PERSONAL PROTECTIVE EQUIPMENT AVAILABILITY AND USE IN PRIMARY HEALTH CARE FACILITIES: A SYSTEMATIC REVIEW OF BARRIERS AND ENABLERS

Abstract

The primary health care (PHC) worker provides first contact health services and is exposed to infectious, biological and other occupational hazards. Personal protective equipment (PPE) is an important part of infection prevention and control (IPC), and often availability is not equal to correct and sustained use. This review brings together evidence on the availability and use of PPE in PHC and other on-the-front-line health-care settings, focusing on the barriers and enabling conditions for PPE use.The manuscript followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The underlying review conducted a search of the PubMed, Scopus, Web of Science and Google Scholar data bases for English language studies from 2015 to 2026. Of these, 85 records were found during the screening process, 10 were removed as duplicates, 75 were screened and 45 were assessed for full text, with 32 studies included in the narrative synthesis. The underlying manuscript does not contain a study-level extraction matrix, and does not contain any information on protocol registration or database-specific search history, which are therefore reported transparently, without being reconstructed. The evidence shows that there are continuing shortages of PPE, especially respirators and gowns, and some eye-protection items. LMIC evidence demonstrates that shortages are coupled with procurement, distribution, stock management and facility infrastructure weaknesses. Nigerian evidence revealed that 22.1% of the respondents in the study had access to PPEs regularly and access to N95 respirators was limited. In both qualitative and implementation evidence, barriers included were inadequate supply, lack of clarity or poor communication of guidance, lack of training, discomfort, workload, and weak managerial support. Factors that enabled the operation were reliable supply, good communication, practical IPC training, supportive leadership, supervision, and a positive safety culture. Availability and use of PPE in PHC is an occupational health and IPC system-level issue, not an individual behaviour. Improvements need to be sustainable, and this means that integrated interventions should be implemented in procurement and inventory systems, financing, leadership of the facilities, training, supervision, and monitoring the implementation. The protocols and strategies for future systematic reviews should be prospectively registered in the review register, strategies should be reported by data source, and study-level risk-of-bias analyses and data extraction should be provided.