Implementation strategies for health systems in low‐income countries
Citation: Pantoja T, Opiyo N, Lewin S, et al. Implementation strategies for health systems in low‐income countries: an overview of systematic reviews. Cochrane Database of Systematic Reviews. 2017;(9):CD011086.
Language: Abstract available in EN / ES / Thai / Persian. Full text available in EN.
Free to view: Yes.
Funding sources: The Effective Health Care Research Consortium.
What is this? A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions is low in low‐income countries.
In this Cochrane overview of systematic reviews, the authors searched for systematic reviews on the effects of implementation strategies for health systems in low-income countries. The authors did not restrict their searches by language or date of publication and did the search on 17 December 2016. They included 39 systematic reviews. They also identified 5 ongoing reviews of implementation strategies and 6 additional systematic reviews that are awaiting assessment.
What works: Educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions are useful implementation strategies targeted at healthcare workers.
Training healthcare workers to be more patient centred in clinical consultations; use of birth kits; clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings; and in-service neonatal emergency care training improve professional practice and healthcare outcomes.
Mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; community based health education, and reminders and recall strategies to increase vaccination uptake or patients being treated for active tuberculosis; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion); health insurance information and application support are effective intervention strategies when targeted at healthcare recipients.
What doesn’t work: Educational meetings may not be effective for complex behaviours.
What is uncertain: The effects on their knowledge of teaching critical appraisal skills to health professionals were uncertain.
It was uncertain whether safety checklists improve adherence to guidelines or patient safety in intensive care units, emergency departments or acute care settings.
It is uncertain whether tailored interventions are more likely to improve professional practice than non-tailored interventions.
It was uncertain whether multifaceted interventions, such as training and workshops, improve informed decision-making by healthcare workers in low-income countries.
Implications: The authors of the review stated that the limitations in available evidence include wide variations in settings, targeted behaviours, estimates of effects, and certainty of the evidence for the implementation strategies examined. They also stated that further research is needed to evaluate social outcomes, resource use, impacts on equity and adverse effects.
Other considerations: The authors of the review discuss their findings in the context of pregnant women, children aged under five, place of residence and socioeconomic status.
This summary was prepared by Ana Pizarro, edited by Firas Khalid, and finalized by Mike Clarke.