Механизмы управления в системах здравоохранения в странах с низким уровнем дохода: обзор систематических обзоров
Appendices
Appendix 1. PubMed and LILACS search strategies
PubMed
From 2000 to present. Update: weekly
#1. MEDLINE[Title/Abstract]
#2. (systematic[Title/Abstract] AND review[Title/Abstract])
#3. meta analysis[Publication Type]
#4. #1 OR #2 OR #3 (Methods filter for systematic reviews – Clinical Queries – Max Specificity)
#5. overview[Title] AND (reviews[Title] OR systematic[Title]
#6. meta‐review[Title]
#7. review of reviews[Title]
#8. review[Title] AND systematic reviews[Title]
#9. umbrella[Title] AND (review[Title] OR reviews[Title] OR systematic[Title])
#10. policy[Title] AND (brief[Title] OR evidence[Title])
#11. #5 OR #6 OR #7 OR #8 OR #9 OR #10 (Methods filter for overviews)
#12. #4 OR #11 (Methods filter for systematic reviews and for overviews)
LILACS
From 2000 to present. Update: monthly
(TW:"revision sistematica" OR TW:"revisao sistematica" OR TW:"systematic review" OR MH:"review literature as topic" OR MH:"meta‐analysis as topic" OR PT:"meta‐analysis")
OR
(PT:revision AND (TW:metaanal$ OR TW:"meta‐analysis" OR TW:"metaanalise" OR TW:"meta‐analisis" OR TI:overview$ OR TW:"estudio sistematico" OR TW:"systematic study" OR TW:"estudo sistematico" OR TI:review OR TI:revisao OR TI:revision OR TI:systematic OR TI:sistematico))
OR
((TW:overview OR TW:"estudio sistematico" OR TW:"systematic study" OR TW:"estudo sistematico") AND (TI:review OR TI:revisao OR TI:revision OR TI:systematic OR TI:sistematico))
CINAHL (EBSCO)
From 2000 to present. Update: monthly
((TI meta analys* or AB meta analys*) or (TI systematic review or AB systematic review))
PsycINFO (EBSCO)
From 2000 to present. Update: monthly
meta‐analysis OR search*
EMBASE (Ovid)
From 2000 to present. Update: monthly
meta‐analysis.tw. OR systematic review.tw
Appendix 2. SUPPORT Summaries checklist for making judgments about how much confidence to place in a systematic review
| Review: | |
| Assessed by: | |
| Date: | |
| Section A:Methods used to identify, include and critically appraise studies | |
| A.1 Were the criteria used for deciding which studies to include in the review reported? Did the authors specify: _ Types of studies _ Participants _ Intervention(s) _ Outcome(s) Coding guide ‐ check the answers above YES: All four should be yes | _ Yes _ Can't tell/partially _ No |
| Comments (note important limitations or uncertainty) | |
| A.2 Was the search for evidence reasonably comprehensive? Were the following done: _ Language bias avoided (no restriction of inclusion based on language) _ No restriction of inclusion based on publication status _ Relevant databases searched (including Medline + Cochrane Library) _ Reference lists in included articles checked _ Authors/experts contacted Coding guide ‐ check the answers above: YES: All five should be yes PARTIALLY: Relevant databases and reference lists are both ticked off | _ Yes _ Can't tell/partially _ No |
| Comments (note important limitations or uncertainty) | |
| A.3 Is the review reasonably up‐to‐date? Were the searches done recently enough that more recent research is unlikely to be found or to change the results of the review? Coding guide – consider how many years since the last search (e.g. if more than 10 years the review is unlikely to be up‐to‐date) and whether there is ongoing research | _ Yes _ Can't tell/not sure _ No |
| Comments (note important limitations or uncertainty) | |
| A.4 Was bias in the selection of articles avoided? Did the authors specify: _ Explicit selection criteria _ Independent screening of full text by at least 2 reviewers _ List of included studies provided _ List of excluded studies provided Coding guide ‐ check the above YES: All four should be yes | _ Yes _ Can't tell/partially _ No |
| Comments (note important limitations or uncertainty) | |
| A.5 Did the authors use appropriate criteria to assess the risk for bias in analysing the studies that are included?†( See Appendix for an example of criteria ‐ Assessing Risk of Bias Criteria for EPOC Reviews) _ The criteria used for assessing the risk of bias were reported _ A table or summary of the assessment of each included study for each criterion was reported _ Sensible criteria were used that focus on the risk of bias (and not other qualities of the studies, such as precision or applicability) Coding guide ‐ check the above YES: All four should be yes | _ Yes _ Can't tell/partially _ No |
| Comments (note important limitations or uncertainty) | |
| A.6 Overall – how would you rate the methods used to identify, include and critically appraise studies? Summary assessment score A relates to the 5 questions above. If the "No"or "Partial"option is used for any of the questions above, the review is likely to have important limitations. Examples of major limitations might include not reporting explicit selection criteria, not providing a list of included studies or not assessing the risk of bias in included studies. | _ Major limitations (limitations that are important enough that the results of the review are not reliable and they should not be used in the policy brief) _ Important limitations (limitations that are important enough that it would be worthwhile to search for another systematic review and to interpret the results of this review cautiously, if a better review cannot be found) _ Reliable (only minor limitations) |
| Comments (note any major limitations or important limitations). | |
| Section B:Methods used to analyse the findings | |
| B.1 Were the characteristics and results of the included studies reliably reported? Was there: _ Independent data extraction by at least 2 reviewers _ A table or summary of the characteristics of the participants, interventions and outcomes for the included studies _ A table or summary of the results of the included studies. Coding guide ‐ check the answers above YES: All three should be yes | _ Yes _ Partially _ No _ Not applicable (e.g. no included studies) |
| Comments (note important limitations or uncertainty) | |
| B.2 Were the methods used by the review authors to analyse the findings of the included studies reported? | _ Yes _ Partially _ No _ Not applicable (e.g. no studies or no data) |
| Comments (note important limitations or uncertainty) | |
| B.3 Did the review describe the extent of heterogeneity? _ Did the review ensure that included studies were similar enough that it made sense to combine them, sensibly divide the included studies into homogeneous groups, or sensibly conclude that it did not make sense to combine or group the included studies? _ Did the review discuss the extent to which there were important differences in the results of the included studies? _ If a meta‐analysis was done, was the I2, chi square test for heterogeneity or other appropriate statistic reported? | _ Yes _ Can't tell/partially _ No _ Not applicable (e.g. no studies or no data) |
| Comments (note important limitations or uncertainty) | |
| B.4 Were the findings of the relevant studies combined (or not combined) appropriately relative to the primary question the review addresses and the available data? How was the data analysis done? _ Descriptive only _ Vote counting based on direction of effect _ Vote counting based on statistical significance _ Description of range of effect sizes _ Meta‐analysis _ Meta‐regression _ Other: specify _ Not applicable (e.g. no studies or no data) How were the studies weighted in the analysis? _ Equal weights (this is what is done when vote counting is used) _ By quality or study design (this is rarely done) _ Inverse variance (this is what is typically done in a meta‐analysis) _ Number of participants _ Other, specify: _ Not clear _ Not applicable (e.g. no studies or no data) Did the review address unit of analysis errors? _ Yes ‐ took clustering into account in the analysis (e.g. used intra‐cluster correlation coefficient) _ No, but acknowledged problem of unit of analysis errors _ No mention of issue _ Not applicable ‐ no clustered trials or studies included Coding guide ‐ check the answers above If narrative OR vote counting (where quantitative analyses would have been possible) OR inappropriate table, graph or meta‐analyses OR unit of analyses errors not addressed (and should have been) the answer is likely NO. If appropriate table, graph or meta‐analysis AND appropriate weights AND the extent of heterogeneity was taken into account, the answer is likely YES. If no studies/no data: NOT APPLICABLE If unsure: CAN'T TELL/PARTIALLY | _ Yes _ Can't tell/partially _ No _ Not applicable (e.g. no studies or no data) |
| Comments (note important limitations or uncertainty) | |
| B.5 Did the review examine the extent to which specific factors might explain differences in the results of the included studies? _ Were factors that the review authors considered as likely explanatory factors clearly described? _ Was a sensible method used to explore the extent to which key factors explained heterogeneity? _ Descriptive/textual _ Graphical _ Meta‐regression _ Other | _ Yes _ Can't tell/partially _ No _ Not applicable (e.g. too few studies, no important differences in the results of the included studies, or the included studies were so dissimilar that it would not make sense to explore heterogeneity of the results) |
| Comments (note important limitations or uncertainty) | |
| B.6 Overall ‐ how would you rate the methods used to analyse the findings relative to the primary question addressed in the review? Summary assessment score B relates to the 5 questions in this section, regarding the analysis. If the "No” or "Partial” option is used for any of the 5 preceding questions, the review is likely to have important limitations. Examples of major limitations might include not reporting critical characteristics of the included studies or not reporting the results of the included studies. | _ Major limitations (limitations that are important enough that the results of the review are not reliable and they should not be used in the policy brief) _ Important limitations (limitations that are important enough that it would be worthwhile to search for another systematic review and to interpret the results of this review cautiously, if a better review cannot be found) _ Reliable (only minor limitations) |
| Use comments to specify if relevant, to flag uncertainty or need for discussion | |
| Section C:Overall assessment of the reliability of the review | |
| C.1 Are there any other aspects of the review not mentioned before which lead you to question the results? | _ Additional methodological concerns _ Robustness _ Interpretation _ Conflicts of interest (of the review authors or for included studies) _ Other _ No other quality issues identified |
| C.2 Based on the above assessments of the methods how would you rate the reliability of the review? _ Major limitations (exclude); briefly (and politely) state the reasons for excluding the review by completing the following sentence: This review was not included in this policy brief for the following reasons: Comments (briefly summarise any key messages or useful information that can be drawn from the review for policy makers or managers): _ Important limitations ; briefly (and politely) state the most important limitations by editing the following sentence, if needed, and specifying what the important limitations are: This review has important limitations. _ Reliable ; briefly note any comments that should be noted regarding the reliability of this review by editing the following sentence, if needed: This is a good quality systematic review with only minor limitations. | |
Appendix 3. Characteristics of included reviews
| Authority and accountability for health policies | ||
| Interagency collaboration | ||
| Review objective: to evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes in any population or age group. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials , non‐randomised trials, controlled before‐after studies and interrupted time series studies that assess any interventions of interagency collaboration and partnership and local government agencies | This review included 16 studies: 7 randomised trials(7 studies), 4 non‐randomised trials(4 studies), 4controlled before‐after studies(4 studies) and 1 interrupted time series study. 11 studies were included in the meta‐analysis. 7 studies reported on interventions to improve the care or treatment of patients and 9 studies about health education, health promotion or disease prevention |
| Participants | All population types and all age groups were included | Studies were delivered through community and primary care services (8 studies), in schools (5 studies), and in the wider community (3 studies). |
| Settings | Any local or national setting | Studies took place in the UK (7 studies), Denmark (1 study), Sweden (1 study), Norway and Sweden (1 study), the Netherlands (1 study), the USA (2 studies), Canada (1 study), Israel (1 study), and Australia (1 study). |
| Outcomes | Mortality, morbidity and behavioural change | A variety of outcomes were reported, including behavioural changes, morbidity and healthcare process |
| Date of most recent search: December 2011 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Decision‐making about what is covered by health insurance | ||
| Review objective: to determine the effects of a pharmaceutical policy restricting the reimbursement of selected medications on medicine use, healthcare utilisation, health outcomes and costs (expenditures). | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised and non‐randomised trials, interrupted time series studies including repeated measures studies, and controlled before‐after studies assessing prescribing policies – introduction of restriction to reimbursement, relaxation of previously instituted restrictions to reimbursement, or exemption from restrictive policies for targeted cost‐effective medicines | 24 studies evaluating restrictions to reimbursement policies. Most interventions were prior authorization. 5 studies evaluated policies of releasing or relaxing past restrictions to reimbursement. All of the studies were interrupted time series. |
| Participants | Healthcare consumers and providers within a large jurisdiction or system of care (regional, national or international) | Participants were predominantly the beneficiaries of publicly subsidised or administered pharmaceutical insurance plans – most often senior citizens aged 65 years or over and low‐income adult populations. |
| Settings | All settings | Health insurance systems with substantial coverage of medicines in the USA (14 studies), Canada (11 studies), Norway (2 studies) and Denmark (2 studies) |
| Outcomes | Primary outcomes: medicine use (prescribed, dispensed or actually used), healthcare utilisation, health outcomes, costs (expenditures). Secondary outcomes: changes in equity of access to medicines, changes in access to medically necessary medicines by disadvantaged groups, changes in the distribution of financial burden | Medicine use and medicine expenditures (24 studies), health outcome data (2 studies), healthcare utilisation (9 studies) |
| Date of most recent search: MEDLINE (2005 to January 2009) and other databases (2005 to October 2008) | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations; however, the most recent searches were in January 2009. | ||
| Policies to reduce corruption | ||
| Review objective: to assess the effectiveness of interventions to combat healthcare fraud and abuse. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Interventional studies with or without a concurrent control group assessing any intervention to combat healthcare fraud (including prevention, detection, and response interventions) | 4 studies were included: 3 assessing detection actions and 2 response actions. The study designs were: longitudinal with concurrent control group (1 study), data mining (2 studies) and before‐after study (1 study). |
| Participants | Providers, patients or insured people, insurers (third party payers) | Taiwan's National Health Insurance, Medicare and Medicaid (in USA) |
| Settings | Public and private health sectors | Taiwan (2 studies) and the USA (2 studies) |
| Outcomes | Prevention, detection, and response related outcomes | Detection of fraudulent claims, amount of anti‐fraud expenditure, occurrence of healthcare fraud and abuse, fraudulent activities in diagnostic laboratories |
| Date of most recent search: December 2010 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Authority and accountability for organisations | ||
| Contracting out | ||
| Review objective: to assess the effects of contracting out healthcare services in health services utilisation, equity of access, health expenditure and health outcomes. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, controlled before‐after studies and interrupted time series studies of contracting out of healthcare services via a formal contractual relationship between government and non‐state providers | 1 controlled before‐after study, 1 interrupted time series study, and 1 cluster randomised trial |
| Participants | Populations that would potentially access health services (users and non‐users) as well as health facilities in low‐ and middle‐income countries | ‐ Bolivia: a neighbourhood in the capital city of la Paz ‐ Pakistan: the population of the rural district of Rahimyar Khan ‐ Cambodia: 6 districts of the country (2 contracted out and 4 run by the government). It also evaluated a non‐reported number of districts contracted in |
| Settings | Not limited to any level of healthcare delivery | 2 studies (Pakistan, Cambodia) evaluated a contracting out motivated by weaknesses or absence of public system. Both took place in mostly rural areas. 1 study (Bolivia) included a programme based in an urban setting consisting of a network of 8 health centres and 1 hospital |
| Outcomes | Objective measures of health services utilisation, access to care, healthcare expenditure, health outcomes or changes in equity | Health services utilisation and access to care (3 studies), health expenditure (1 study) and health outcomes (1 study). No studies were found that measured changes in equity of access |
| Date of most recent search: April 2006 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations, but the last search for studies was in 2006. | ||
| Multi‐institutional arrangements | ||
| Review objective: to assess the effects of the social franchising of health service delivery on access to and the quality of services and health outcomes in low‐ and middle‐income countries. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, non‐randomised trials, interrupted time series studies, and controlled before‐after studies reporting on social franchises delivering health services, driven by seeking social benefits | No studies meeting the inclusion criteria were identified. |
| Participants | All levels of healthcare delivery, all types of patients and healthcare providers | — |
| Settings | Low‐ and middle‐income countries | — |
| Outcomes | Healthcare access, quality of care, health outcomes, adverse effects, equitable access or utilization, cost/service, patient satisfaction | — |
| Date of most recent search: October 2007 to March 2008 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations, but the last search for studies was done in 2008. | ||
| Authority and accountability for commercial products | ||
| Registration ‐ medicines | ||
| Review objective: to assess the evidence on the effectiveness of interventions implemented to combat or prevent medicine counterfeiting, particularly in low‐ and middle‐income countries. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials; non‐randomised studies (e.g. cohort studies, retrospective studies, cross‐sectional studies, before‐after studies); and non‐comparative studies Any intervention at the health system level to combat or prevent medicine counterfeiting. The review excluded studies that focused on internet/online medicine counterfeiting, analytical techniques and medication errors. Studies that also considered substandard medicines were included only when they did not differentiate between substandard and counterfeit medicines, or where it was unclear if the poor quality medicine was counterfeit or substandard | Designs: 21 studies with 25 comparisons: cross‐sectional (17 studies); before‐after (5 studies); retrospective (1 study); non‐comparative (1 study); randomised trial (1 study) Interventions: medicine registration (5 comparisons); WHO prequalification of medicines (3 studies); licensing of drug or medicine outlets (8 studies); multi‐faceted interventions (6 studies); deployment of handheld spectrometers at the point of sale (1 study); a public awareness campaign (1 study); an international model of collaboration (1 study) |
| Participants | "Counterfeit/spurious/falsely‐labeled/falsified/medicines", as defined by WHO as medicines with the wrong ingredients, without active ingredients, with insufficient active ingredients or with fake packaging | Most of the studies did not distinguish between counterfeit and substandard medicines |
| Settings | Any setting | Studies from low‐ and middle‐income countries |
| Outcomes | Changes in failure rates of tested medicines; changes in the prevalence of counterfeit medicines; changes in quality of medicine; changes in consumer behaviour; seizures of counterfeit medicines; and closures of illegal outlets/warehouses | Changes in failure rates of medicines (19 comparisons); changes in prevalence of counterfeit medicines (4 studies); changes in purchasing behaviour of consumers (1 study); confiscation of counterfeit medicines (2 studies); closure of illegal outlet(2 studies) Some studies reported more than one outcome. |
| Date of most recent search: April 2014 | ||
| Limitations: This was a well‐conducted systematic review with only minor limitations. However, the included studies used largely observational designs. | ||
| Pricing and purchasing policies | ||
| Review objective: to determine the effects of pharmaceutical pricing and purchasing policies on medicine use, healthcare utilisation, health outcomes and costs (expenditures). | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, non‐randomised trials, controlled repeated measures studies, interrupted time series studies and controlled before‐after studies of pharmaceutical pricing and purchasing policies | 18 studies were included. Some used more than one design: 14 interrupted time series, 1 interrupted time series/controlled before‐after/controlled repeated measures, 1 controlled repeated measures/repeated measures and 2 controlled before‐after/repeated measures studies. 17 studies evaluated reference pricing, one of which also assessed maximum prices, and 1 study evaluated index pricing. |
| Participants | Healthcare users and providers | In 8 Canadian studies, the patients were Pharmacare beneficiaries in British Columbia: senior citizens aged 65 years and older. The other studies included all beneficiaries of national medicine insurance plans, including vulnerable groups of people from all ages. 1 German and 1 Spanish study did not provide information about the participants. |
| Settings | Large jurisdictions or systems of care. Jurisdictions could be regional, national or international. Studies within organisations, such as health maintenance organisations, were included if the organisation was multi‐sited and served a large population. | Canada (8 studies), USA (2 studies), Spain (2 studies), Germany (2 studies), Norway (2 studies), Australia (1 study) and Sweden (1 study) |
| Outcomes | Medicine use, healthcare utilisation, health outcomes, costs (expenditures), including medicine costs and prices, other healthcare costs and administration costs | Medicine use (10 studies), third party (insurance) medicine expenditures (9 studies), medicine prices (4 studies), medicine expenditures savings (5 studies), and patient costs |
| Date of most recent search: December 2012 | ||
| Limitations: This is well‐conducted systematic review with only minor limitations. | ||
| Marketing regulations | ||
| Review objective: to examine the benefits and harms of direct‐to‐consumer advertising of prescription‐only medicines | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, controlled clinical trials, controlled before‐after studies, interrupted time series studies, and cross‐sectional studies with a control group | 3 interrupted time series studies and 1 comparative cross‐sectional survey were found |
| Participants | Not pre‐specified | Patients and physicians in primary care |
| Settings | Not pre‐specified | USA (2 studies), USA and Canada (1 study), Netherlands (1 study) |
| Outcomes | Health‐seeking behaviours of patients at the point of access to care; requests for prescription‐only medicines; patient‐doctor communication and satisfaction with care; prescribing patterns; costs | Requests for prescription only medicines (4 studies); prescription volume (4 studies); patient‐doctor communication and satisfaction with care (1 study) |
| Date of most recent search: October 2004 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations | ||
| Authority and accountability for health professionals | ||
| Training and licensing | ||
| Review objective: to assess the effect of changes in the pre‐licensure education of health professionals on health‐worker supply. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, controlled before‐after studies and interrupted time series studies of interventions that could increase the capacity of health professional training institutions; reduce the loss of students (and increase the likelihood that students will graduate); or increase the recruitment of students from other countries into health professional training institutions | 2 controlled before‐after studies of minority academic advising programmes consisting of academic, personal, financial and vocational advice, skills building, mentorships, supplementary training and annual evaluations |
| Participants | Health professional students prior to licensure | 2 studies among minority groups and general health professional students |
| Settings | No restrictions | 2 studies from the USA |
| Outcomes | Increased numbers of health workers ultimately available for recruitment into the health workforce, improved population‐to‐health professional ratios | 2 studies of the numbers of health workers ultimately available for recruitment into the health workforce |
| Date of most recent search: February 2008 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations | ||
| Training and licensing | ||
| Review objective: to assess the effectiveness of interventions to hire, retain and train district health systems managers in low‐ and middle‐income countries. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, quasi‐randomised trials, controlled before‐after studies, interrupted time series studies Interventions related to hiring, retaining and training managers | One randomised trial: district managers were hired through private contracts to work within the Ministry of Health system. One controlled before‐after study: 18‐month manager training programme. |
| Participants | District health systems managers in low‐ and middle‐income countries | District health systems managers |
| Settings | Districts in low‐ and middle‐income countries | Cambodia (1 study); Mexico, Colombia, El Salvador (1 study) |
| Outcomes | Health systems: population health outcomes; access; utilization; quality; efficiency; equity. Operational: job‐posting vacancy rates, skills | Health facility staffing and supervision, maternal and child health service use (e.g. immunisation, antenatal care), and population health outcomes (e.g. diarrhea incidence). Managers' competencies |
| Date of most recent search: December 2011 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Rectruitment and retention strategies | ||
| Review objective: to assess the effectiveness of interventions to increase the proportion of healthcare professionals working in rural and other underserved areas | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, non‐randomised trials, controlled before‐after studies and interrupted time series studies of any intervention to increase the recruitment or retention of health professionals in underserved areas | 1 interrupted time series study from Taiwan of the effects of National Health Insurance on the equality of distribution of healthcare professionals |
| Participants | Qualified healthcare professionals of any cadre or specialty | Physicians, doctors of Chinese medicine and dentists |
| Settings | All settings | Taiwan |
| Outcomes | Recruitment of health professionals: the proportion of health professionals who initially choose to work in rural or urban underserved communities as a result of being exposed to the intervention. Retention: the proportion of healthcare professionals who continue to work in rural or urban underserved communities as a consequence of the intervention | Equality of geographic distribution of healthcare professionals measured using the Gini coefficient |
| Date of most recent search: April 2014 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Rectruitment and retention strategies | ||
| See characteristics above under 'Training and licensing' | ||
| Movement of health workers between public and private organisations | ||
| Review objective: to assess the effects of financial incentives and movement restriction interventions to manage the movement of health workers between public and private organisations in low‐ and middle‐income countries. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials and non‐randomised trials; controlled before‐after studies; controlled interrupted time series and interrupted time series studies without controls | No studies were found eligible for inclusion in the review. 9 surveys, 1 review of government reports, 1 study of speeches in the national assembly, and 1 policy analysis paper were found. |
| Participants | All health professionals | No studies were found eligible for inclusion in the review. |
| Settings | Any public or private sector organisations | No studies were found eligible for inclusion in the review. |
| Outcomes | Change in the numbers or proportion of health workers entering or leaving the public or private sectors; duration of stay in a particular sector | No studies were found eligible for inclusion in the review. |
| Date of most recent search: November 2012 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Emigration and immigration policies | ||
| Review objective: to assess the effects of policy interventions to control the emigration of health professionals from low‐ and middle‐income countries to high‐income countries | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, non‐randomised trials, controlled before‐after studies, or interrupted studies of any interventions in source or recipient countries (or both) as well as international agreements that could have an impact on the outcomes | 1 interrupted time series study of the effects of a modification to USA immigration laws (The American Act of October, 1965, which decreased barriers to emigration from countries outside the Americas to the USA) |
| Participants | Health professional nationals of a low‐ and middle‐income country whose graduate training was in a low‐ and middle‐income country | Nurses |
| Settings | Not restricted | USA and the Philippines |
| Outcomes | Proportion (or other measure of change in number) of health professionals that emigrate from a low‐ and middle‐income country to a high‐income countrie | Annual number of nurses migrating from the Philippines to the USA |
| Date of most recent search: March 2011 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Dual practice | ||
| Review objective: to assess the effects of interventions implemented to manage dual practice. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, non‐randomised trials, controlled before‐after studies, interrupted time series studies | No studies were found eligible for inclusion in the review |
| Participants | All health professionals | No studies were found eligible for inclusion in the review |
| Settings | Not specified | No studies were found eligible for inclusion in the review |
| Outcomes | Increased working hours by health workers in public facilities, reduced patient waiting times, reduced absenteeism, reduction in number of private sector licenses issued, reduction in private earning, reduced job satisfaction | No studies were found eligible for inclusion in the review |
| Date of most recent search: May 2011 | ||
| Limitations: This is a well‐conducted systematic review with minor limitations, but no studies were found that met the inclusion criteria. | ||
| Quality of practice | ||
| Review objective: to evaluate the effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour and patient outcomes. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, non‐randomised trials, interrupted time series studies and controlled before‐after studies evaluating the effect of external inspection against external standards on healthcare organisation change, healthcare professional behaviour or patient outcomes | 1 cluster‐randomised trial conducted in South Africa and 1 before‐after study reanalysed as an interrupted time series study, conducted in England. The study in South Africa assessed the effects of external inspection on compliance with hospital accreditation standards. The study conducted in England assessed the effects of the Healthcare Commissions Infection Inspection programme on compliance with standards related to healthcare‐acquired infections. |
| Participants | Hospitals, primary healthcare organisations and other community‐based healthcare organisations containing health professionals | 20 public hospitals in Kwa Zulu province of South Africa, and all acute hospital trusts in England |
| Settings | Any health system | 1 study was conducted in South Africa and 1 in England |
| Outcomes | Measures of healthcare organisational change (e.g. organisational performance, waiting list times, inpatient hospital stay time); measures of healthcare professional behaviour (e.g. referral rate, prescribing rate); measure of patient outcomes (e.g. mortality and condition‐specific measures) | Outcomes assessed in 1 study were related to adherence to standards in: medical records, patient outcomes such as satisfaction and patient education, and outcomes related with health processes. The other study assessed the rate of hospital‐acquired infections. |
| Date of most recent search: May 2011 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Stakeholder involvement | ||
| Stakeholder participation in policy and organizational decisions | ||
| Review objective: to assess the effects of consumer involvement and to compare different methods of involvement in developing healthcare policy and research, clinical practice guidelines, and patient information material. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials of ways to involve consumers and enable them to inform and participate in decisions about healthcare policy and research, clinical practice guidelines or patient information material | 6 randomised trials of involvement compared with no involvement in developing patient information, satisfaction interviews conducted by patients compared with staff, informed consent forms developed by consumers versus investigators, and methods of consulting consumers regarding priorities for improving community health |
| Participants | Healthcare consumers or professionals involved in decisions about healthcare at the population level, or evaluating the effects of consumer involvement | Involvement in research (3 studies), developing patient information (2 studies) and healthcare policy (1 study) |
| Settings | No specific settings | Canada (2 studies), USA (2 studies), Norway (1 study) and the UK (1 study) |
| Outcomes | Participation or response rates of consumers; consumer views elicited; consumer influence on decisions, healthcare outcomes or resource utilisation; consumer or professional satisfaction with the involvement process or resulting products; impact on participating consumers; costs | Levels of patient satisfaction with different health services, self‐reported participant understanding, satisfaction with study participation, adherence to the protocol and refusal to participate; knowledge and anxiety with a specific medical procedure; impact on prioritising health concerns and determinants |
| Date of most recent search: October 2009 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations | ||
| Community mobilisation | ||
| Review objective: to assess the impact of women's groups practising participatory learning and action cycles on birth outcomes in low‐ and middle‐income countries. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials of participatory women's groups in low‐ and middle‐income countries | 7 cluster‐randomised trials of participatory women's groups in low‐ and middle‐income countries |
| Participants | Women's groups in which most of the participants are of reproductive age (15–49 years) | 7 studies that included a total of 111 women's groups and 119,428 births |
| Settings | Low‐ and middle‐income countries | Rural areas in Bangladesh (2 studies), India (2 studies), Malawi (2 studies), and Nepal (1 study) |
| Outcomes | Maternal mortality, neonatal mortality and stillbirths | Maternal mortality (7 studies), neonatal mortality (7 studies), and stillbirths (7 studies) |
| Date of most recent search: October 2012 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Community mobilisation | ||
| Review objective: to assess the effectiveness of community‐based interventions in reducing vector populations for dengue control. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Randomised trials, non‐randomised trials, controlled before‐after studies and interrupted time series studies of community‐based interventions aimed at reducing vector populations for dengue control. | 11 included studies: 2 randomised trials, 6 controlled before‐after studies and 3 interrupted time series studies assessing community‐based dengue control interventions alone (5 studies); combined with chemical larvicides (2 studies); combined with fish and chemical larvicides (2 studies); and combined with larvae‐eating crustaceans (Mesocyclops copepods) (2 studies) Studies used educational materials (7 studies); educational meetings such as workshops (9 studies); and educational outreach visits (8 studies). Studies described the involvement of local opinion leaders (6 studies) and national institutions (5 studies), or the use of mass media (5 studies). |
| Participants | Community people and professionals serving the community. | Household inhabitants (mostly housewives), the elderly, children, health committees, healthcare personnel, government officers, teachers and community organisations |
| Settings | Community | 5 studies took place in the Americas: Honduras (3 studies), Mexico (1 study), and Cuba (1 study). 6 studies were carried out in Asia: Vietnam (2 studies), Thailand (1 study), Taiwan (1 study), French Polynesia (1 study), Fiji Islands (1 study). |
| Outcomes | Incidence of dengue disease or infestation of the community with Aedes mosquitoes | Classical entomological/larval indices such as the House Index (HI), the Container Index (CI) and the Breteau Index (BI) – all measures of larvae infestation in the home or in water containers; seroconversion or incidence of dengue disease |
| Date of most recent search: March 2005 | ||
| Limitations: This is a well‐conducted systematic review with only minor limitations. | ||
| Patient information | ||
| Review objective: to synthesise the evidence for using public disclosure of performance data to improve healthcare quality. | ||
| Types of | What the review authors searched for | What the review authors found |
| Study designs and interventions | Peer‐reviewed articles published between 1986 and 2006. Type of studies not pre‐specified | 2 randomised trials, 2 non‐randomised trials, 1 controlled before‐after study, 9 interrupted time series studies, and 31 other observational studies |
| Participants | Not pre‐specified | Hospitals, patients, and hospital staff (45 studies) |
| Settings | Not pre‐specified | USA (43 studies), United Kingdom (1 study), Canada (1 study) |
| Outcomes | Selection of health plans, hospitals, and individual providers, quality improvement activity, clinical outcomes, unintended consequences | Selection of health plans (8 studies), selection of hospitals (9 studies), selection of individual providers (7 studies), quality improvement activity (11 studies), clinical outcomes (11 studies), unintended consequences (13 studies) |
| Date of most recent search: March 2006 | ||
| Limitations: Only peer‐reviewed, English‐language articles were included. | ||
Appendix 4. Supplementary and additional related reviews
Recruitment and retention strategies
Increasing access to health workers in remote and rural areas through improved retention (WHO 2010)
Public disclosure of performance data
Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations (Ketelaar 2011) (Supplementary review)
Appendix 5. Reviews awaiting classification
Likely included reviews
Bowman LR, Donegan S, McCall PJ. Is dengue vector control deficient in effectiveness or evidence?: Systematic review and meta‐analysis. PLOS Neglected Tropical Diseases 2016;10(3):e0004551.
Abdel‐Aleem H, El‐Gibaly OMH, El‐Gazzar AFS, Al‐Attar GST. Mobile clinics for women's and children's health. Cochrane Database of Systematic Reviews. 2016;8:CD009677.
Akl EA, El‐Jardali F, Bou Karroum L, El‐Eid J, Brax H, Akik C, et al. Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review. PloS one. 2015;10(9):e0137159.
Algie CM, Mahar RK, Wasiak J, Batty L, Gruen RL, Mahar PD. Interventions for reducing wrong‐site surgery and invasive clinical procedures. The Cochrane database of systematic reviews. 2015;3(3):CD009404.
Ambia J, Mandala J. A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention. Journal of the International AIDS Society. 2016;19(1):20309.
Barnard S, Kim C, Park MH, Ngo TD. Doctors or mid‐level providers for abortion. The Cochrane database of systematic reviews. 2015;7(7):CD011242.
Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative performance of private and public healthcare systems in low‐ and middle‐income countries: a systematic review. PLoS medicine. 2012;9(6):e1001244.
Blacklock C, Gonçalves Bradley DC, Mickan S, Willcox M, Roberts N, Bergström A, et al. Impact of Contextual Factors on the Effect of Interventions to Improve Health Worker Performance in Sub‐Saharan Africa: Review of Randomised Clinical Trials. PloS one. 2016;11(1):e0145206.
Byrne A, Hodge A, Jimenez‐Soto E, Morgan A. What works? Strategies to increase reproductive, maternal and child health in difficult to access mountainous locations: a systematic literature review. PloS one. 2014;9(2):e87683.
Coast E, Jones E, Lattof SR, Portela A. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review. Health policy and planning. 2016;31(10):1479‐91.
Cornish F, Priego‐Hernandez J, Campbell C, Mburu G, McLean S. The impact of Community Mobilisation on HIV Prevention in Middle and Low Income Countries: A Systematic Review and Critique. AIDS and behavior. 2014;18(11):2110‐34.
Dawson A, Tran NT, Westley E, Mangiaterra V, Festin M. Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle‐income countries. PloS one. 2014;9(10):e109315.
de Jongh TE, Gurol‐Urganci I, Allen E, Zhu NJ, Atun R. Integration of antenatal care services with health programmes in low‐ and middle‐income countries: systematic review. Journal of global health. 2016;6(1):010403.
Dyer TA, Brocklehurst P, Glenny AM, Davies L, Tickle M, Issac A, et al. Dental auxiliaries for dental care traditionally provided by dentists. The Cochrane database of systematic reviews. 2014;8(8):CD010076.
Ehiri JE, Gunn JK, Center KE, Li Y, Rouhani M, Ezeanolue EE. Training and deployment of lay refugee/internally displaced persons to provide basic health services in camps: a systematic review. Global health action. 2014;7:23902.
Emdin CA, Chong NJ, Millson PE. Non‐physician clinician provided HIV treatment results in equivalent outcomes as physician‐provided care: a meta‐analysis. Journal of the International AIDS Society. 2013;16(no pagination):18445.
Fernandez Turienzo C, Sandall J, Peacock JL. Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta‐analysis. BMJ open. 2016;6(1):e009044.
Feyissa GT, Lockwood C, Munn Z. The effectiveness of home‐based HIV counseling and testing in reducing stigma and risky sexual behavior among adults and adolescents: a systematic review and meta‐analysis. JBI Database of Systematic Reviews and Implementation Reports. 2015;13(6):318‐72.
Fiander M, McGowan J, Grad R, Pluye P, Hannes K, Labrecque M, et al. Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes. The Cochrane database of systematic reviews. 2015;3(3):CD004749.
Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. The Cochrane database of systematic reviews. 2015;9(9):CD002098.
Gaitonde R, Oxman AD, Okebukola PO, Rada G. Interventions to reduce corruption in the health sector. Cochrane Database of Systematic Reviews. 2016;8:CD008856.
George AS, Branchini C, Portela A. Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review. PloS one. 2015;10(10):e0138116.
Ghada Abou El S, Therese D, Hatem AM. Planned home versus hospital care for preterm prelabour rupture of the membranes (PPROM) prior to 37 weeks' gestation. Cochrane Database of Systematic Reviews. 2014;4(4):CD008053.
Giedion U, Alfonso EA, Diaz Y. The Impact of Universal Coverage Schemes in the Developing World: A Review of the Existing Evidence. Universal Health Coverage (UNICO) studies series; no. 25. Washington D.C.: The Worldbank. 2013.
Handford CD, Tynan AM, Agha A, Rzeznikiewiz D, Glazier RH. Organization of care for persons with HIV‐infection: a systematic review. AIDS care. 2016:1‐10.
Health Quality Ontario. Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review. Ontario health technology assessment series. 2016;16(9):1‐50.
Hensen B, Taoka S, Lewis JJ, Weiss HA, Hargreaves J. Systematic review of strategies to increase men's HIV‐testing in sub‐Saharan Africa. AIDS (London, England). 2014;28(14):2133‐45.
Hernández AV, Pasupuleti V, Benites‐Zapata V, Velásquez‐Hurtado E, Loyola‐Romaní J, Rodríguez‐Calviño Y, et al. [Systematic review of the efectiveness of community‐based interventions to decrease neonatal mortality]. Revista peruana de medicina experimental y salud pública. 2015;32(3):532‐45.
Hesselink G, Berben S, Beune T, Schoonhoven L. Improving the governance of patient safety in emergency care: a systematic review of interventions. BMJ open. 2016;6(1):e009837.
Hopkins U, Itty AS, Nazario H, Pinon M, Slyer J, Singleton J. The effectiveness of delegation interventions by the registered nurse to the unlicensed assistive personnel and their impact on quality of care, patient satisfaction, and RN staff satisfaction: a systematic review. JBI Library of Systematic Reviews. 2012;10(15):895‐934.
Hoyler M, Hagander L, Gillies R, Riviello R, Chu K, Bergström S, et al. Surgical care by non‐surgeons in low‐income and middle‐income countries: a systematic review. Lancet (London, England). 2015;385 Suppl 2:S42.
Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, et al. Task shifting for non‐communicable disease management in low and middle income countries‐‐a systematic review. PloS one. 2014;9(8):e103754.
Kien C, Reichenpfader U, Nußbaumer B, Rohleder S, Punz P, Christof C, et al. [Comparative effectiveness and safety of screening and counselling interventions conducted by non‐physicians and physicians: A systematic review]. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2015;109(1):18‐27.
Kilpatrick K, Kaasalainen S, Donald F, Reid K, Carter N, Bryant‐Lukosius D, et al. The effectiveness and cost‐effectiveness of clinical nurse specialists in outpatient roles: a systematic review. Journal of evaluation in clinical practice. 2014;20(6):1106‐23.
Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, et al. Effects of Community‐Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review. American journal of public health. 2016;106(4):e1‐e26.
Kredo T, Adeniyi FGB, Bateganya M, Pienaar ED. Task shifting from doctors to non‐doctors for initiation and maintenance of antiretroviral therapy. Cochrane Database of Systematic Reviews. 2014;7(7):CD007331.
Lassi ZS, Musavi NB, Maliqi B, Mansoor N, de Francisco A, Toure K, et al. Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low‐ and middle‐income countries. Human resources for health. 2016;14(1):10.
Lavender T, Richens Y, Milan SJ, Smyth RMD, Dowswell T. Telephone support for women during pregnancy and the first six weeks postpartum. Cochrane Database of Systematic Reviews. 2013;7(7):CD009338.
Lawrence D, Fedorowicz Z, van Zuuren EJ. Day care versus in‐patient surgery for age‐related cataract. The Cochrane database of systematic reviews. 2015;11(11):CD004242.
Liu G, Jack H, Piette A, Mangezi W, Machando D, Rwafa C, et al. Mental health training for health workers in Africa: a systematic review. The lancet Psychiatry. 2016;3(1):65‐76.
MacPherson P, Munthali C, Ferguson J, Armstrong A, Kranzer K, Ferrand RA, et al. Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care. Tropical medicine & international health : TM & IH. 2015;20(8):1015‐32.
Mbuagbaw L, Medley N, Darzi AJ, Richardson M, Habiba Garga K, Ongolo‐Zogo P. Health system and community level interventions for improving antenatal care coverage and health outcomes. The Cochrane database of systematic reviews. 2015;12(12):CD010994.
Mdege ND, Chindove S. Bringing antiretroviral therapy (ART) closer to the end‐user through mobile clinics and home‐based ART: systematic review shows more evidence on the effectiveness and cost effectiveness is needed. The International journal of health planning and management. 2013;29(1):e31‐47.
Moraros J, Lemstra M, Nwankwo C. Lean interventions in healthcare: do they actually work? A systematic literature review. International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua. 2016;28(2):150‐65.
Nunan M, Duke T. Effectiveness of pharmacy interventions in improving availability of essential medicines at the primary healthcare level. Tropical medicine & international health : TM & IH. 2011;16(5):647‐58.
Oluoch T, Santas X, Kwaro D, Were M, Biondich P, Bailey C, et al. The effect of electronic medical record‐based clinical decision support on HIV care in resource‐constrained settings: a systematic review. International journal of medical informatics. 2012;81(10):e83‐92.
Palmer KS, Agoritsas T, Martin D, Scott T, Mulla SM, Miller AP, et al. Activity‐based funding of hospitals and its impact on mortality, readmission, discharge destination, severity of illness, and volume of care: a systematic review and meta‐analysis. PloS one. 2014;9(10):e109975.
Pega F, Liu SY, Walter S, Lhachimi SK. Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low‐ and middle‐income countries. The Cochrane database of systematic reviews. 2015;9(9):CD011247.
Penazzato M, Davies MA, Apollo T, Negussie E, Ford N. Task shifting for the delivery of pediatric antiretroviral treatment: a systematic review. Journal of acquired immune deficiency syndromes (1999). 2014;65(4):414‐22.
Pollaris G, Sabbe M. Reverse triage: more than just another method. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2015;23(4):240‐7.
Polus S, Lewin S, Glenton C, Lerberg PM, Rehfuess E, Gülmezoglu AM. Optimizing the delivery of contraceptives in low‐ and middle‐income countries through task shifting: a systematic review of effectiveness and safety. Reproductive health. 2015;12(1):27.
Rashidian A, Omidvari AH, Vali Y, Sturm H, Oxman AD. Pharmaceutical policies: effects of financial incentives for prescribers. The Cochrane database of systematic reviews. 2015;8(8):CD006731.
Reichow B, Servili C, Yasamy MT, Barbui C, Saxena S. Non‐specialist psychosocial interventions for children and adolescents with intellectual disability or lower‐functioning autism spectrum disorders: a systematic review. PLoS medicine. 2013;10(12):e1001572.
Reisman J, Arlington L, Jensen L, Louis H, Suarez‐Rebling D, Nelson BD. Newborn Resuscitation Training in Resource‐Limited Settings: A Systematic Literature Review. Pediatrics. 2016;138(2):1‐16.
Robyn PJ, Sauerborn R, Bärnighausen T. Provider payment in community‐based health insurance schemes in developing countries: a systematic review. Health policy and planning. 2013;28(2):111‐22.
Salam RA, Das JK, Lassi ZS, Bhutta ZA. Impact of community‐based interventions for the prevention and control of malaria on intervention coverage and health outcomes for the prevention and control of malaria. Infectious diseases of poverty. 2014;3(1):25.
Schmidt E, Goldhaber‐Fiebert SN, Ho LA, McDonald KM. Simulation exercises as a patient safety strategy: a systematic review. Annals of internal medicine. 2013;158(5 Pt 2):426‐32.
Sharon RL, Amanda N, Andrew FS, Phil A. Physician anaesthetists versus non‐physician providers of anaesthesia for surgical patients. Cochrane Database of Systematic Reviews. 2014;7(7):CD010357.
Sondaal SF, Browne JL, Amoakoh‐Coleman M, Borgstein A, Miltenburg AS, Verwijs M, et al. Assessing the Effect of mHealth Interventions in Improving Maternal and Neonatal Care in Low‐ and Middle‐Income Countries: A Systematic Review. PloS one. 2016;11(5):e0154664.
Spaan E, Mathijssen J, Tromp N, McBain F, ten Have A, Baltussen R. The impact of health insurance in Africa and Asia: a systematic review. Bulletin of the World Health Organization. 2012;90(9):685‐92.
Sunguya BF, Poudel KC, Mlunde LB, Urassa DP, Yasuoka J, Jimba M. Nutrition training improves health workers' nutrition knowledge and competence to manage child undernutrition: a systematic review. Frontiers in public health. 2013;1:37.
Susan FM, Benjamin MH, Ramila B, Tim E, Debra B. Demand‐side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low‐ and middle‐income countries. JBI Library of Systematic Reviews. 2012;10(58):4165‐567.
Thomas SM, Jeyaraman M, Hodge WG, Hutnik C, Costella J, Malvankar‐Mehta MS. The effectiveness of teleglaucoma versus in‐patient examination for glaucoma screening: a systematic review and meta‐analysis. PloS one. 2014;9(12):e113779.
Tibingana‐Ahimbisibwe B, Katabira C, Mpalampa L, Harrison RA. The effectiveness of adolescent‐specific prenatal interventions on improving attendance and reducing harm during and after birth: a systematic review. International journal of adolescent medicine and health. 2016.
Till SR, Everetts D, Haas DM. Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. Cochrane Database of Systematic Reviews. 2015;12(12):CD009916.
Watterson JL, Walsh J, Madeka I. Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature. BioMed research international. 2015;2015(no pagination):153402.
Weeks G, George J, Maclure K, Stewart D. Non‐medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. The Cochrane database of systematic reviews. 2016;11:CD011227.
Wiysonge CS, Abdullahi LH, Ndze VN, Hussey GD. Public stewardship of private for‐profit healthcare providers in low‐ and middle‐income countries. Cochrane Database of Systematic Reviews. 2016;8(8):CD009855.
Wong WC, Luk CW, Kidd MR. Is there a role for primary care clinicians in providing shared care in HIV treatment? A systematic literature review. Sexually transmitted infections. 2012;88(2):125‐31.
Likely excluded reviews
Bassili A, Fitzpatrick C, Qadeer E, Fatima R, Floyd K, Jaramillo E. A systematic review of the effectiveness of hospital‐ and ambulatory‐based management of multidrug‐resistant tuberculosis. The American journal of tropical medicine and hygiene. 2013;89(2):271‐80.
Bhageerathy R, Nair S, Bhaskaran U. A systematic review of community‐based health insurance programs in South Asia. The International journal of health planning and management. 2016.
Blaya JA, Fraser HS, Holt B. E‐health technologies show promise in developing countries. Health affairs (Project Hope). 2010;29(2):244‐51.
Callese TE, Richards CT, Shaw P, Schuetz SJ, Paladino L, Issa N, et al. Trauma system development in low‐ and middle‐income countries: a review. The Journal of surgical research. 2015;193(1):300‐7.
Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review. BMC health services research. 2015;15(1):194.
Dawson AZ, Walker RJ, Campbell JA, Egede LE. Effective Strategies for Global Health Training Programs A Systematic Review of Training Outcomes in Low and Middle Income Countries. Global journal of health science. 2016;8(11):56719.
Higgs ES, Goldberg AB, Labrique AB, Cook SH, Schmid C, Cole CF, et al. Understanding the role of mHealth and other media interventions for behavior change to enhance child survival and development in low‐ and middle‐income countries: an evidence review. Journal of health communication. 2014;19 Suppl 1:164‐89.
Hubert GJ, Müller‐Barna P, Audebert HJ. Recent advances in TeleStroke: a systematic review on applications in prehospital management and Stroke Unit treatment or TeleStroke networking in developing countries. International journal of stroke : official journal of the International Stroke Society. 2014;9(8):968‐73.
Margaret Elizabeth K, Denis P, Peter CR, Wim Van L. The contribution of primary care to health and health systems in low‐ and middle‐income countries: A critical review of major primary care initiatives. 2010.
Pannick S, Davis R, Ashrafian H, Byrne BE, Beveridge I, Athanasiou T, et al. Effects of Interdisciplinary Team Care Interventions on General Medical Wards: A Systematic Review. JAMA internal medicine. 2015;175(8):1288‐98.
Schiavo R, May Leung M, Brown M. Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings. Pathogens and global health. 2014;108(2):76‐94.
Zulfiqar AB, Zohra SL, Nadia M. Systematic review on human resources for health interventions to improve maternal health outcomes: Evidence from developing countries. 2010.
Uncertain reviews
Acheampong F, Anto BP, Koffuor GA. Medication safety strategies in hospitals‐‐a systematic review. The International journal of risk & safety in medicine. 2014;26(3):117‐31.
Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Annals of Saudi medicine. 2011;31(4):407‐16.
Al‐Mallah MH, Farah I, Al‐Madani W, Bdeir B, Al Habib S, Bigelow ML, et al. The Impact of Nurse‐Led Clinics on the Mortality and Morbidity of Patients with Cardiovascular Diseases: A Systematic Review and Meta‐analysis. The Journal of cardiovascular nursing. 2015;31(1):89‐95.
Bakitas MA, Elk R, Astin M, Ceronsky L, Clifford KN, Dionne‐Odom JN, et al. Systematic Review of Palliative Care in the Rural Setting. Cancer control : journal of the Moffitt Cancer Center. 2015;22(4):450‐64.
Balfour J, Abdulcadir J, Say L, Hindin MJ. Interventions for healthcare providers to improve treatment and prevention of female genital mutilation: a systematic review. BMC health services research. 2016;16(1):409.
Bannan DF, Tully MP. Bundle interventions used to reduce prescribing and administration errors in hospitalized children: a systematic review. Journal of clinical pharmacy and therapeutics. 2016;41(3):246‐55.
Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical Foundations of Telemedicine Interventions in Primary Care. Telemedicine journal and e‐health : the official journal of the American Telemedicine Association. 2016;22(5):342‐75.
Boccia D, Hargreaves J, Lönnroth K, Jaramillo E, Weiss J, Uplekar M, et al. Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2011;15 Suppl 2:S37‐49.
Booth A, Cantrell A, Preston L, Chambers D, Goyder E. What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review2015 2015/12/None.
Brocklehurst P, Mertz B, Jerković‐Ćosić K, Littlewood A, Tickle M. Direct access to midlevel dental providers: an evidence synthesis. Journal of public health dentistry. 2014;74(4):326‐35.
Candy B, France R, Low J, Sampson L. Does involving volunteers in the provision of palliative care make a difference to patient and family wellbeing? A systematic review of quantitative and qualitative evidence. International journal of nursing studies. 2014;52(3):756‐68.
Chapman SM, Wray J, Oulton K, Peters MJ. Systematic review of paediatric track and trigger systems for hospitalised children. Resuscitation. 2016;109:87‐109.
Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. The Cochrane database of systematic reviews. 2015;11(11):CD010907.
Damiani G, Pinnarelli L, Sommella L, Vena V, Magrini P, Ricciardi W. The Short Stay Unit as a new option for hospitals: a review of the scientific literature. Medical science monitor : international medical journal of experimental and clinical research. 2011;17(6):SR15‐9.
Gentry S, van Velthoven MHMMT, Tudor Car L, Car J. Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. Cochrane Database of Systematic Reviews. 2013;5(5):CD009189.
Harding R, Albertyn R, Sherr L, Gwyther L. Pediatric palliative care in sub‐saharan Africa: a systematic review of the evidence for care models, interventions, and outcomes. Journal of pain and symptom management. 2014;47(3):642‐51.
Hastings SE, Armitage GD, Mallinson S, Jackson K, Suter E. Exploring the relationship between governance mechanisms in healthcare and health workforce outcomes: a systematic review. BMC health services research. 2014;14(1):479.
Hines S, Munday J, Kynoch K. Effectiveness of nurse‐led preoperative assessment services for elective surgery: a systematic review update. JBI database of systematic reviews and implementation reports. 2015;13(6):279‐317.
Hotchkiss DR, Diana ML, Foreit KG. How can routine health information systems improve health systems functioning in low‐ and middle‐income countries? Assessing the evidence base. Advances in health care management. 2012;12:25‐58.
Housden L, Wong ST, Dawes M. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta‐analysis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2013;185(13):E635‐44.
Ireland S, Kent B. Telephone pre‐operative assessment for adults: a comprehensive systematic review. JBI Library of Systematic Reviews. 2012;10(25):1452‐503.
Kågesten A, Parekh J, Tunçalp O, Turke S, Blum RW. Comprehensive adolescent health programs that include sexual and reproductive health services: a systematic review. American journal of public health. 2014;104(12):e1‐e14.
Lazarus JV, Safreed‐Harmon K, Nicholson J, Jaffar S. Health service delivery models for the provision of antiretroviral therapy in sub‐Saharan Africa: a systematic review. Tropical medicine & international health : TM & IH. 2014;19(10):1198‐215.
Leidy Johanna Rueda D, Diná Lopes Monteiro da C. The efficacy of telephone use to assist and improve the wellbeing of family caregivers of persons with chronic diseases: a systematic review. JBI Library of Systematic Reviews. 2015;12(12):106‐40.
McCormack L, Sheridan S, Lewis M, Boudewyns V, Melvin CL, Kistler C, et al. Communication and dissemination strategies to facilitate the use of health‐related evidence. Evidence report/technology assessment. 2013(213):1‐520.
Meid AD, Lampert A, Burnett A, Seidling HM, Haefeli WE. The impact of pharmaceutical care interventions for medication underuse in older people: a systematic review and meta‐analysis. British journal of clinical pharmacology. 2015;80(4):768‐76.
Mengistu TA, Tafere TE. Effect of antenatal care on institutional delivery in developing countries: a systematic review. JBI Library of Systematic Reviews. 2011;9(35):1447‐70.
Mitchell GK, Burridge L, Zhang J, Donald M, Scott IA, Dart J, et al. Systematic review of integrated models of health care delivered at the primary?secondary interface: how effective is it and what determines effectiveness? Australian journal of primary health. 2015;21(4):391‐408.
Palmas W, March D, Darakjy S, Findley SE, Teresi J, Carrasquillo O, et al. Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta‐Analysis. Journal of General Internal Medicine. 2015;30:1004‐12.
Pérez‐Escamilla R, Martinez JL, Segura‐Pérez S. Impact of the Baby‐friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Maternal & child nutrition. 2016;12(3):402‐17.
Rinke ML, Bundy DG, Velasquez CA, Rao S, Zerhouni Y, Lobner K, et al. Interventions to Reduce Pediatric Medication Errors: A Systematic Review. Pediatrics. 2014;134(2):338‐60.
Rudge MV, Lima SA, El Dib RP, Marini G, Magalhães C, Calderon Ide M. Effect of ambulatory versus hospital treatment for gestational diabetes or hyperglycemia on infant mortality rates: a systematic review. São Paulo medical journal = Revista paulista de medicina. 2013;131(5):331‐7.
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Review flow diagram.
| Governance arrangement | Applicability limitations | ||
| Findings | Interpretation | ||
| Authority and accountability for health policies | |||
| Interagency collaboration | All studies included in this review took place in high income countries. | The reality of local agencies in low‐income countries is probably very different to that in high‐income countries so results reported in this review should be applied with caution in low‐income countries settings. | |
| Decision‐making about what is covered by health insurance – restrictions on drug reimbursement | All of the included studies took place in high‐income countries. Thus there is uncertainty regarding the transferability of the results to low‐ and middle‐income country settings. Participants were mainly senior citizens or low‐income adult populations in publicly subsidised or administered pharmaceutical benefit plans. Only two of the studies included in this review reported health outcome data, precluding any conclusions about the impact of the policies on patient outcomes. | Applicability of these interventions to low‐income country settings depends on there being: – a regulatory framework; – an administrative and managerial system which support the implementation of the policy; –an insurance system with relatively broad medicines benefit; – efficient, timely access to patient‐specific information; – availability of preferred products incentivised by the re‐imbursement policy; – product quality assessments and prescriber and patient trust in the quality of preferred products. | |
| Policies to reduce corruption – fraud detection and response actions | There is no study from low income‐countries and only two from middle‐income countries. | Low‐income countries might be more prone and vulnerable to health care fraud and its consequences. When assessing the transferability of these findings to low‐income countries the following factors should be considered. – The availability of human and technical resources to combat fraud. – The acceptability and costs of the interventions. | |
| Authority and accountability for organisations | |||
| Subcontracting to non‐state not‐for‐profit providers | All of the studies took place in low‐ and middle‐income countries In the three included studies, the contracts were carried out with non‐governmental organisations (NGOs); no studies were found that evaluated contracts with private for‐profit providers. The studies provided very little description of the actual measures implemented by the contractor (management, organisation, salaries, and incentives) to achieve the goals established in the contract. | Differences in health systems; patient and physician attitudes to NGOs; and legal restrictions may limit applicability of the findings. Subcontracting can be a potentially effective strategy in particular settings but it may be difficult for governments to re‐deploy public funds to private providers when available funds are already committed to public services. Factors that need to be considered to asses whether the intervention effects are likely to be transferable include: – the availability of not‐for‐profit organisations to carry out the contracts; – the capacity within the public sector for set up and monitor the contracts. | |
| Multi‐institutional arrangements –social franchising | The review did not find any studies conducted in low‐ and middle‐income countries that met its inclusion criteria. | Although social franchising is currently used and advocated in low‐ and middle‐income countries, no rigorous evaluations of its impacts (both positive and negative) are available. | |
| Authority and accountability for commercial products | |||
| Registration – drugs | The studies were all undertaken in low‐ and middle‐income countries. The results suggest that drug registration, WHO prequalification of drugs, and multi‐faceted interventions may be effective in reducing the prevalence of counterfeit drugs. | The findings are applicable to low‐ and middle‐ income settings. However, a country's existing pharmaceutical supply chain and infrastructure, availability of routine data on quality of drugs, qualified and skilled personnel, and financial resources may facilitate the transferability of the findings. While registration may be effective, it should probably encompass both domestic manufacturers and importers and be complemented with routine postmarketing surveillance to sustain the quality of drugs circulating in the market. Countries that rely heavily on imported drugs may consider opting for drugs that are WHO‐prequalified. However, even among WHO‐prequalified products, the quality may vary depending on the country of export. The success of multifaceted interventions requires collaborations with drug regulatory bodies, skilled human resources, and technical capacity for routine drug inspections. | |
| Reference pricing | All of the 18 studies included were in high‐income countries. | The effectiveness of reference pricing policy in low‐income countries may depend on factors such as: – health systems structure and settings as copayments, reimbursment and cost share; – access to prices data sources; – availability of adequate incentives for healthcare providers, patients, physicians, pharmacists and pharmaceutical companies to comply with the reference pricing policy; – significant price differences between the drugs in the intervention group before reference pricing is introduced; – clear information for managers, clinicians and patients; – availability and access to drugs in the reference group; – a regulatory framework that allows generic substitution or prescribing by international non‐proprietary name (INN); – appropriate exemptions (exemptions that are too limited could lead to higher co‐payments for appropriate use of more expensive drugs and incentives to use a less effective drug. Exemptions that are too broad could reduce savings by not shifting drug use towards appropriate use of less expensive drugs.). | |
| Marketing regulations – Drugs direct‐to‐consumer advertising | The studies, all conducted in high‐income countries, show that direct‐to‐consumer advertising alters prescribing behaviour and volume, but no studies examined the impact of such advertising on health outcomes | Given the absence of any evidence of improvement in health outcomes from direct‐to‐consumer advertising, its benefits are uncertain in any setting. | |
| Authority and accountability for health professionals | |||
| Pre‐licensure education | All included studies took place in high‐income countries. | The challenges faced in health care worker education in high‐ and low‐income countries are qualitatively and quantitatively different (e.g. the availability of funds, laws regarding equity and awareness of these, job prospects including remuneration, and curricula). Appropriate interventions could be expected to have a comparatively higher impact in low‐income countries, where alternatives and opportunities are generally more limited than in high‐income countries. However, there is no evidence regarding the effects of such interventions. | |
| Recruitment and retention strategies | Some observational studies, mostly from high‐income countries, suggest that some interventions, such as selecting students from rural areas, exposing students to clinical rotations in rural areas, or financial incentive programmes might increase the number of health professionals in underserved areas. However, the certainty of this evidence is very low. | Economic and cultural differences, differences between health system structures, and differences in state and educational institutional capacity to regulate and manage various types of interventions may limit the applicability of findings from high‐ to low‐income countries. | |
| Training/recruitment and retention strategies | The two included studies took place in low and middle income countries. Tested in a low income country, there is uncertainty about the impact of having private contracts (contract‐in districts) compared to public contracts of district health managers. | The capacity and strength of the government to oversee and supervise districts with private contracts could be an important issue to consider when it comes to assure the attainment of public regulations and goals. The level of power decentralisation in the districts might change the impact of policies related with health managers. The higher the degree of decentralisation, the higher the impact they might have. | |
| Movement of health workers between public and private organisations | No studies met the inclusion criteria for the review. | Health worker availability remains one of the key barriers to strengthening health systems in low‐income countries. Effective interventions to manage the movement of health professionals could help to address this and need to be evaluated rigorously. | |
| Emigration and immigration policies – reducing immigration restrictions | The available evidence is based on an intervention made in a high‐income country. | Policies in high‐income countries may have an effect on the number of health workers migrating from low‐ and middle‐income countries. Low‐ and middle‐income countries have little direct influence on high‐income country policies, including immigration policies. However, low‐ and middle‐income countries may attempt to influence such policies by means of diplomacy, lobbying, or public relations before they are enacted. | |
| Dual practice | No studies met the inclusion criteria for the review. | Dual practice may be more of a problem in low‐income countries, due to low wages in the public sector, and interventions to manage it may have different effects, e.g. the risk of health professionals migrating is likely to be greater in low‐income countries compared to high‐income countries. | |
| Authority and accountability for quality of practice – authority and accountability for quality of outpatient care – external inspection | Neither of the two studies included in this review took place in a low‐income country: one was done in South Africa and the other in England. Both studies assessed the effect of external inspection of compliance of different standards on quality of hospital services. According to the findings in this review, it is uncertain whether external inspection contributes or not to improve quality of health services in hospital setting. | External inspection of compliance standards may have varying acceptability and impact across different healthcare and cultural settings; may involve different components from training to organisational restructuring; and may impact in different ways on consumer and provider satisfaction across different settings Although quality of care is an objective of care in all health systems, it is not possible to be confident about the applicability of the reported interventions to low income countries and to settings other than hospital care | |
| Stakeholder involvement | |||
| Stakeholder participation in policy and organisational decisions – consumer involvement in preparing patient information | All the studies took place in high‐income countries. Some interventions used technologies such as telephones and email. Baseline levels of consumers involvement were not reported. | Strategies to overcome barriers such as low baseline levels of social participation and education should be explored when considering consumer involvement in low‐income countries. Training and support may be essential. The attitudes and the perspectives of health professionals and policymakers regarding consumer involvement should also be considered. As the availability of communication technologies may be a problem, face‐to‐face involvement may be most appropriate. | |
| Community mobilisation – women's groups practising participatory learning and action | All 7 studies took place in low‐and middle‐income countries, including Bangladesh, Malawi, India and Nepal. | The use of women's groups practicing participatory learning and action probably decreases newborn mortality and may reduce maternal mortality in rural areas in low‐income countries. However, its effectiveness may depend on participation of a substantial proportion of pregnant women. It might also depend on adequate supervision and support, home visits, access to care, improving the quality of care, and adequate resources. The intervention might be less effective in urban areas if there is less community cohesion and interaction among women included in women's groups, and higher baseline use of health services. | |
| Community mobilisation – community‐based dengue control | 10 out of 11 studies included in the systematic review took place in low‐ and middle‐income countries. | These findings are applicable to low‐income countries; however, the availability acceptability and costs of the interventions should be considered. | |
| Patient information – public disclosure of performance data | The studies, all conducted in high‐income countries, provided mixed evidence for using the public disclosure of performance data to improve the quality of care. | There is no evidence to date that the public disclosure of performance data affects the quality of care. Even if public disclosure were effective in improving quality of care in high‐income countries, the results would not be directly transferable to low‐income country settings because of differences in health infrastructure, the ability of health facilities and providers to produce accurate data, the capacity to disseminate the data, and the ability of consumers to interpret the data. There is a need for high‐quality studies of public disclosure of performance data in high‐, middle‐ and low‐income countries. | |
| aPriorities for primary research are based on the applicability limitations to low‐income countries of the governance arrangement interventions identified by the included reviews. We did not search for additional primary studies. | |||
| Governance arrangement | Included review | No studies | Very low certainty of evidence | Low certainty of evidence |
| Authority and accountability for health policies | ||||
| Interagency collaboration | PO, ACU, QoC, RU | PO | PO | |
| Decision‐making about what is covered by health insurance – Restrictions on drug reimbursement | QoC | PO | — | |
| Policies to reduce corruption – fraud detection and response actions | PO, ACU, QoC | RU | — | |
| Authority and accountability for organisations | ||||
| Subcontracting to non‐state not‐for‐profit providers | QoC, RU | — | PO, ACU | |
| Multi‐institutional arrangements Social franchising | PO, ACU, QoC, RU | — | — | |
| Authority and accountability for commercial products | ||||
| Registration – drugs | — | — | PO, ACU, QoC, RU | |
| Reference pricing – reference and index price | PO, QoC | — | ACU, RU | |
| Marketing regulations – drugs direct to consumer advertising | PO, QoC, RU | — | — | |
| Authority and accountability for health professionals | — | — | — | — |
| Training and licensing Pre‐licensure education – minority academic advising programme | PO, ACU, QoC, RU | — | — | |
| Recruitment and retention strategies | PO, ACU, QoC, RU | — | ||
| Training and licensing/recruitment and retention strategies | QoC, RU | PO, ACU | — | |
| Movement of health workers between public and private organisations | PO, ACU, QoC, RU | — | — | |
| Emigration and immigration policies – reducing immigration restrictions | PO, QoC, RU | — | — | |
| Dual practice | PO, ACU, QoC, RU | — | — | |
| Authority and accountability for quality of practice Authority and accountability for quality of outpatient care – external inspection | PO, ACU, RU | QoC | — | |
| Stakeholder involvement | ||||
| Stakeholder participation in policy and organisational decisions ‐ consumer involvement in preparing patient information | PO, ACU, RU | — | QoC | |
| Community mobilisation – women's groups practising participatory learning and action | ACU, QoC, RU | — | — | |
| Community mobilisation – community‐based dengue control | ACU, QoC, RU | — | — | |
| Patient information Public disclosure of performance data | QoC, RU | — | PO, ACU | |
| ACU: access, coverage and utilisation outcomes; PO: patient outcomes; QoC: quality of care outcomes; RU: resource use outcomes. | ||||
| Governance arrangement | What we found |
| Authority and accountability for health policies | |
| Decentralised versus centralised authority for health services | No reviews identified |
| Policies that regulate what drugs are reimbursed | No reviews identified |
| Policies that regulate what services are reimbursed | No reviews identified |
| Restrictions on reimbursement for health insurance | No reviews identified |
| Strategies for expanding health insurance coverage | No reviews identified |
| Policies to manage absenteeism | No reviews identified |
| Requirements for monitoring or evaluation | No reviews identified |
| Authority and accountability for organisations | |
| Ownership | Review in progress (Herrera 2013) |
| Stewardship of private health services | No reviews identified |
| Accreditation | No reviews identified |
| Provision of drug insurance | Review in progress (Pantoja 2015) |
| Provision of health insurance | No reviews identified |
| Policies that regulate interactions between donors and governments | No reviews identified |
| Governance arrangements for coordinating care across multiple providers | No reviews identified |
| Mergers | No reviews identified |
| Authority and accountability for commercial products | |
| Registration of health technology | No reviews identified |
| Patents and profits of drugs | No reviews identified |
| Patents and profits of health technology | No reviews identified |
| Pricing and purchasing policies of health technology and services | No reviews identified |
| Marketing regulations for health technology and services | No reviews identified |
| Sales and dispensing policies for drugs | Review in progress (Peñaloza 2015) |
| Liability for commercial products | No reviews identified |
| Authority and accountability for health professionals | |
| Licensure of health professionals | No reviews identified |
| Specialty certification | No reviews identified |
| Scope of practice | No reviews identified |
| Authority and accountability for quality assurance of hospital care | No reviews identified |
| Professional competence | No reviews identified |
| Professional liability | No reviews identified |
| Stakeholder involvement | |
| Community monitoring | No reviews identified |
| Patient information about drugs | No reviews identified |
| Patients' rights | No reviews identified |
| Governance: definitions |
|
|
| Stewardhip: definitions and features distinguishing it from governance |
| Stewardship is similar to the concept of public governance but, as envisaged by the WHO, is more specifically focused on the state's role in taking responsibility for the health and well‐being of the population, and guiding the health system as a whole (Travis 2003). Stewardship has been described as one of the four basic functions of health system organisations (Murray 2000). The other three functions in this model are financing, provision, and resource generation. Definitions of stewardship include the following.
|
| Governance arrangement | Definition |
| Authority and accountability for health policies | |
| Interagency collaboration | Collaboration and partnerships for health and social development between the health sector and other different sectors |
| Centralisation and decentralisation | Policies to regulate the degree of which managerial responsibilities are transferred to regional or local authorities in contrast to having them at the central level |
| District management | Policies that regulate the management of district health systems |
| Decision‐making about what or who is covered by health insurance | Processes for deciding what is reimbursed and who is covered by health insurance |
| Policies to reduce corruption | Policies for reducing corruption in the health sector |
| Policies to manage absenteeism | Regulations for managing absenteeism of health professionals |
| Requirements for monitoring or evaluation | Policies that regulate programme monitoring and evaluation |
| Authority and accountability for organisations | |
| Ownership | Policies that regulate who can own health service organisations |
| Stewardship of private health services | Policies that regulate health services provided by the private sector |
| Insurance | Policies that regulate the provision of insurance (e.g. who can provide insurance, mandatory open enrolment, coverage of essential drugs) |
| Accreditation | Processes for accrediting healthcare providers |
| Multi‐institutional arrangements | Policies for how multiple organisations work together |
| Authority and accountability for commercial products | |
| Registration | Procedures for registering or licensing commercial products (e.g. drugs) |
| Patents and profits | Policies that regulate patents and profits |
| Pricing and purchasing policies | Policies that determine the price that is paid or how commercial products are purchased |
| Marketing regulations | Policies that regulate marketing of commercial products |
| Sales and dispensing | Policies that regulate the sale and dispensing of drugs or other healthcare products |
| Liability for commercial products | Policies that regulate liability for commercial products |
| Authority and accountability for health professionals | |
| Training and licensing | Policies that regulate training and licensure requirements for health professionals |
| Scope of practice | Policies that regulate what health professionals can do |
| Recruitment and retention strategies | Policies that regulate where health professionals work (e.g. restrictions on where they can work or requirements to work in rural areas) |
| Emigration and immigration policies | Policies that regulate emigration and immigration of health professionals |
| Dual practice | Policies that regulate dual practice, in which health workers hold two or more jobs, for example in both the public or private sectors |
| Quality of practice | Policies or systems for assuring quality of care |
| Professional competence | Policies or procedures for assuring professional competence |
| Policies to manage absenteeism | Policies for managing absenteeism of health professionals |
| Professional liability | Policies that regulate liability for health professionals |
| Stakeholder involvement | |
| Stakeholder participation in policy and organisational decisions | Policies and procedures for involving stakeholders in decision‐making |
| Community mobilisation | Processes that enable people to organise themselves |
| Community monitoring | Monitoring of health services by individuals or community organisations |
| Patient information | Policies that regulate what information is provided to patients |
| Patients' rights | Policies that regulate patients' rights, including access to care and information |
| Governance arrangement | Definition |
| Authority and accountability for health policies | |
| Interagency collaboration | Policies to facilitate interagency collaboration, for instance, between local government and local health authorities in order to address social determinants of health, can contribute to improve health of the population. |
| Decentralisation and centralisation | Shifting authority closer to those who are affected might improve accountability, openness and participation, which might in turn lead to more appropriate priorities, more efficiency and less corruption, and in turn better health outcomes. |
| District management | Regulations that lead to improvements in the management of district health systems can improve access to and the quality of care, and in turn better health outcomes. |
| Decision‐making about what or who is covered by health insurance | Changes in processes used to decide what is reimbursed or who is covered by health insurance might improve access to cost‐effective interventions, and in turn lead to better health outcomes. |
| Policies to reduce corruption | Regulations that reduce corruption can increase the availability of resources for care, and in turn improve health outcomes. |
| Requirements for monitoring or evaluation | Policies that improve decisions about when and how healthcare programmes are monitored or evaluated can lead to better‐informed decisions, and in turn better health outcomes. |
| Authority and accountability for organisations | |
| Ownership | For‐profit health services might limit access for people who cannot afford to pay or divert funds from care to profits and taxes, which might result in poorer quality care and worse health outcomes. |
| Stewardship of private health services | Regulations that increase the accountability of the private sector might improve the quality of care, and in turn lead to better health outcomes. |
| Insurance | Changes in regulations that determine who can provide insurance, who receives it, who pays for it, and who makes decisions about reimbursement might affect coverage and access to care, and in turn health outcomes. |
| Accreditation | Changes in provider accreditation might improve the quality of care, and in turn health outcomes. |
| Multi‐institutional arrangements | Changes in how donors and governments work together might result in more effective and efficient use of resources, and in turn lead to better health outcomes. |
| Authority and accountability for commercial products | |
| Registration | Changes in how drugs or other health technologies are licensed might improve safety, and in turn health outcomes, |
| Patents and profits | Changes in patent regulations might affect the development and availability of drugs or other health technologies, and in turn health outcomes. |
| Pricing and purchasing policies | Regulations that reduce the price that is paid or how drugs or services are purchased might improve access to care, and in turn health outcomes. |
| Marketing regulations | Regulations that limit inappropriate marketing of drugs, other technologies or services might reduce inappropriate use and increase the availability of resources for cost‐effective care, and in turn improve health outcomes. |
| Sales and dispensing | Changes in who can sell drugs or other healthcare products might improve access or improve quality, and in turn health outcomes. |
| Liability for commercial products | Changes in liability for drugs, other technologies or services might improve safety, and in turn health outcomes. |
| Authority and accountability for health professionals | |
| Training and licensing | Regulations that improve training or licensure of health professionals might improve the safety and quality of care, and in turn health outcomes. |
| Scope of practice | Regulations that determine what health professionals can do might improve access to care or safety, and in turn health outcomes. |
| Recruitment and retention strategies | Regulations that determine where health professionals can work might improve access to care, and in turn health outcomes. |
| Emigration and immigration policies | Regulations that determine emigration or immigration of health professionals might improve access to care, and in turn health outcomes. |
| Dual practice | Regulations that affect the extent of dual practice might improve access to care, and in turn health outcomes. |
| Quality of practice | Policies or systems for assuring quality of care might improve the quality of care, and in turn health outcomes. |
| Professional competence | Policies or procedures for assuring professional competence might improve the safety and quality of care, and in turn health outcomes. |
| Policies to manage absenteeism | Regulations that reduce absenteeism can improve access to care, and in turn health outcomes. |
| Professional liability | Changes in liability for health professionals might improve safety or remove impediments to evidence‐based care, and in turn improve health outcomes. |
| Stakeholder involvement | |
| Stakeholder participation in policy and organisational decisions | Involving stakeholders in decision‐making might improve the overall decision‐making about how to use resources and organise care, and in turn lead to better health outcomes. |
| Community mobilisation | Processes that enable people to organise themselves might raise awareness, change behaviours and lead to improvements in access and utilisation of health services, and in turn improve health outcomes. |
| Community monitoring | Monitoring of health services by individuals or community organisations might help to ensure quality, improve access to care, and reduce corruption, and in turn improve health outcomes. |
| Patient information | Regulations that improve the extent to which patients are well‐informed might lead to better informed decisions, and in turn improve health outcomes. |
| Patients' rights | Policies that regulate patients' rights, such as access to care and information, might improve access and utilisation of health services and improve the quality of health services, and in turn improve health outcomes. |
| Governance arrangement | Included reviews |
| Authority and accountability for health policies | |
| Interagency collaboration | Collaboration between local health and local government agencies for health improvement (Hayes 2012) |
| Decentralisation and centralisation | No eligible systematic review found |
| District management | No eligible systematic review found |
| Decision‐making about what or who is covered by health insurance | |
| Policies that regulate what drugs are reimbursed | No eligible systematic review found |
| Policies that regulate what services are reimbursed | No eligible systematic review found |
| Restrictions on drug reimbursement | Pharmaceutical policies: effects of restrictions on reimbursement (Green 2010) |
| Restrictions on reimbursement for health insurance | No eligible systematic review found |
| Strategies for expanding health insurance coverage | No eligible systematic review found |
| Policies to reduce corruption | No evidence of the effect of the interventions to combat health care fraud and abuse: a systematic review of literature (Rashidian 2012) |
| Policies to manage absenteeism | No eligible systematic review found |
| Requirements for monitoring or evaluation | No eligible systematic review found |
| Authority and accountability for organisations | |
| Ownership | No eligible systematic review found |
| Stewardship of private health services | No eligible systematic review found |
| Contracting out | The impact of contracting out on health outcomes and use of health services in low and middle income countries (Lagarde 2009) |
| Accreditation | No eligible systematic review found |
| Regulation of insurance provision | |
| Provision of drug insurance | No eligible systematic review found |
| Provision of health insurance | No eligible systematic review found |
| Multi‐institutional arrangements | |
| Policies that regulate interactions between donors and governments | No eligible systematic review found |
| Social franchising | The effect of social franchising on access to and quality of health services in low‐ and middle‐income countries (Koehlmoos 2009) |
| Governance arrangements for coordinating care across multiple providers | No eligible systematic review found |
| Mergers | No eligible systematic review found |
| Authority and accountability for commercial products | |
| Registration | |
| Drugs | Interventions to combat or prevent drug counterfeiting: a systematic review (El‐Jardali 2015) |
| Health technology | No eligible systematic review found |
| Patents and profits | |
| Drugs | No eligible systematic review found |
| Health technology | No eligible systematic review found |
| Pricing and purchasing policies | |
| Drugs | Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies (Acosta 2014) |
| Health technology and services | No eligible systematic review found |
| Marketing regulations | |
| Drugs | Benefits and harms of direct to consumer advertising: a systematic review (Gilbody 2005) |
| Health technology and services | No eligible systematic review found |
| Sales and dispensing | |
| Drugs | No eligible systematic review found |
| Health technology | No eligible systematic review found |
| Liability for commercial products | No eligible systematic review found |
| Authority and accountability for health professionals | |
| Training and licensing | |
| Pre‐licensure education | Effects of changes in the pre‐licensure education of health workers on health‐worker supply (Pariyo 2009) |
| Training district health system managers | Interventions for hiring, retaining and training district health system managers in low‐ and middle‐income countries (Rockers 2013) |
| Licensure | No eligible systematic review found |
| Specialty certification | No eligible systematic review found |
| Scope of practice | No eligible systematic review found |
| Recruitment and retention strategies | Interventions for increasing the proportion of health professionals practising in underserved communities (Grobler 2015) |
| Recruitment and retention strategies | Interventions for hiring, retaining and training district health system managers in low‐ and middle‐income countries (Rockers 2013) |
| Movement of health workers between public and private organisations | Financial interventions and movement restrictions for managing the movement of health workers between public and private organizations in low‐ and middle‐income countries (Rutebemberwa 2014) |
| Emigration and immigration policies | Interventions for controlling emigration of health professionals from low‐ and middle‐income countries (Peñaloza 2011) |
| Dual practice | Interventions to manage dual practice among health workers (Kiwanuka 2011) |
| Authority and accountability for quality of practice | |
| Authority and accountability for quality of outpatient care | External inspection versus external standards for improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes (Flodgren 2011) |
| Authority and accountability for quality assurance of hospital (inpatient) care | External inspection versus external standards for improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes (Flodgren 2011) |
| Professional competence | No eligible systematic review found |
| Professional liability | No eligible systematic review found |
| Stakeholder involvement | |
| Stakeholder participation in policy and organisational decisions | Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material (Nilsen 2010) |
| Community mobilisation | Women's groups practicing participatory learning and action to improve maternal and newborn health in low‐resource settings: a systematic review and meta‐analysis (Prost 2013) |
| What do community‐based dengue control programmes achieve? A systematic review of published evaluations (Heintze 2007) | |
| Community monitoring | No eligible systematic review found |
| Patient information | |
| Drug information | No eligible systematic review found |
| Public disclosure of performance data | Systematic review: the evidence that publishing patient care performance data improves quality of care (Fung 2008) |
| Patients’ rights | No eligible systematic review found |
| Review ID | Excluded reviews | Reasons for exclusion |
| Financial incentives for return of service in underserved areas: a systematic review | Addressed by Grobler 2015 | |
| Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies | Addressed by upcoming Herrera 2013 | |
| Consumer involvement in health research: a review and research agenda | More than 10 years out of date | |
| Quality of care in for‐profit and not‐for‐profit nursing homes: systematic review and meta‐analysis | Not transferable to low‐income countries | |
| Systematic review of involving patients in the planning and development of health care | Addressed by Nilsen 2010 | |
| A systematic review and meta‐analysis of studies comparing mortality rates of private for‐profit and private not‐for‐profit hospitals. | More than 10 years out of date | |
| Comparison of mortality between private for‐profit and private not‐for‐profit hemodialysis centers | More than 10 years out of date | |
| Payments for care at private for‐profit and private not‐for‐profit hospitals: a systematic review and meta‐analysis | Not transferable to low‐income countries | |
| Community‐based health insurance in low‐income countries: a systematic review of the evidence | Addressed by Meng 2010 | |
| Public reporting in health care: how do consumers use quality‐of‐care information? A systematic review | Addressed by Fung 2008 | |
| Active pharmaceutical management strategies of health insurance systems to improve cost‐effective use of medicines in low‐ and middle‐income countries: a systematic review of current evidence. | Major limitations | |
| Health sector accreditation research: a systematic review | Major limitations | |
| The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact | Major limitations | |
| Effectiveness of intermediate care in nursing‐led in‐patient units | Not transferable to low‐income countries | |
| Provision of a surgeon’s performance data for people considering elective surgery | Addressed by Fung 2008 | |
| Strategies for expanding health insurance coverage in vulnerable populations | Scope of the Implementation overview | |
| Evidence from systematic reviews to inform decision making regarding financing mechanisms that improve access to health services for poor people. A policy brief prepared for the International Dialogue on Evidence‐Informed Action to Achieve Health Goals in Developing Countries IDEAHealth | Addressed by Lagarde 2009 | |
| Linking families and facilities for care at birth: what works to avert intrapartum‐related deaths? | Major limitations | |
| Staffing remote rural areas in middle‐ and low‐income countries: a literature review of attraction and retention | Addressed by Grobler 2015 | |
| The effectiveness of contracting‐out primary health care services in developing countries: a review of the evidence | Addressed by Lagarde 2009 | |
| Contracting for the delivery of community health services: a review of global experience | Addressed by Lagarde 2009 | |
| The public release of performance data: what do we expect to gain? A review of the evidence | More than 10 years out of date | |
| Expanding health insurance coverage in vulnerable groups: a systematic review of options | Addressed by Jia 2014 | |
| Community accountability at peripheral health facilities: a review of the empirical literature and development of a conceptual framework | Major limitations | |
| Private versus public strategies for health service provision for improving health outcomes in resource‐limited settings | Major limitations | |
| Comparison of tiered formularies and reference pricing policies: a systematic review | Addressed by Acosta 2014 | |
| Rural retention of human resources for health | Addressed by Grobler 2015 | |
| Can working with the private for‐profit sector improve utilization of quality health services by the poor? A systematic review of the literature | Major limitations | |
| Systematic review of the links between human resource management practices and performance | Major limitations | |
| Strategies for engaging the private sector in sexual and reproductive health: how effective are they? | More than 10 years out of date | |
| Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence | Addressed by Flodgren 2011 | |
| Community participation in rural primary health care: intervention or approach? | Addressed by Nilsen 2010 | |
| Impact of pharmaceutical prior authorisation policies: a systematic review of the literature | Addressed by Green 2010 | |
| Ranji 2007 | Effects of rapid response systems on clinical outcomes: systematic review and meta‐analysis | Scope of the Delivery overview |
| Nurse‐led clinics as an effective service for cardiac patients: results from a systematic review | Major limitations | |
| Can interventions improve health services from informal private providers in low and middle‐income countries? A comprehensive review of the literature | Major limitations | |
| Specialty board certification and clinical outcomes: the missing link | More than 10 years out of date | |
| Hospital ownership and financial performance: a quantitative research review | Not transferable to low‐income countries | |
| Physician dual practice: a review of literature | Addressed by Kiwanuka 2011 | |
| Improving antibiotic selection: a systematic review and quantitative analysis of quality improvement strategies | Addressed by New Reference | |
| Clinical governance in primary care: a literature review | Addressed by Phillips 2010 | |
| Examining characteristics, knowledge and regulatory practices of specialised drug shops in Sub‐Saharan Africa: a systematic review of the literature | Not a review of effects of interventions | |
| Working with the private sector for child health | More than 10 years out of date | |
| Motivation and retention of health workers in developing countries: a systematic review | Not a review of effects of interventions | |
| A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas | Addressed by Grobler 2015 |
| Review | A. Identification, selection and critical appraisal of studiesa | B. Analysisb | C. Overallc | |||||||||||
| 1. Selection criteria | 2. Search | 3. Up‐to‐date | 4. Study selection | 5. Risk of bias | 6. Overall | 1. Study characteristics | 2. Analytic methods | 3. Heterogeneity | 4. Appropriate synthesis | 5. Exploratory factors | 6. Overall | 1. Other considerations | 2. Reliability of the review | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | + | + | + | + | + | NA | + | NA | + | No | + | |
| + | ? | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | − | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | ? | + | ? | + | + | + | + | + | + | ? | + | No | + | |
| + | + | + | + | + | + | NA | NA | NA | NA | NA | NA | No | + | |
| + | + | + | + | + | + | NA | NA | NA | NA | NA | NA | No | + | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | + | + | + | + | + | + | + | + | + | No | + | |
| + | + | + | ? | + | + | + | + | + | + | + | + | No | ||
| ? | − | + | ? | + | − | ? | + | ? | + | NA | + | No | − | |
| + | ? | + | + | + | + | + | + | + | + | NA | + | No | + | |
| + | ? | + | + | + | + | NA | NA | NA | NA | NA | NA | No | + | |
| aIdentification, selection and critical appraisal of studies ‐ details of assessment criteria 1. Selection criteria: were the criteria used for deciding which studies to include in the review reported? (+ yes; ? can't tell/partially; − no) 2. Search: was the search for evidence reasonably comprehensive? (+ yes; ? can't tell/partially; − no) 3. Up‐to‐date: is the review reasonably up‐to‐date? (+ yes; ? can't tell/partially; − no) 4. Study selection: was bias in the selection of articles avoided? (+ yes; ? can't tell/partially; − no) 5. Risk of bias: did the authors use appropriate criteria to assess the risk for bias in analysing the studies that are included? (+ yes; ? can't tell/partially; − no) 6. Overall: how would you rate the methods used to identify, include and critically appraise studies? (+ only minor limitations, − important limitations) bAnalysis ‐ details of assessment criteria 1. Study characteristics: were the characteristics and results of the included studies reliably reported? (+ yes; ? can't tell/partially; − no, NA: not applicable; e.g. no studies or data) 2. Analytic methods: were the methods used by the review authors to analyse the findings of the included studies reported? (+ yes; ? can't tell/partially; − no, NA: not applicable; e.g. no studies or data) 3. Heterogeneity: did the review describe the extent of heterogeneity? (+ yes; ? can't tell/partially; − no, NA: not applicable; e.g. no studies or data) 4. Appropriate synthesis: were the findings of the relevant studies combined (or not combined) appropriately relative to the primary question the review addresses and the available data? (+ yes; ? can't tell/partially; − no, NA: not applicable; e.g. no studies or data) 5. Exploratory factors: did the review examine the extent to which specific factors might explain differences in the results of the included studies? (+ yes; ? can't tell/partially; − no, NA: not applicable; e.g. no studies or data) 6. Overall: how would you rate the methods used to analyse the findings relative to the primary question addressed in the review? (+ only minor limitations, − important limitations) cOverall ‐ details of assessment criteria 1. Other considerations: are there any other aspects of the review not mentioned before which lead you to question the results? 2. Reliability of the review: based on the above assessments of the methods how would you rate the reliability of the review? (+ only minor limitations, − important limitations) | ||||||||||||||
| Governance arrangement | Key messages |
| Authority and accountability for health policies | |
| Interagency collaboration | ➡ Local interagency collaborative interventions may lead to little or no difference in physical health and quality of life compared with standard care. ➡ It is uncertain whether local interagency collaborative interventions decrease mortality or mental health symptoms. ➡ This review did not include any evidence from low‐income countries. |
| Decision‐making about what or who is covered by health insurance ‐ Restrictions on drug reimbursement | ➡ Restrictions on reimbursement in health insurance systems with substantial coverage for medicines probably decreases targeted drug use and expenditures on targeted drugs or drug classes. ➡ The effects of restrictions on reimbursement vary by drug and drug class, and by how the restrictions are implemented and enforced. ➡ The impacts of restrictions on health outcomes and health service utilisation are uncertain. ➡ All the studies were done in high‐income countries and participants were mainly senior citizens or low‐income adult populations whose medications were being paid for in whole or part through publicly funded drug benefit plans. ➡ There are no studies on the effect of reimbursement restrictions on equity. |
| Policies to reduce corruption | ➡ It is uncertain if prevention, detection or response interventions reduce healthcare fraud and abuse and related expenditures. ➡ None of the included studies took place in a low‐income country. |
| Authority and accountability for organisations | |
| Contracting out | ➡ Contracting out services to non‐state not‐for‐profit providers may increase access to and utilisation of health services. ➡ Patient outcomes may be improved and household health expenditures reduced by contracting out. ➡ None of the included studies presented evidence on whether contracting out was more effective than making a similar investment in the public sector. We are therefore uncertain of the effects of investing in contracting out compared to an equivalent investment in public sector health services. |
| Multi‐institutional arrangements ‐ Social franchising | ➡ We found no evidence regarding the effects of social franchising on access to or the quality of health services in low‐ and middle‐income countries. We are therefore uncertain of the effects of social franchising. ➡ There is a need for well‐designed experimental studies that are informed by the theoretical and empirical literature. |
| Authority and accountability for commercial products | |
| Registration ‐ Drugs | ➡ Certain regulatory measures, specifically drug registration, may decrease the prevalence of counterfeit and substandard drugs. It is uncertain whether licensing of drug outlets reduces the prevalence of counterfeit drugs or the failure rates of drugs undergoing quality testing. ➡ WHO prequalification of drugs may lead to a reduction in the failure rates of drugs undergoing quality testing. ➡ Multifaceted interventions (including a mix of regulations, training of inspectors, public‐private collaborations and legal actions against counterfeiters) may be effective in decreasing the prevalence of counterfeit and substandard drugs. ➡ All studies identified took place in low‐ and middle‐income countries. ➡ The transferability of the findings may be influenced by a country's existing pharmaceutical supply chain and infrastructure, the availability of routine data on drug quality, qualified and skilled personnel, and financial resources. |
| Pricing and purchasing policies ‐ Drugs | ➡ Reference pricing may reduce insurers' cumulative drug expenditures by shifting drug use from cost‐share drugs to reference drugs. ➡ Index pricing may increase the use of generic drugs, reduce the use of brand‐name drugs, slightly reduce the price of generic drugs, and have little or no effect on the price of brand‐name drugs. ➡ It is uncertain whether maximum pricing affects drug expenditures. ➡ The effects of these policies on healthcare utilisation or health outcomes is uncertain. ➡ None of the included studies took place in a low‐income country. ➡ The effects of other pharmaceutical pricing and purchasing policies are uncertain. |
| Marketing regulations ‐ Drugs | ➡ Direct‐to‐consumer advertising increases patient demand for advertised medicines and the number of related prescriptions by doctors. ➡ We found no studies that reported on the impact of direct‐to‐consumer advertising on health outcomes. We are therefore uncertain of their effects. ➡ In light of the lack of evidence of the benefits, potential harms, and costs of direct‐to‐consumer advertising: ‐ the value of policies that allow for the increased use of direct to consumer advertising is uncertain at best; and ‐ rigorous monitoring and evaluation are warranted if such policies are implemented. |
| Authority and accountability for health professionals | |
| Training and licensing ‐ Pre‐licensure education | ➡ There is little evidence of the effects of interventions to increase the capacity of health professional training institutions, reduce student dropout rates or increase the number of students recruited from other countries into health professional training institutions. ➡ Academic advising programmes for minority groups may: ‐ increase the number of minority students enrolled in health sciences; ‐ slightly increase retention through to graduation; ‐ decrease differences in retention levels through to graduation between minority and non‐minority students in the health sciences. ➡ We found no studies of the effects of other pre‐licensure measures to increase health worker supply. |
| Training and licensing ‐ Training district health system managers | ➡ Private contracting ("contracting in") of district health managers compared to direct employment by the Ministry of Health may improve access and utilisation of healthcare. It is uncertain whether contracting in improves health outcomes. ➡ Intermittent training programmes may increase knowledge of planning processes and monitoring and evaluation skills of district managers. ➡ The effects of other interventions are uncertain, including changes in how district managers are hired, strategies for retaining district managers such as making the positions more attractive, and other training programmes such as in‐service workshops with onsite support. |
| Recruitment and retention strategies | ➡ It is uncertain whether any of the following types of interventions to recruit or retain health professionals increase the number of health professionals practising in in underserved areas ‐ Educational interventions (e.g. student selection criteria, undergraduate and postgraduate teaching curricula, exposure to rural and urban underserved areas) ‐ Financial interventions (e.g. undergraduate and postgraduate bursaries or scholarships linked to future practice location, rural allowances, increased public sector salaries) ‐ Regulatory strategies (e.g. compulsory community service, relaxing work regulations imposed on foreign medical graduates who are willing to work in rural or urban underserved areas) ‐ Personal and professional support strategies (e.g. providing adequate professional support and attending to the needs of the practitioners family) |
| Recruitment and retention strategiesRockers 2013 | ➡ Private contracting ("contracting in") of district health managers compared to direct employment by the Ministry of Health may improve access and utilisation of healthcare. It is uncertain whether contracting in improves health outcomes. ➡ Intermittent training programmes may increase knowledge of planning processes and monitoring and evaluation skills of district managers. ➡ The effects of other interventions are uncertain, including changes in how district managers are hired, strategies for retaining district managers such as making the positions more attractive, and other training programmes such as in‐service workshops with onsite support. |
| Movement of health workers between public and private organisations | ➡ No rigorous studies have evaluated the effects of interventions to manage the movement of health workers between public and private organisations. ➡ There is a need for well‐designed studies to evaluate the impact of interventions that attempt to regulate health worker movement between public and private organisations in low‐income countries. |
| Emigration and immigration policies | ➡ Lowering immigration restrictions in high‐income countries probably increases the migration of nurses from low‐ and middle‐income countries to high‐income countries. The effectiveness of interventions implemented in low‐ and middle‐income countries to decrease the emigration of health professionals is uncertain. No studies were found that evaluated such interventions. ➡ Low‐ and middle‐income countries should monitor changes in high‐income countrie immigration legislation, model the impact of proposed migration changes on their own retention of domestic health professionals, and lobby for immigration laws in high‐income countries that consider the health system needs of source countries. ➡ Rigorous studies are needed of the effectiveness of interventions designed to decrease the emigration of health professionals, particularly the effectiveness of interventions in low‐ and middle‐income countries. |
| Dual practice | ➡ No studies met the inclusion criteria for the review, as no rigorous studies have evaluated the effects of interventions to manage dual practice. ➡ There is a need for well‐designed studies to evaluate the impact of interventions that attempt to regulate health worker dual practice in low‐income countries. |
| Authority and accountability for quality of practice ‐ Authority and accountability for quality of outpatient care ‐ Authority and accountability for quality assurance of hospital (inpatient) care | ➡ It is uncertain whether external inspection results in improved compliance with accreditation standards, improved quality of care or decreased healthcare‐acquired infection (i.e. methicillin‐resistant Staphylococcus aureus) rates in hospitals. ➡ This review found no direct evidence on the effectiveness of external inspections of compliance with standard in ambulatory settings. We are therefore uncertain of the effects in this setting. ➡ This review found no direct evidence on the effectiveness of external inspections of compliance with standards in low‐income countries. |
| Stakeholder involvement | |
| Stakeholder participation in policy and organisational decisions | ➡ Consumer consultations in developing patient information probably: ‐ facilitate the development of material that is more relevant, readable and understandable to patients; ‐ improve patient knowledge; ‐ make little or no difference in decreasing the anxieties that patients may associate with clinical procedures. ➡ Consumer interviewers may lead to small differences in the results of satisfaction surveys compared to healthcare professional interviewers. ➡ It is uncertain whether telephone discussions compared with face‐to‐face meetings change consumer priorities for community health goals. ➡ Consumer consultation in the development of consent documents may have little or no impact on self‐reported participant understanding of the trial described in the consent document, satisfaction with study participation, adherence to the protocol or refusal to participate ➡ There are good arguments for introducing consumer involvement in low‐income countries. To accomplish this: ‐ strategies to overcome barriers such as low baseline levels of social participation, organisation and education should be explored; ‐ efforts to include consumers or families of disadvantaged groups should be considered in order to achieve inclusive representation; ‐ evaluations are needed of the effects of consumer involvement on healthcare decisions and how to achieve more effective consumer involvement. |
| Community mobilisation | ➡ Women's groups practising participatory learning and action probably improve newborn survival, may improve maternal survival, may slightly reduce stillbirths, and may be a cost‐effective strategy in rural areas in low‐ and middle‐income countries. ➡ The effectiveness of women's groups may depend on participation of a substantial proportion of pregnant women, adequate supervision and support, home visits, access to care, improving the quality of care, and adequate resources. |
| Community mobilisation | ➡ Multi‐component community‐based dengue control programmes may reduce mosquito larval indices. ➡ Multi‐component community‐based dengue control programmes combined with chemical larvicides may reduce mosquito larval indices. ➡ Multi‐component community‐based dengue control programmes combined with fish and chemical larvicides may reduce mosquito larval indices. ➡ Multi‐component community‐based dengue control programmes combined with the use of crustaceans that eat mosquito larvae (Mesocyclops copepods) may reduce mosquito larval indices. ➡ It is uncertain whether multi‐component community‐based dengue control programmes combined with the use of crustaceans that eat mosquito larvae (Mesocyclops copepods) reduce dengue incidence. ➡ Most studies took place in low‐ and middle‐income countries. |
| Patient information ‐ Public disclosure of performance data | ➡ Public disclosure of performance for health plans: ‐ may lead to patients selecting health plans that have better quality ratings; ‐ has uncertain effects on quality improvement activities; ‐ may slightly improve health outcomes. ➡ Public disclosure of performance for hospitals: ‐ may lead to little or no difference in patient selection of hospitals; ‐ probably stimulates quality improvement activities; ‐ may improve health outcomes. ➡ Public disclosure of performance for individual healthcare providers: ‐ probably leads to patients selecting providers that have better quality ratings; ‐ has uncertain effects on quality improvement activities; ‐ may improve health outcomes. ➡ All of the included studies took place in high‐income countries. ‐ Public disclosure of performance may be difficult to implement in low‐income countries because of limitations of the ability of health facilities and providers to produce accurate data, the capacity to disseminate the data, the ability of patients to interpret the data and, in some places, the lack of choice available in terms of facilities or providers. |
| Direction of effects and certainty of the evidencea | |||||||||
| Governance arrangement | Patient outcomes | Access, coverage, utilisation | Quality of care | Resource use | Social outcomes | Impacts on equity | Health care provider outcomes | Adverse effects b | Other |
| Authority and accountability for health policies | |||||||||
| Interagency collaboration | ? ⊕⊖⊖⊖ ∅⊕⊕⊖⊖c | NR | NR | NR | ∅⊕⊕⊖⊖d | NR | NR | NR | NR |
| Decision‐making about what is covered by health insurance – restrictions on drug reimbursement | ? ⊕⊖⊖⊖e | ✔⊕⊕⊕⊖f | NR | ✔⊕⊕⊕⊖f | NR | NR | NR | NR | NR |
| Policies to reduce corruption – fraud detection and response actions | NR | NR | NR | ?⊕⊖⊖⊖g | NR | NR | NR | NR | NR |
| Authority and accountability for organisations | |||||||||
| Contracting out – to non‐state not‐for–profit providers | ✔⊕⊕⊖⊖h | ✔⊕⊕⊖⊖i | NR | NR | NR | NR | NR | NR | NR |
| Multi‐institutional arrangements – social franchising | NS | NS | NS | NS | NS | NS | NS | NS | NS |
| Authority and accountability for commercial products | |||||||||
| Registration – drugs | NR | NR | NR | NR | NR | NR | NR | NR | ✔⊕⊕⊖⊖j |
| Pricing and purchasing policies – medicines – reference pricing | NR | ✔⊕⊕⊖⊖k | NR | ✔⊕⊕⊖⊖k | NR | NR | NR | NR | NR |
| Pricing and purchasing policies – medicines – index pricing | NR | ✔⊕⊕⊖⊖l | NR | ∅⊕⊕⊖⊖m | NR | NR | NR | NR | NR |
| Marketing regulations – medicines direct‐to‐consumer advertising | NS | ✔✕⊕⊕⊕⊕n | NR | NS | NR | NR | NR | NR | NR |
| Authority and accountability for health professionals | |||||||||
| Training and licensing – pre‐licensure education – minority academic advising programme | NR | NR | NR | NR | NR | ✔⊕⊕⊖⊖o | NR | NR | NR |
| Training and licensing – manager training programme versus no training | NR | NR | NR | NR | NR | NR | NR | NR | ✔⊕⊕⊖⊖p |
| Recruitment and retention strategies – health professionals in underserved areas | NS | NS | NS | NS | NS | ?⊕⊖⊖⊖q | NS | NS | NS |
| Recruitment and retention strategies – private versus public contracts of district health managers | ?⊕⊖⊖⊖r | ✔⊕⊕⊖⊖r | NR | NR | NR | NR | NR | NR | NR |
| Movement of health workers between public and private organisations | NS | NS | NS | NS | NS | NS | NS | NS | NS |
| Emigration and immigration policies – reducing immigration restrictions | NS | ✕⊕⊕⊕⊖s | NS | NS | NR | NR | NR | NR | NR |
| Dual practice | NR | NS | NS | NS | NS | NS | NS | NR | NR |
| Authority and accountability for quality of practice – authority and accountability for quality of outpatient care – external inspection | NS | NS | ? ⊕⊖⊖⊖t | NR | NR | NR | NS | NR | NR |
| Stakeholder involvement | |||||||||
| Stakeholder participation in policy and organisational decisions – communication forums | NS | NS | NS | NS | NS | NS | NS | NS | ? ⊕⊖⊖⊖u |
| Stakeholder participation in policy and organisational decisions – consumer involvement in research | NS | NS | ✔⊕⊕⊖⊖v | NS | NS | NS | NS | NS | ∅⊕⊕⊖⊖w |
| Stakeholder participation in policy and organisational decisions – consumer involvement in preparing patient information | ∅⊕⊕⊕⊖x | NS | NS | NS | NS | NS | NS | NS | ✔⊕⊕⊕⊖y |
| Community mobilisation – women's groups practising participatory learning and action | ✔⊕⊕⊖⊖z ✔⊕⊕⊕⊖aa | NS | NS | NS | NS | NS | NS | NS | NS |
| Community mobilisation – community‐based dengue control | ✔⊕⊕⊖⊖bb ✔⊕⊕⊖⊖cc ? ⊕⊖⊖⊖dd | NS | NS | NS | NS | NS | NS | NS | NS |
| Patient information – public disclosure of performance data – health plans | ∅⊕⊕⊖⊖ee | ✔⊕⊕⊖⊖ff | NS | NS | NS | NS | NS | NS | NS |
| Patient information – public disclosure of performance data – hospitals | ✔⊕⊕⊖⊖gg | ✔⊕⊕⊖⊖hh | ✔⊕⊕⊕⊖ii | NS | NS | NS | NS | NS | NS |
| Patient information – public disclosure of performance data –individual healthcare providers | ✔⊕⊕⊖⊖jj | ✔⊕⊕⊕⊖kk | NS | NS | NS | NS | NS | NS | NS |
| The certainty of the evidence is an assessment of how good an indication the research provides of the likely effect; i.e. the likelihood that the effect will be substantially different from what the research found. By 'substantially different' we mean a large enough difference that it might affect a decision. These judgements are made using the GRADE system and the following definitions. | |||||||||
| Ratings | Definitions | Implications | |||||||
| ⊕⊕⊕⊕ High | This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different is low. | This evidence provides a very good basis for making a decision about whether to implement the intervention. Impact evaluation and monitoring of the impact are unlikely to be needed if it is implemented. | |||||||
| ⊕⊕⊕⊖ Moderate | This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different is moderate. | This evidence provides a good basis for making a decision about whether to implement the intervention. Monitoring of the impact is likely to be needed and impact evaluation may be warranted if it is implemented. | |||||||
| ⊕⊕⊖⊖ Low | This research provides some indication of the likely effect. However, the likelihood that it will be substantially different is high. | This evidence provides some basis for making a decision about whether to implement the intervention. Impact evaluation is likely to be warranted if it is implemented. | |||||||
| ⊕⊖⊖⊖ Very low | This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different is very high. | This evidence does not provide a good basis for making a decision about whether to implement the intervention. Impact evaluation is very likely to be warranted if it is implemented. | |||||||
| a✓: a desirable effect; ∅: little or no effect; ?: an uncertain effect; ✕: an undesirable effect; NS: no studies found by this review that reported this outcome; NR: outcome not reported by this review. | |||||||||
| Interventions found to have desirable effects on at least one outcome with moderate‐ or high‐certainty evidence and no moderate‐ or high‐certainty evidence of undesirable effects |
| Authority and accountability for health policies |
| Decision‐making about what is covered by health insurance
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| Authority and accountability for commercial products |
| Marketing regulations
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| Stakeholder participation in policy and organisational decisions |
| Community mobilisation
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| Patient information
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| Interventions for which the certainty of the evidence was low or very low (or no studies were found) for all outcomes examined |
| Authority and accountability for health policies |
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| Authority and accountability for organisations |
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| Authority and accountability for commercial products |
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| Authority and accountability for health professionals |
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| Stakeholder participation in policy and organisational decisions |
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| aFor this intervention, the direction of the effect depends on the medicine. For instance, for essential medicines this may be a desirable effect (and is therefore listed as such above) but for non‐essential medicines this may be a undesirable effect. |
