Synthesizing health systems evidence: The contribution of a network based on North-South collaboration

Article type
Authors
Koehlmoos T1, Pantoja T2, Kiwanuka S3, Meng Q4, Oxman A5, Oliver S6, Garner P7, Bennett S8, Ransom M9
1ICDDR, B, Bangladesh
2Escuela de Medicina, Pontificia Universidad Católica de Chile
3School of Public Health, Makerere University, Uganda
4Center for Health Management and Policy, Shandong University, China
5EPOC satellite for low and middle income countries, Norwegian Knowledge Centre for the Health Services
6EPPI-Centre, Institute of Education, UK
7Liverpool School of Tropical Medicine, UK
8Bloomberg School of Public Health, Johns Hopkins University, USA
9Alliance for Health Policy & Systems Research, World Health Organization, Switzerland
Abstract
Background: In 2007, a dearth of systematic reviews focused on, and review teams who were capable of, synthesizing health systems evidence to improve health and decision making in low- and middle-income countries (LMICs) led the Alliance for Health Policy & Systems Research (HPSR) to create a network of Centres for Systematic Review (CSRs) focusing on health finance, human resources, the non-state sector, and the advancement of HPSR synthesis methodology.

Methods: After competitive bids, CSRs were established in Bangladesh, China, Chile and Uganda. Support for capacity building was provided by the Cochrane Effective Practice and Organization of Care Group, the EPPI-Centre and the Cochrane Infectious Diseases Group. The CSRs participated in two workshops, multiple individual training activities, and long-distance mentoring.

Results: In four years the network produced more than twelve systematic reviews on priority topics including Cochrane reviews on dual practice, social franchising, and community health insurance, and more than ten presentations at high-profile international fora. Teams identified methodological challenges in the field and collected resources to address them. CSR members contribute to the global review community by serving as editors within the Cochrane and Campbell Collaborations and on The Cochrane Library Oversight Committee. They facilitate capacity building and extensive engagement with policy makers in their home countries and regions. The Pan-American Health Organization (PAHO) recognized one CSR-produced Cochrane protocol on emigration policy as the most policy-relevant protocol for the Health Agenda for the Americas in 2010.

Conclusions: LMIC-based review teams mastered an array of review skills but more importantly pioneered new methodology, expanded capacity building networks, facilitated knowledge translation within their settings and contributed actively to the global synthesis movement. Maintaining this capacity requires sustainable funding for individuals and organizations but also investment in information, communication and technology to support partnerships and rapid access to synthesized evidence.