Effectiveness of interprofessional care on hypertension in low- and medium-income countries of Africa: a systematic review
DOI:
https://doi.org/10.4314/ajbr.v27i1.1Keywords:
African regions, effectiveness, hypertension, interprofessional care, reviewAbstract
The burden of hypertension is becoming worrisome in a resource-constrained continent like Africa. There is a dearth of information on the extent of the present use of interprofessional care in the continent, its effectiveness and factors that could limit its use. This systematic review sought to describe the extent as well as the effectiveness of the use of interprofessional care in the management of hypertension across the African regions. A comprehensive literature search was conducted on Pubmed, Google Scholar and ScienceDirect. The search covered the period from 1993 to 2023 (30 years period). This review was done in line with the guidelines set out by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. A total of 35 articles were included in the review out of which the East African region had 10 (29%), Central African 3 (9%), North African 4 (11%), Southern African 7 (20%) and West Africa 11 (31%). The assessment of team cooperation, institutional or government support, right operational environment, free inter-professional communication, cost-effectiveness in patient management and easy access to care for the patients in the articles was generally affirmative to indicate effectiveness of interprofessional care. A few cases of interprofessional conflicts were also reported. Interprofessional care of hypertension is proven to be beneficial and effective in the management of hypertension in Africa but grossly under-reported. Its use may be threatened by lack of team cooperation, occurrence of conflicts between the health workers and inadequate support from government among other factors.
References
Abid, L., Hammami, R., Abdesselem, S., Boudiche, S., Hédi, B.S., Sayahi, K., Bahloul, A., Chamtouri, I., Charfeddine, S., Rais, L. and Drissa, M., (2022): Design and Rationale of the National Observational Multicentric Tunisian Registry of Hypertension: Protocol for Evaluating Hypertensive Patient Care in Clinical Practice. JMIR Research Protocols, 11(9), p.e21878.
Adams, O., Shengelia, B., Stilwell, B., Larizgoitia, I., Issakov, A., Kwankam, S.Y., & Siem T Jam, F. (2002). Provision of personal and non-personal health services: Proposal for monitoring (WHO/EIP/OSD/DP 02.25).
Adeyemo A, Tayo BO, Luke A, Ogedegbe O, Durazo-Arvizu R, Cooper RS. (2013). The Nigerian antihypertensive adherence trial: a community-based randomized trial. J Hypertens. Jan;31(1):201-7. doi: 10.1097/HJH.0b013e32835b0842. PMID: 23137954; PMCID: PMC3530610.
Adler, A.J., Laar, A., Prieto-Merino, D., Der, R.M., Mangortey, D., Dirks, R., Lamptey, P. and Perel, P., (2019): Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study. BMJ open, 9(4), p.e026799.
Marfo, A.F. and Owusu-Daaku, F.T., (2016): Evaluation of a pharmacist-led hypertension preventative and detection service in the Ghanaian community pharmacy: an exploratory study. International Journal of Pharmacy Practice, 24(5), pp.341-348.
Ajisegiri, W.S., Abimbola, S., Tesema, A.G., Odusanya, O.O., Peiris, D. and Joshi, R., (2022): The organisation of primary health care service delivery for non-communicable diseases in Nigeria: a case-study analysis. PLOS Global Public Health, 2(7), p.e0000566.
Albsoul-Younes, A.M., Hammad, E.A., Yasein, N.A. and Tahaineh, L.M., (2011): Pharmacist-physician collaboration improves blood pressure control. Saudi medical journal, 32(3), pp.288-292.
Alwan, A., (2011): Global status report on noncommunicable diseases 2010. World Health Organization.
Haj Amor, S., Beaney, T., Saidi, O., Clarke, J., Poulter, N.R., Ben Alaya, N. and Ben Romdhane, H., (2021). May Measurement Month 2019: an analysis of blood pressure screening results from Tunisia. European Heart Journal Supplements, 23(Supplement_B), pp.B144-B146.
Ansa, B.E., Zechariah, S., Gates, A.M., Johnson, S.W., Heboyan, V. and De Leo, G., (2020): September. Attitudes and behavior towards interprofessional collaboration among healthcare professionals in a large academic medical center. In Healthcare (Vol. 8, No. 3, p. 323). MDPI.
Atiim, G.A. and Elliott, S.J., (2016): The global epidemiologic transition: noncommunicable diseases and emerging health risk of allergic disease in sub-Saharan Africa. Health Education & Behavior, 43(1_suppl), pp.37S-55S.
Aveling, E.L., Kayonga, Y., Nega, A. and Dixon-Woods, M., (2015): Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers’ views in two African hospitals. Globalization and health, 11(1), pp.1-8.
Oparah, A.C., Adje, D.U. and Enato, E.F., 2006. Outcomes of pharmaceutical care intervention to hypertensive patients in a Nigerian community pharmacy. International Journal of pharmacy practice, 14(2), pp.115-122.
Barker, K.K. and Oandasan, I., 2005. Interprofessional care review with medical residents: lessons learned, tensions aired–a pilot study. Journal of Interprofessional Care, 19(3), pp.207-214.
Bovet, P., Gervasoni, J.P., Mkamba, M., Balampama, M., Lengeler, C. and Paccaud, F., 2008. Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study. BMC public health, 8, pp.1-8.
Boykin, A., Wright, D., Stevens, L., & Gardner, L. (2018). Interprofessional care collaboration for patients with heart failure. American Journal of Health-System Pharmacists, 75(1), e45-e49.
Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V., & Tomkowiak, J. (2011). Interprofessional collaboration: Three best practice models of interprofessional education. Medical Education Online, 16.
Carey, R.M., Muntner, P., Bosworth, H.B. and Whelton, P.K., 2018. Prevention and control of hypertension: JACC health promotion series. Journal of the American College of Cardiology, 72(11), pp.1278-1293.
Carroll, C., Booth, A., Leaviss, J. and Rick, J., 2013. “Best fit” framework synthesis: refining the method. BMC medical research methodology, 13(1), pp.1-16.
Carter, B.L., Coffey, C.S., Ardery, G., Uribe, L., Ecklund, D., James, P., Egan, B., Weg, M.V., Chrischilles, E. and Vaughn, T., 2015. Cluster-randomized trial of a physician/pharmacist collaborative model to improve blood pressure control. Circulation: Cardiovascular Quality and Outcomes, 8(3), pp.235-243.
CASP, U., 2013. Critical Appraisal Skills Programme. CASP qualitative checklist, https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf (accessed 14 February 2020).
Chisholm-Burns, M.A., Lee, J.K., Spivey, C.A., Slack, M., Herrier, R.N., Hall-Lipsy, E., Zivin, J.G., Abraham, I., Palmer, J., Martin, J.R. and Kramer, S.S., 2010. US pharmacists' effect as team members on patient care: systematic review and meta-analyses. Medical care, pp.923-933.
Coleman, R., Gill, G. and Wilkinson, D., 1998. Noncommunicable disease management in resource-poor settings: a primary care model from rural South Africa. Bulletin of the World Health Organization, 76(6), p.633.
D'amour, D., Ferrada-Videla, M., San Martin Rodriguez, L. and Beaulieu, M.D., 2005. The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of interprofessional care, 19(sup1), pp.116-131.
Doede, A.L., Allen, T.E., Ja'Lynn, S.G., Herbst, A.G., Hlungwani, M.C., Ramakuela, N.J., Xie, A.X. and Campbell, C.L., 2017. Community health workers and the management of noncommunicable diseases among rural health clinics in Limpopo Province, South Africa: a pilot study. Family & community health, 40(4), pp.338-346.
Doherty, R.B. and Crowley, R.A., 2013. Principles supporting dynamic clinical care teams: an American College of Physicians position paper. Annals of internal medicine, 159(9), pp.620-626.
El-Awaisi, A., Awaisu, A., Aboelbaha, S., Abedini, Z., Johnson, J. and Al-Abdulla, S.A., 2021. Perspectives of healthcare professionals toward interprofessional collaboration in primary care settings in a Middle Eastern Country. Journal of multidisciplinary healthcare, pp.363-379.
Liljas, A. E. M., Brattström, F., Burström, B., Schön, P., & Agerholm, J. (2019). Impact of Integrated Care on Patient-Related Outcomes Among Older People - A Systematic Review. International journal of integrated care, 19(3), 6. https://doi.org/10.5334/ijic.4632
Fairall, L.R., Folb, N., Timmerman, V., Lombard, C., Steyn, K., Bachmann, M.O., Bateman, E.D., Lund, C., Cornick, R., Faris, G. and Gaziano, T., 2016. Educational outreach with an integrated clinical tool for nurse-led non-communicable chronic disease management in primary care in South Africa: a pragmatic cluster randomised controlled trial. PLoS medicine, 13(11), p.e1002178.
Fiscella, K. and McDaniel, S.H., 2018. The complexity, diversity, and science of primary care teams. American Psychologist, 73(4), p.451.
Gaboury, I., Lapierre, L.M., Boon, H., & Moher, D. (2011). Interprofessional collaboration within integrative healthcare clinics through the lens of the relationship-centered care model. Journal of Interprofessional Care, 25: 124–130.
Gafane-Matemane, L.F., Mokwatsi, G.G. and Boateng, D., 2023. Hypertension management in sub-Saharan Africa: an overview of challenges and opportunities for telemedicine. Conn Health Telemed, 2(1), pp.9-22.
Galletta, M., Portoghese, I., Carta, M.G., D'Aloja, E. and Campagna, M., 2016. The effect of nurse‐physician collaboration on job satisfaction, team commitment, and turnover intention in nurses. Research in nursing & health, 39(5), pp.375-385.
Green, A.S., Lynch, H.M., Nanyonga, R.C., Squires, A.P., Gadikota-Klumpers, D.D., Schwartz, J.I. and Heller, D.J., 2020. Assessing providers’ approach to hypertension management at a large, private hospital in Kampala, Uganda. Annals of global health, 86(1).
Hareri, H.A., Abebe, M. and Asefaw, T., 2013. Assessments of adherence to hypertension managements and its influencing factors among hypertensive patients attending black lion hospital chronic follow up unit, Addis Ababa, Ethiopia-a cross-sectional study. International Journal of Pharmaceutical Sciences and Research, 4(3), p.1086.
Harris, M.F., Advocat, J., Crabtree, B.F., Levesque, J.F., Miller, W.L., Gunn, J.M., Hogg, W., Scott, C.M., Chase, S.M., Halma, L. and Russell, G.M., 2016. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries. Journal of multidisciplinary healthcare, pp.35-46.
Hashmi, F.K., Hassali, M.A., Khalid, A., Saleem, F., Aljadhey, H. and Bashaar, M., (2017): A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan. BMC health services research, 17(1), pp.1-9.
Heller, D.J., Balzer, L.B., Kazi, D., Charlebois, E.D., Kwarisiima, D., Mwangwa, F., Jain, V., Kotwani, P., Chamie, G., Cohen, C.R. and Clark, T.D., (2020): Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation. PloS one, 15(1), p.e0222801.
Hlongwa, P. and Rispel, L.C., (2021): Interprofessional collaboration among health professionals in cleft lip and palate treatment and care in the public health sector of South Africa. Human resources for health, 19(1), pp.1-9.
Hwang, A.Y., Gums, T.H., & Gums, J.G. (2017). The benefits of physician-pharmacist collaboration. The Journal of Family Practice, 66(12), E1-E8.
Isetts, B.J., Buffington, D.E., Carter, B.L., Smith, M., Polgreen, L.A. and James, P.A., 2016. Evaluation of pharmacists' work in a physician‐pharmacist collaborative model for the management of hypertension. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(4), pp.374-384.
Jin, X., Azhar, S., Murtaza, G., Xue, F., Mumtaz, A., Niu, H., Taha, A. and Zhang, Y., 2014. Quantitative study evaluating perception of general public towards role of pharmacist in health care system of Pakistan. Age (mean±SD, 31.53±10.8), 15(126), pp.42-4.
Katende, G., Groves, S. and Becker, K., 2014. Hypertension education intervention with Ugandan nurses working in hospital outpatient clinic: a pilot study. Nursing research and practice, 2014.
Kengne, A.P., Sobngwi, E., Fezeu, L., Awah, P., Dongmo, S. and Mbanya, J.C., 2009. Setting-up nurse-led pilot clinics for the management of non-communicable diseases at primary health care level in resource-limited settings of Africa. Pan African Medical Journal, 3(1).
Khabala, K.B., Edwards, J.K., Baruani, B., Sirengo, M., Musembi, P., Kosgei, R.J., Walter, K., Kibachio, J.M., Tondoi, M., Ritter, H. and Wilkinson, E., 2015. Medication Adherence Clubs: a potential solution to managing large numbers of stable patients with multiple chronic diseases in informal settlements. Tropical Medicine & International Health, 20(10), pp.1265-1270.
Khan, N., McGarry, K., Naqvi, A.A. and Holden, K., 2020b. Doctors’ perceptions, expectations and experience regarding the role of pharmacist in hospital settings of Pakistan. International journal of clinical pharmacy, pp.1-18.
Khan, N., McGarry, K., Naqvi, A.A., Iqbal, M.S. and Haider, Z., 2020a. Pharmacists' viewpoint towards their professional role in healthcare system: a survey of hospital settings of Pakistan. BMC health services research, 20(1), pp.1-15.
Labhardt, N.D., Balo, J.R., Ndam, M., Grimm, J.J. and Manga, E., 2010. Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years. BMC health services research, 10(1), pp.1-10.
James, S., Sewpaul, R., Reddy, P., Madela, S. and Madela, S., 2020. Early detection, care and control of hypertension and diabetes in South Africa: A community-based approach. African Journal of Primary Health Care and Family Medicine, 12(1), pp.1-9.
Maher, D., Ford, N. and Unwin, N., 2012. Priorities for developing countries in the global response to non-communicable diseases. Globalization and health, 8(1), pp.1-8.
Margolis, K.L., Asche, S.E., Bergdall, A.R., Dehmer, S.P., Groen, S.E., Kadrmas, H.M., Kerby, T.J., Klotzle, K.J., Maciosek, M.V., Michels, R.D. and O’Connor, P.J., 2013. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. Jama, 310(1), pp.46-56.
Mathers, C.D. and Loncar, D., 2006. Projections of global mortality and burden of disease from 2002 to 2030. PLoS medicine, 3(11), p.e442.
Mathole, T., Lembani, M., Jackson, D., Zarowsky, C., Bijlmakers, L. and Sanders, D., 2018. Leadership and the functioning of maternal health services in two rural district hospitals in South Africa. Health Policy and Planning, 33(suppl_2), pp.ii5-ii15.
Mendis, S., Johnston, S.C., Fan, W., Oladapo, O., Cameron, A. and Faramawi, M.F., 2010. Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial. Bulletin of the World Health Organization, 88(6), pp.412-419.
Mensah, G.A., 2013. Descriptive epidemiology of cardiovascular risk factors and diabetes in sub-Saharan Africa. Progress in cardiovascular diseases, 56(3), pp.240-250.
Miranda, J.J., Kinra, S., Casas, J.P., Davey Smith, G. and Ebrahim, S., 2008. Non‐communicable diseases in low‐and middle‐income countries: context, determinants and health policy. Tropical Medicine & International Health, 13(10), pp.1225-1234.
Mischo-Kelling, M., Wieser, H., Cavada, L., Lochner, L., Vittadello, F., Fink, V., & Reeves, S. (2015). The state of interprofessional collaboration in Northern Italy: A mixed methods study. Journal of Interprofessional Care, 29(1), 79-81.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. and PRISMA Group*, 2009. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine, 151(4), pp.264-269.
Morgan, S., Pullon, S. and McKinlay, E., 2015. Observation of interprofessional collaborative practice in primary care teams: an integrative literature review. International journal of nursing studies, 52(7), pp.1217-1230.
Morris-Paxton, A.A., Rheeder, P., Ewing, R.M.G. and Ewing, D., 2018. Detection, referral and control of diabetes and hypertension in the rural Eastern Cape Province of South Africa by community health outreach workers in the rural primary healthcare project: Health in Every Hut. African Journal of Primary Health Care and Family Medicine, 10(1), pp.1-8.
Nakata, C. and Im, S., 2010. Spurring cross‐functional integration for higher new product performance: A group effectiveness perspective. Journal of Product Innovation Management, 27(4), pp.554-571.
Nejjari, C., Arharbi, M., Chentir, M.T., Boujnah, R., Kemmou, O., Megdiche, H., Boulahrouf, F., Messoussi, K., Nazek, L. and Bulatov, V., 2013. Epidemiological Trial of Hypertension in North Africa (ETHNA): an international multicentre study in Algeria, Morocco and Tunisia. Journal of hypertension, 31(1), pp.49-62.
Ngoga, G., Park, P.H., Borg, R., Bukhman, G., Ali, E., Munyaneza, F., Tapela, N., Rusingiza, E., Edwards, J.K. and Hedt-Gauthier, B., 2019. Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013–2014. Public health action, 9(4), pp.142-147.
Ogedegbe, G., Plange-Rhule, J., Gyamfi, J., Chaplin, W., Ntim, M., Apusiga, K., Iwelunmor, J., Awudzi, K.Y., Quakyi, K.N., Mogaverro, J. and Khurshid, K., 2018. Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: A pragmatic cluster randomized trial in Ghana. PLoS medicine, 15(5), p.e1002561.
Omboni, S., Tenti, M., & Coronetti, C. (2019). Physician-pharmacist collaborative practice and telehealth may transform hypertension management. Journal of human hypertension, 33(3), 177–187.
Orji, I.A., Baldridge, A.S., Omitiran, K., Guo, M., Ajisegiri, W.S., Ojo, T.M., Shedul, G., Kandula, N.R., Hirschhorn, L.R., Huffman, M.D. and Ojji, D.B., 2021. Capacity and site readiness for hypertension control program implementation in the Federal Capital Territory of Nigeria: a cross-sectional study. BMC health services research, 21(1), pp.1-12.
Owolabi, M., Olowoyo, P., Mocumbi, A., Ogah, O. S., Odili, A. et al. (2023). African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): novel strategies for accelerating hypertension control in Africa. Journal of human hypertension, 10.1038/s41371-023-00828-8.
Ozoemena, E.L., Iweama, C.N., Agbaje, O.S., Umoke, P.C., Ene, O.C., Ofili, P.C., Agu, B.N., Orisa, C.U., Agu, M. and Anthony, E., 2019. Effects of a health education intervention on hypertension-related knowledge, prevention and self-care practices in Nigerian retirees: a quasi-experimental study. Archives of Public Health, 77, pp.1-16.
Pace, R., Pluye, P., Bartlett, G., Macaulay, A.C., Salsberg, J., Jagosh, J. and Seller, R., 2012. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. International journal of nursing studies, 49(1), pp.47-53.
Pastakia, S.D., Ali, S.M., Kamano, J.H., Akwanalo, C.O., Ndege, S.K., Buckwalter, V.L., Vedanthan, R. and Bloomfield, G.S., 2013. Screening for diabetes and hypertension in a rural low income setting in western Kenya utilizing home-based and community-based strategies. Globalization and health, 9, pp.1-9.
Peduzzi, M., Orchard, C., & Leonello, V.M. (2015). Interprofessional education and collaborative practice in Primary Health Care. Revista da Escola de Enfermagem da USP, 49(2).
Pfaff, K.A., Baxter, P.E., Jack, S.M., & Ploeg, J. (2014). Exploring new graduate nurse confidence in interprofessional collaboration: A mixed methods study. International Journal of Nursing Studies, 51, 1142–1152.
Rampamba, E.M., Meyer, J.C., Helberg, E.A. and Godman, B., 2019. Empowering hypertensive patients in South Africa to improve their disease management: a pharmacist-led intervention. Journal of research in pharmacy practice, 8(4), p.208.
Reeves, S., McMillan, S.E., Kachan, N., Paradis, E., Leslie, M., & Kitto, S. (2014). Interprofessional collaboration and family member involvement in intensive care units: Emerging themes from a multi-sited ethnography. Journal of Interprofessional Care. Advanced online publication.
Rice, K., Zwarenatein, M., Conn, L.G., Kenaszchuk, C., Russell, A., & Reeves, S. (2010). An intervention to improve interprofessional collaboration and communications: A comparative qualitative study. Journal of Interprofessional Care, 24(4), 350-361.
Some, D., Edwards, J.K., Reid, T., Van den Bergh, R., Kosgei, R.J., Wilkinson, E., Baruani, B., Kizito, W., Khabala, K., Shah, S. and Kibachio, J., 2016. Task shifting the management of non-communicable diseases to nurses in Kibera, Kenya: does it work?. PloS one, 11(1), p.e0145634.
Soni, J.S., Oparah, A.C., Usifoh, S.F., Oseji, F.O., Aghohuwa, M.A. and Epelle, P., 2020. The Roles of Pharmacists in Optimizing Care for Hypertensive Patients in Hospital and Community Pharmacies in Edo State, South-South Nigeria. East and Central African Journal of Pharmaceutical Sciences, 23(1), pp.28-35.
Sorbor, G.F. and Dapar, M.P., 2020. Impact of clinical pharmacistled structured medication review services on treatment outcomes on hypertensive patients: a pilot study. International Journal of Innovative Research and Advanced Studies, 7, p.7.
Soubra, L. and Elba, G., 2023. Pharmacist role in hypertension management in the community setting: questionnaire development, validation, and application. Patient preference and adherence, pp.351-367.
Supper, I.O.M.C.Y.L., Catala, O., Lustman, M., Chemla, C., Bourgueil, Y. and Letrilliart, L., 2015. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. Journal of public health, 37(4), pp.716-727.
Useh, U. and Akindele, M.O., 2018. Interprofessional Care for Chronic Diseases of Lifestyle. African Journal of Biomedical Research, 21(2), pp.101-105.
Van Dongen, J.J.J., Lenzen, S.A., van Bokhoven, M.A., Daniëls, R., van der Weijden, T. and Beurskens, A., 2016. Interprofessional collaboration regarding patients’ care plans in primary care: a focus group study into influential factors. BMC family practice, 17, pp.1-10.
Vedanthan, R. and Tuikong, N., 2016. Ko er C, Blank E, Kamano JH, Naanyu V, Kimaiyo S, Inui TS, Horowitz CR, Fuster V: Barriers and Facilitators to Nurse Management of Hypertension: A Qualitative Analysis from Western Kenya. Ethn Dis, 26(3), pp.315-322.
Vestergaard, E. and Nørgaard, B., 2018. Interprofessional collaboration: An exploration of possible prerequisites for successful implementation. Journal of Interprofessional Care, 32(2), pp.185-195.
Wagner, E.H., Flinter, M., Hsu, C., Cromp, D., Austin, B.T., Etz, R., Crabtree, B.F. and Ladden, M.D., 2017. Effective team-based primary care: observations from innovative practices. BMC Family Practice, 18(1), pp.1-9.
Wami, S.D., Demssie, A.F., Wassie, M.M. and Ahmed, A.N., 2016. Patient safety culture and associated factors: A quantitative and qualitative study of healthcare workers’ view in Jimma zone Hospitals, Southwest Ethiopia. BMC health services research, 16(1), pp.1-10.
World Health Organization (2017). The World Health Report 2000-Health systems: Improving performance. Retrieved from http://www.who.int/whr/2000/media_centre/press_release/en/.
World Health Organization, 2010. Framework for action on interprofessional education and collaborative practice (No. WHO/HRH/HPN/10.3). World Health Organization.
World Health Organization. (2013). Interprofessional collaborative practice in primary health care. Retrieved from www.who.int/hrh/resources/IPE_SixCaseStudies.pd
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