Financial arrangements for health systems in low-income countries: an overview of systematic reviews

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Wiysonge CS1, Herrera CA2, Ciapponi A3, Lewin S4, Garcia Marti S3, Opiyo N5, Oxman AD4, Pantoja T6, Paulsen E4, Peñaloza B6, Rada G7
1Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, 2Department of Public Health, Evidence Based Health Care Program, Pontificia Universidad Católica de Chile, Santiago, Chile, 3Instituto de Efectividad Clínica y Sanitaria - IECS, Benos Aires, Argentina, 4Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway, 5Child and Newborn Health Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya, 6Department of Family Medicine, Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, 7Department of Internal Medicine, Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

Background:

This is one of four overviews of systematic reviews (SRs) of strategies for improving health systems in low-income countries (LIC), including delivery, financial and governance arrangements and implementation strategies.

Objectives:

- Provide a broad overview of what is known about the effects of financial arrangements (Table 1) for health systems in LIC based on the findings of up-to-date SRs.

- Identify needs and priorities for SRs and evaluations of alternative financial arrangements.

Methods:

We included SRs that:

- had a methods section, explicit selection criteria and not important limitations affecting the reliability of its findings;

- assessed the effects of financial arrangements;

- reported any of the following types of outcomes: patient outcomes, 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 collaboration tools) that met 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 13 SRs, extracted and summarized key messages from those reviews, identified needs for new/updated SRs and identified needs for new studies.