{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T15:30:01Z","timestamp":1794238201634,"version":"4.9.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:00:00Z","timestamp":1708560000000},"content-version":"vor","delay-in-days":64,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["207522"],"award-info":[{"award-number":["207522"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["207522"],"award-info":[{"award-number":["207522"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>First referral hospitals (FRHs) are the hospitals closest to the community, which offer expertise or technologies to complement more widely available \u2018basic\u2019 ambulatory care or inpatient care. Despite having been a subject of interest in global health policy in the latter half of the 20th century, in more recent decades, they appear to have been overshadowed. This paper reviews what is understood by FRH, drawing on both academic and policy literature, complemented by specific country case studies. We undertook three reviews: a grey literature review of global and regional policy reports and documents, a structured review of the academic literature on FRH and a review of FRH-related policies in eight countries. Our findings indicate that there is confusion regarding the definitions and roles of FRH; they have fallen off the policy agenda globally and they suffer from lack of advocates in part related to the absence of cohesive definition. Meanwhile, these facilities continue to fulfil important functions in health systems in low- and middle-income countries, and expectations for service delivery remain high. In light of these findings, this paper calls for renewed interest and investment in FRH from the global health academic and policy-making community.<\/jats:p>","DOI":"10.1093\/heapol\/czad120","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T19:59:05Z","timestamp":1708631945000},"page":"224-232","source":"Crossref","is-referenced-by-count":14,"title":["First referral hospitals in low- and middle-income countries: the need for a renewed focus"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2367-2072","authenticated-orcid":false,"given":"Rosanna","family":"Jeffries Mazhar","sequence":"first","affiliation":[{"name":"Health Systems Collaborative, Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford , Peter Medewar Building, South Parks Road, Oxford OX13SY, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0760-5574","authenticated-orcid":false,"given":"Tamara Mulenga","family":"Willows","sequence":"additional","affiliation":[{"name":"Health Systems Collaborative, Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford , Peter Medewar Building, South Parks Road, Oxford OX13SY, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6843-6677","authenticated-orcid":false,"given":"Suraj","family":"Bhattarai","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, London School of Hygiene & Tropical Medicine , Keppel Street, London, WC1E 7HT United Kingdom"},{"name":"Department of Global Health, Global Health Research & Medical Interventions for Development (GLOHMED) , 99 Shree Marg, Lalitpur, Kathmandu 44700, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9149-2888","authenticated-orcid":false,"given":"Chit-Su","family":"Tinn","sequence":"additional","affiliation":[{"name":"Faculty of Social Sciences and Humanities, Mahidol University , 999, Phutthamonthon Sai 4 Road, Salaya, Nakhon Pathom 73170, Thailand"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford , Peter Medewar Building, South Parks Road, Oxford OX1 3SY, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4436-7448","authenticated-orcid":false,"given":"Nadine","family":"Misago","sequence":"additional","affiliation":[{"name":"Interdisciplinary Research Group in Public Health, Doctoral School, University of Burundi , Avenue de l\u2019Unesco N\u00b0 2., Bujumbura 1550, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7427-0826","authenticated-orcid":false,"given":"Mike","family":"English","sequence":"additional","affiliation":[{"name":"Health Systems Collaborative, Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford , Peter Medewar Building, South Parks Road, Oxford OX13SY, United Kingdom"},{"name":"Health Services Unit, KEMRI-Wellcome Trust Research Programme , 197 Lenana Rd, Nairobi P.O Box 43640-00100, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"key":"2024022219585465700_R1","volume-title":"Walking the Talk: Reimagining Primary Health Care after COVID-19","author":"Bar\u0131\u015f","year":"2021"},{"key":"2024022219585465700_R2","article-title":"District health in Africa: progress and prospects 25 years after the Harare Declaration: concept note","volume-title":"Regional Conference on Health District, Senegal","author":"Belma","year":"2013"},{"key":"2024022219585465700_R3","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s00268-020-05793-8","article-title":"Which surgical operations should be performed in district hospitals in East, Central and Southern Africa? 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