{
  "abstract": "Background Medical specialists are integral to the medical workforce and play a pivotal role in referral systems. However, in low-income and middle-income countries (LMICs), there is a perception that specialists often fail to align with local health needs, system capacities and Universal Health Coverage (UHC) objectives.Methods A systematic review was conducted in 2024 using a best-fit framework to assess the contributions of specialists to health systems and population health in LMICs. Searches covered eight databases and specialist journals, guided by an expert-validated ‘a priori’ framework for data extraction and analysis. We used the Johanna Briggs Institute critical appraisal tools to assess the quality of the evidence, and the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to report the findings. The study protocol was registered in the PROSPERO database (CRD42024572877).Findings We found and reviewed 89 studies, focusing on the stock of specialists in LMICs and highlighting a critical shortage of specialists, particularly surgeons, anaesthetists and psychiatrists. Evidence linked specialists’ availability to improved health outcomes such as lives saved through expanded surgical capacity, though broader health system contributions were less clear. Specialists were reported to play key roles in referrals, hospital management, mentoring and research. Governance of their professions was found to be rather uneven across LMICs, with wide differences in specialty types, training curricula, accreditation systems and regulation of private-sector involvement. Reports frequently documented specialists’ engagement with private health markets, revealing blurred boundaries between public and private care. A dynamic market for specialists was also observed, driven by a sustained global demand for their services. However, few policies were found addressing shortages and improving governance of specialties, with existing strategies focusing on task-shifting, clinical training and sharing responsibilities.Conclusions This review offers an evidence-based framework for understanding specialists’ roles and health system engagement in LMICs. We discuss the need to reconsider specialists’ deployment, prioritise alignment with UHC goals and enhance governance to optimise their contributions to health systems.",
  "authors": [
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Giuliano Russo"
    },
    {
      "affiliations": [
        "School of Public Policy and Global Affairs, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Veena Sriram"
    },
    {
      "affiliations": [
        "Queen Mary University of London Faculty of Medicine and Dentistry, London, UK"
      ],
      "name": "Tamara Mulenga Willows"
    },
    {
      "affiliations": [
        "Preventative Medicine, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil"
      ],
      "name": "Renata Alonso Miotto"
    },
    {
      "affiliations": [
        "Instituto Nacional de Saúde, Maputo, Mozambique"
      ],
      "name": "Ana Mocumbi"
    },
    {
      "affiliations": [
        "Preventative Medicine, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil"
      ],
      "name": "Mário C Scheffer"
    }
  ],
  "title": "Medical specialists in LMICs: a systematic review and best-fit framework synthesis of the evidence on their roles and contribution to health systems",
  "uid": "5183b8ef-4517-5b59-8298-28dc5c498ee5"
}