Strategies for improving health systems in low-income countries: lessons learnt from four overviews of systematic reviews of health systems interventions

2015 Vienna

Pantoja T¹, Opiyo N², Ciaponni A³, Herrera C⁴, Lewin S⁵, Oxman A⁵, Paulsen E⁵, Rada G⁶, Wiysonge C⁷

¹Pontificia Universidad Catolica de Chile, Cochrane EPOC Group, Chile

²Child and Newborn Health Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kenya

³Argentine Cochrane Centre IECS, Institute for Clinical Effectiveness and Health Policy, Argentina

⁴Department of Public Health, Evidence Based Health Care Program, Pontificia Universidad Católica de Chile, Chile

⁵Global Health Unit, Norwegian Knowledge Centre for the Health Services, Norway

⁶Department of Internal Medicine, Evidence-Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Chile

⁷Centre for Evidence-Based Health Care, Stellenbosch University, South Africa

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.