Abstract
The pluralistic organization of healthcare in low middle-income countries consists of multiple treatment avenues delivered by vastly different health actors. The informal health system, a less acknowledged sector by both the literature and governing bodies, is a pivotal resource for the rural poor, accounting for the majority of their care. Numerous studies have cited that unregulated informal networks are highly ineffective, providing inadequate and sometimes dangerous services. There needs to be greater recognition that informal systems can highly beneficial when supported by the right resources. Here our literature review shows that formal and informal systems intersect through complex linkages. Following PRISMA guidelines for scoping reviews, a total of 3,045 articles were retrieved, out of which 26 were included for final data analysis. Through both unidirectional and bidirectional connections, linkages between the two systems can characterized into 6 board categories: training, referrals, shared space/ fora, technology, data sharing, policy. Subsequent analysis found several common elements of effective linkages; these included the clear delineation of roles and responsibilities, the utilization of each system’s best features, structures of accountability, bidirectional communication and the presence of both horizontal and vertical involvement. Identifying these relationships provides the potential for strengthening them. We anticipate this study as basis upon which future interventions can find opportunities to build better networks of collaboration in order to develop self reliant and sustainable healthcare networks.
