LRSs.2 The gap in knowledge translation and in policy to implementation has been reported often. The 10/90 gap – where there is 10% investment on the pro- blems of 90% – is also often highlighted.3 The limited in-country research capacity, scarce funding and poor quality data results that very little evidence (for action) is gene- rated from LRS. The research work conducted in these settings fails to find a place in repu- ted journals due to lack of methodological rigour and poor quality data. This has a domi- no effect and when it comes to decision making, the sufficient local pieces of eviden- ce are not available. The limited resources make it necessary to optimally utilize the available resources. At a program manager level, this could be achie- ved by improving focus on efficiency and effectiveness; designing service provision as per the local epidemiology and needs; ensu- ring equitable distribution; and making health system responsive to the need of peo- ple. Additionally, the cost analyses (cost effec- tiveness, cost benefit and accounting, etc.) are other sub-optimally utilized tools in these settings. The publication of Healthcare in Low- resource Settings would provide a platform to researchers and policy makers alike. The Journal aims to publish editorials, commenta- ries, policy analysis, review articles, original research work and would often have discus- sions and debates on important health issues with focus on HLS. Opinion articles and view- points on topical issues and both qualitative and quantitative research would find place in the Journal. Free access to the research publi- shed in HLS is likely to benefit the cause of researchers in LRSs. Healthcare in Low- resource Settings would publish series to build capacity of researchers in LRS in research methodology, cost analyses and epidemiologi- cal principles. Healthcare in Low-resource Settings is an idea converted into a Journal to provide a common platform for information sharing and dissemination. It will welcome authors to document best practices and com- pare health situations in low resources with those in other settings. It is expected that with the time, the pieces of evidence publi- shed in this Journal assist in cross-learning to find solutions to common health challen- ges. I sincerely hope that a few years down the line, the Journal would have accumulated some path-breaking research evidences to guide the health system in such settings, when it becomes a common platform used by researchers in all countries. The growth and improvement in healthcare will benefit from research evidences in HLS. This is my since- re thought and wish, and all of you are welco- me to join this exciting journey. I really feel privileged to introduce this Healthcare in Low-resource Settings 2013; volume 1:e1 Correspondence: Chandrakant Lahariya, B7/24/2, First Floor, Safdarjung Enclave Main, Safda-rjung Enclave Main, New Delhi-110029, India. Tel. +91.98101.60665. E-mail: c.lahariya@gmail.com Conflict of interests: the author declares no potential conflict of interests. Received for publication: 2 January 2013. Accepted for publication: 13 January 2013. This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0). ©Copyright C. Lahariya., 2013 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2013; 1:e1 doi:10.4081/hls.2013.e1 No n- co mm er cia l u se on ly [page 2] [Healthcare in Low-resource Settings 2013; 1:e1] Journal to you. The Journal aims to bring path-breaking changes in health service deli- very and healthcare provision in LRSs. It requires your regular contributions and inputs. The journey would be satisfying only if it could improve the health of people in the settings where they need it the most. References 1. Lahariya C. Journals have a bigger role to play in the healthcare delivery. Indian J Community Med 2006;31:120. 2. Sidiqui K, Newell JN. Putting evidence into practices in low-resource settings. B World Health Organ 2005;83:882. 3. Currat LJ, de Francisco A, Nchinda TC. The 10/90 report on health research 2000. Geneva: Global Forum for Health Research Publ.;2000. Editorial No n- co mm er cia l u se on ly