Article type
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Abstract
Background: We have conducted four Effective Practice & Organisation of Care (EPOC) overviews of systematic reviews (SRs) of interventions for improving health systems in low-income countries (LICs), including delivery, financial and governance arrangements and implementation strategies. Our objectives were to: 1) provide a broad overview of what is known about the effects of health systems interventions in LICs based on the findings of up-to-date SRs; and 2) identify priorities for new SRs and primary research of such interventions.
Objectives: To reflect on the overall findings and lessons learnt from conducting four overviews of systematic reviews of strategies for improving health systems in LICs.
Methods: We used structured discussions to identify the key challenges and lessons from conducting the overviews. These discussions took place during face-to-face and online meetings over a 24-month period (March 2013 to March 2015).
Results: The four overviews will be published in the Cochrane Library in 2015, and structured summaries of the included reviews will be available at www.supportsummaries.org. The overviews summarize a very substantial body of evidence from Cochrane and non-Cochrane reviews on the effects of interventions for improving health systems. However, there are important differences in the extent of the available evidence across the four overviews, with substantially less evidence available for governance and financial arrangements. Synthesizing the findings of overlapping reviews of the same intervention was challenging. Also, for many comparisons the evidence is of low or very low certainty (mainly due to risk of bias and inconsistency), and for many interventions there are few data on equity outcomes, resource use or unintended consequences.
Conclusions: The overviews are an important resource for evidence-informed decision making on health systems in LICs. They are also a resource for identifying important gaps in the body of evidence for this field and have informed priorities for new reviews and research.
Objectives: To reflect on the overall findings and lessons learnt from conducting four overviews of systematic reviews of strategies for improving health systems in LICs.
Methods: We used structured discussions to identify the key challenges and lessons from conducting the overviews. These discussions took place during face-to-face and online meetings over a 24-month period (March 2013 to March 2015).
Results: The four overviews will be published in the Cochrane Library in 2015, and structured summaries of the included reviews will be available at www.supportsummaries.org. The overviews summarize a very substantial body of evidence from Cochrane and non-Cochrane reviews on the effects of interventions for improving health systems. However, there are important differences in the extent of the available evidence across the four overviews, with substantially less evidence available for governance and financial arrangements. Synthesizing the findings of overlapping reviews of the same intervention was challenging. Also, for many comparisons the evidence is of low or very low certainty (mainly due to risk of bias and inconsistency), and for many interventions there are few data on equity outcomes, resource use or unintended consequences.
Conclusions: The overviews are an important resource for evidence-informed decision making on health systems in LICs. They are also a resource for identifying important gaps in the body of evidence for this field and have informed priorities for new reviews and research.