Abstract
BackgroundWhile there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries.MethodsWe searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.’s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis.Results292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category.ConclusionsThis scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps.
Highlights
While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide
We used the framework developed by van Olmen and colleagues [7] to address the following research questions: What kind of research has been conducted on HS challenges? Where has this research been conducted, in which health sectors and on which populations? What types of challenge have been documented? To what extent do the reported challenges vary across countries? having a better grasp on this international literature could help identify key priorities for HS improvement and knowledge gaps that call for scholarly attention
Search strategy: Identification of databases and relevant articles We sought to strike a balance between breadth and comprehensiveness, and developed our bibliographic search strategy in two steps: firstly, we identified a set of articles (n = 43) that represented good examples of the papers we were looking for, that is peer-reviewed articles that examined the challenges, problems, priorities or needs of HSs
Summary
While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature It determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. A mother caring for a sick child at home; private providers; behaviour change programmes; vectorcontrol campaigns; health insurance organizations; occupational health and safety legislation It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well-known determinant of better health [1]. Evidence regarding the needs and challenges of HSs is scattered across multiple scientific journals, in a format that remains not accessible to policymakers and to those engaged in the development of health innovations
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