The most effective health measures for low- and middle-income countries were compiled and analyzed by Cochrane researchers

/ NewsENG2 / By

September 2017

COCHRANE COMMUNICATION

 La best scientific evidence on health policies in middle and especially low income countries was compiled by a special group of Cochrane researchers and it is now available. These are panoramic reviews (review of reviews) that were carried out by COCHRANE researchers from Argentina, Chile, Norway and South Africa and that include easy-to-read summaries, which are accessed in http://supportsummaries.org/. The material constitutes a valuable input for health decision-makers (as well as for their support staff and other interested parties), as it allows them to quickly identify what the more effective and secure policies around four key themes:

From these documents it emerges almost 500 key messages about what the expected effects of implementing different interventions in health systems may be.

This work is a enormous contribution to strengthening health systems in low-income countries, a fundamental aspect to achieve the universal health coverage and reach the Sustainable Development Goals related to health, since achieving these objectives implies making informed decisions about health systems.

One of the strengths of this work is that in addition to identify strategies to address issues related to how health systems are organized, financed and governed, notes effective strategies to implement them and Identify those measures that do not work.

On the other hand, it can help identify needs and priorities to undertake new evaluations and systematic reviews of health systems management forms. 

MAIN CONCLUSIONS

  • The review on the ways in which health care is organized and provided included 50 systematic reviews that in turn included a total of 919 studies. These reviews found positive effects of interventions such as task replacement, role expansion of various health professions, and care coordination strategies.
  • The review on the financial organization of health systems used 15 systematic reviews and 276 studies. The effectiveness of most forms of financial organization reviewed was uncertain. Measures such as providing financial incentives and disincentives to health workers and the effects that such incentives and disincentives have on people using health services were evaluated.
  • The review of the forms of Governance included 21 systematic reviews and 172 studies. He found that restrictions on drug reimbursement (pre-authorization), community mobilization, and public disclosure of facility performance data are likely to have the desirable impact.
  • The review on the implementation strategies It involved 39 systematic reviews and 1332 studies. They found that many implementation strategies (such as educational meetings, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions) can improve professional practice. Other strategies targeting healthcare beneficiaries also demonstrated desirable effects on healthcare use. Two examples of positive impact are: media interventions, which lead to an increase in immediate uptake of HIV testing, and immunization reminders to caregivers of children, which would increase the uptake of mandatory childhood vaccination.

TEXTUAL FROM THE RESEARCHERS, CO-AUTHORS OF THE REVIEWS

  • Simon Lewin, co-coordinator of the Cochrane COPD Group: “These panoramic reviews are a key source of evidence for decision makers in low-income countries who are considering options to strengthen the health system in their area of ​​action. “The panoramic reviews use a unique approach, based on simple summaries of each included review, and we hope this will make the identified evidence much more accessible to decision makers and their support teams.”
  • Andy Oxman, senior researcher at the Norwegian Institute of Public Health: “These panoramic reviews demonstrate that there is a large body of evidence that can inform decisions about health systems in low-income countries. On the other hand, they show that there are many important gaps in what is known. In addition to using the evidence identified in these summaries to inform their decisions, health policymakers and their support teams should consider rigorously evaluating the effects of decisions to change ways of managing the health system when there are uncertainties. important about benefits and harms.
  • Gabriel Rada, co-founder of the Epistemonikos Foundation, the entity that developed the technological support for this project: “It's really exciting to see these panoramic reviews published. Summarizing such a broad area and presenting the findings in a way that is accessible to health systems decision makers requires an enormous effort in terms of technological development and capacity building. In these days of information overload, it is common for researchers to be pragmatic and less ambitious. Those responsible for the project in this case do not lose hope. I am confident that these panoramic reviews, as well as the friendly summaries that accompany each review, will make an important contribution in this area.”
  • Tomás Pantoja, associate professor at the Pontifical Catholic University of Chile: “Summarizing this large body of evidence was an enormous challenge addressed by the collaborative work of a diverse group of enthusiastic researchers in close contact with networks of decision-makers and other potential users of the overviews. This, in some ways, shaped the way the information was organized and presented. An example of this is the 'layered' approach used, in which you can go as deep as you need with respect to the details of the results of each comparison, using only the key messages or go beyond the summary table of specific findings or detailed conclusions of a specific review.
  • Agustín Ciapponi, general director of Cochrane Argentina and the Cochrane IECS center: “This collaborative project provided a comprehensive overview of the effects of forms of health systems management in low-income countries. It is a strong message that urges health decision-makers to cover the gaps that exist between scientific evidence and decision-making. Covering these gaps is essential to improve the health of the population.”
  • Cristian A. Herrera, co-author of reviews and current head of the Planning Division of the Chilean Ministry of Health: “In planning by the Chilean Ministry of Health, it is noted that decision-making at all levels can and should be based on evidence. In real life, many factors influence management and policy-making processes. These reviews provide a significant contribution to knowledge and can be used to shape decisions in health systems in low-income countries. The challenge that we face now is to efficiently connect this immense scientific evidence with the main decision-makers and other social actors, as well as to cover certain 'gaps' of knowledge that are of utmost relevance for health systems.”
  • Charles Shey Wiysonge, director of Cochrane South Africa: “These studies come at an opportune time, when African countries are considering the best approaches to achieving universal health coverage. The panoramic review and plain language summaries of evidence are important resources for engagement and constructive exchange between Cochrane Africa and national actors relevant to health decision-making on the African continent.”