Article type
Year
Abstract
Background:
This is one of four overviews of systematic reviews (SRs) of strategies for improving health systems in low-income countries (LIC) for delivery, financial and governance arrangements and implementation strategies.
Objectives:
To:
-provide a broad overview of what is known about the effects of delivery arrangements (Table 1) for health systems in LIC from findings of up-to-date SRs.
-identify needs and priorities for SRs and evaluations of alternative delivery arrangements.
Methods:
We included SRs that:
-have a methods section, explicit selection criteria and not important limitations affecting the reliability of findings.
-assess the effects of delivery arrangements
-report any of the following types of outcomes: patient outcomes, the quality or utilisation of healthcare services, resource use, healthcare provider outcomes, or social outcomes
-were published within the past 10 years
-are relevant to LIC (or lower-middle-income according to the World Bank classification)
In March 2013 we screened SRs in PDQ-Evidence (www.pdq-evidence.org), a database of SR about health systems. Two authors independently screened titles/abstracts to identify eligible SRs (AO & SL screened the titles and abstracts that could not be confidently included/excluded after the first screening). One author screened the focused searches described above. One author applied the selection criteria to the full text of potentially eligible SRs and assessed the reliability of SRs (using SUPPORT and SURE collaborations tools) that meet all of the other selection criteria (these judgments were checked independently by AO or SL). The certainty of the evidence was assessed using the GRADE approach. We summarised SRs using an approach developed by the SUPPORT Collaboration (www.supportsummaries.org) that includes the preparation of summary of findings tables for the main comparisons in each SR. SUPPORT Summaries are peer-reviewed and published on SUPPORT open access website.
Results:
We included 55 SRs of delivery arrangements, extracted and summarized key messages from those reviews, identified needs for new/updated SRs and identified needs for new studies.
This is one of four overviews of systematic reviews (SRs) of strategies for improving health systems in low-income countries (LIC) for delivery, financial and governance arrangements and implementation strategies.
Objectives:
To:
-provide a broad overview of what is known about the effects of delivery arrangements (Table 1) for health systems in LIC from findings of up-to-date SRs.
-identify needs and priorities for SRs and evaluations of alternative delivery arrangements.
Methods:
We included SRs that:
-have a methods section, explicit selection criteria and not important limitations affecting the reliability of findings.
-assess the effects of delivery arrangements
-report any of the following types of outcomes: patient outcomes, the quality or utilisation of healthcare services, resource use, healthcare provider outcomes, or social outcomes
-were published within the past 10 years
-are relevant to LIC (or lower-middle-income according to the World Bank classification)
In March 2013 we screened SRs in PDQ-Evidence (www.pdq-evidence.org), a database of SR about health systems. Two authors independently screened titles/abstracts to identify eligible SRs (AO & SL screened the titles and abstracts that could not be confidently included/excluded after the first screening). One author screened the focused searches described above. One author applied the selection criteria to the full text of potentially eligible SRs and assessed the reliability of SRs (using SUPPORT and SURE collaborations tools) that meet all of the other selection criteria (these judgments were checked independently by AO or SL). The certainty of the evidence was assessed using the GRADE approach. We summarised SRs using an approach developed by the SUPPORT Collaboration (www.supportsummaries.org) that includes the preparation of summary of findings tables for the main comparisons in each SR. SUPPORT Summaries are peer-reviewed and published on SUPPORT open access website.
Results:
We included 55 SRs of delivery arrangements, extracted and summarized key messages from those reviews, identified needs for new/updated SRs and identified needs for new studies.