Capitation Payment Schemes for Primary Health Care in Low- and Middle-Income Countries: A Scoping Review
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Objectives: This study aimed to examine the implementation and evaluation of capitation payment schemes in primary health care (PHC) across low- and middle-income countries (LMICs). In particular, it focused on how these schemes are being implemented in real-world settings where data in LMICs are limited. The study also aimed to identify challenges in implementation and assess the contextual factors that influence the sustainability of capitation-based health financing strategies.
Materials and Methods: A scoping review was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) framework to systematically gather and synthesize the existing literature in the Sustainable Development Goals period published between 2015 and 2024. A comprehensive search was carried out in PubMed, OvidSP, and Scopus using strategic keywords related to capitation payments, PHC, and LMICs. After 456 initial records were scrutinized, 40 full-text articles were included. The literature were evaluated for implementation attributes, effectiveness, contextual challenges, and policy characteristics. Data extraction and analysis followed the Population, Concept, Context framework and were validated by an independent evaluator.
Results: This research identified 12 LMICs across four continents that have adopted capitation payment schemes for PHC. A wide range of implementation strategies was observed, depending on the context of each country. Significant challenges were identified in data reliability, politically, budget allocation, and policy planning. Evidence gaps were particularly evident in low-income countries, particularly during the pre-implementation phase of policy design, and the lack of diverse outcome evaluations or policy assessments.
Conclusion: Capitation payment schemes present promising opportunities to strengthen PHC and advance universal health coverage goals in LMICs. However, their success is highly dependent on local political, economic, and institutional contexts. Tailored implementation strategies, robust monitoring systems, and improved pre-implementation planning are essential to enhance policy effectiveness and sustainability. Future research should focus on standardized evaluation frameworks throughout the implementation process and on distinguishing policy effects from implementation fidelity.
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