Implications For Health Systems Research Articles

Assessing public health sector performance in Bangladesh: Implications for health systems strengthening and universal health coverage - A secondary data analysis.

The Ministry of Health and Family Welfare has established a health systems strengthening initiative for measuring the performance of public sector health facilities in Bangladesh. The objective of the performance management initiative is to establish routine systems for measuring and scoring health facility performance and promote best practices in public health service management. The performance initiative includes a set of assessments conducted across the four tiers of the public health sector. The findings of assessments demonstrate improvements in the quality of health services and a sharp increase in the utilisation of services across all tiers during the period 2017-2019. The performance management initiative has also identified areas for improvement in the supply-side health system readiness, including ensuring an adequate supply of human resources, essential medicines, and functioning medical equipment and technologies. This initiative outlines the need to systematically address the issue of high health workforce vacancy rates through effective human resource planning and management strategies. The reporting of these ongoing health systems successes and challenges through the performance management initiative in Bangladesh provides an opportunity to develop evidence-based policy reforms for strengthening supply-side health systems. The initiative results, particularly in the context of growing public demand for services, also justifies a monitoring and evaluation mechanism focusing on the quality and coverage of frontline health facilities and the development of more integrated health systems. The performance management initiative will facilitate the maintenance of essential health services while addressing emergency health needs and tracking progress towards achieving the Universal Health Coverage goal.

An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments.

The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county. In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration. Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems. We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.

Evaluating equity of access andpredictors of minimally invasive hysterectomy for endometrial and cervical cancer from 2000 to 2017 in Ontario, Canada: A population-based cohort study.

We sought to assess the uptake of minimally invasive hysterectomy among patients with endometrial and cervical cancer in Ontario, Canada, and assess the equity of access to minimally invasive surgery (MIS) by evaluating associations with patient, disease, institutional, and provider factors. This is a retrospective population-based cohort study of hysterectomy for endometrial and cervical cancer in Ontario (2000-2017). Surgical approach, clinicopathologic, sociodemographic, institutional, and provider factors were identified through administrative databases. Fisher's exact, χ2 , Wilcoxon rank sum, logistic regression, and Cox proportional hazards modeling were used to explore factors associated with MIS. A total of 27 652 patients were included. In total, 6199/24 264 (26%) endometrial and 842/3388 (25%) cervical cancer patients received MIS. The proportion of MIS to open surgeries increased from <0.1% in 2000 to over 55% in 2017 (odds ratio [OR] = 1.31, confidence interval [CI] = 1.28-1.34). Low-income quintile, rurality, low hospital volume, nonacademic hospital, nongynecologic oncology surgeon, and earlier year of surgeon graduation were associated with reduced odds of MIS (OR < 1). The uptake of MIS hysterectomy increased steadily over the time period. Receipt of MIS is dependent upon multiple social determinants, provider variables, and systems factors. These disparities raise concern for health equity in Ontario and have significant implications for health systems planning and resource allocation.

Abstract 004: Process And Health Outcomes Of Patients With Severe Hypertension In A Real-world Setting: Findings From A 12-year Study In A Large Health System

Introduction: Health systems are increasingly leveraging real-world data to improve community health outcomes. Methods: We conducted a longitudinal assessment of health outcomes in patients with severe hypertension using electronic health record data from the Sentara Healthcare System 2010-2021. Severe hypertension was defined as at least two consecutive blood pressure (BP) readings above 160/100 mmHg. We examined follow-up visit rates at 3 and 6 months, and BP control rates (&lt;140/90 mmHg) at 6 and 12 months after the second BP elevation. We also assessed the incidence of cardiovascular disease (CVD) until the end of 2022. Results: The study included 75,657 patients with severe hypertension. Mean age was 61.5 (13.9) years; 55% were female, 57% were White, 37% were Black, and 21.3% had a history of CVD. The median follow-up time was 3.8 years. Among patients with severe hypertension, 72% and 84% had follow-up visits at 3 and 6 months; 38% and 41% achieved BP control at 6 and 12 months. Among patients without prior history of CVD, 22.5% experienced at least one cardiovascular event during the follow-up, including 8.7% with coronary arteriosclerosis, 11.9% with heart failure, 65.2% with cerebral infarction, and 3.5% with myocardial infarction. The median time to cardiovascular events was 793 days. The risk of CVD was significantly higher in Black and older patients, as well as those with blood pressure levels exceeding 180/120 mmHg. Conclusions: This study successfully identified a longitudinal digital cohort of patients with severe hypertension and linked it to health outcomes. The findings have implications for health systems utilizing real-world data in population health research.

Prevalence and genotypes distribution of virus hepatitis B and hepatitis delta virus in chronic liver diseases in Kazakhstan

BackgroundThe geographical distribution of hepatitis B virus (HBV) and hepatitis D virus (HDV) genotypes is uneven and has its own clinical and organizational implications for health systems. Despite the introduction of vaccination and successful antiviral therapy the prevalence of chronic hepatitis B (with or without delta agent) increased over the past 5 years. This study aimed for the first time to investigate the molecular epidemiology of HBV and HDV in Kazakhstan.MethodsTotal 834 chronic hepatitis B (with or without delta agent) patients were included to the study from November 2017 to June 2019. The material was collected from the regional hepatological сenters from 13 cities of Kazakhstan. Genotyping of HBV/HDV isolates was carried out using phylogenetic analysis of null-binary sequences of Kazakhstani isolates, in comparison with the reference sequences. Nucleotide sequence alignment was performed using the ClustalW algorithm, the “neighbor-joining” method was used for the construction of phylogenetic trees and subsequent analysis.ResultsOverall 341 samples were PCR-positive and genotyped for HBV. Comparison and phylogenetic analysis of nucleotide sequences of HBV isolates showed that they were represented by genotypes HBV-D (95.9%), HBV-A (3.5%) and HBV-C (0.6%). At the same time, the identity of the nucleotide sequences of Kazakhstani isolates were: HBV-D (95–100%); HBV-A (97.2–100%) and HBV-C (99%). 256 samples were PCR positive and genotyped for HDV, all of them belonged to genotype 1.ConclusionThis study describes for the first time the molecular epidemiology of HBV and HDV in Kazakhstan. The data obtained expand the knowledge of the global epidemiology of viruses; have potential implications for public health policy and for further clinical research on chronic hepatitis in Kazakhstan.Trial registrationClinicalTrials.gov NCT05095181 (registered on 27/10/2021).

Are We Ready for Whole Population Genomic Sequencing of Asymptomatic Newborns?

The introduction of genomic sequencing technologies into routine newborn screening programs in some form is not only inevitable but also already occurring in some settings. The question is therefore not "if" but "when and how" genomic newborn screening (GNBS) should be implemented. In April 2022, the Centre for Ethics of Paediatric Genomics held a one-day symposium exploring ethical issues relating to the use of genomic sequencing in a range of clinical settings. This review article synthesises the panel discussion and presents both the potential benefits of wide-scale implementation of genomic newborn screening, as well as its practical and ethical issues, including obtaining appropriate consent, and health system implications. A more in-depth understanding of the barriers associated with implementing genomic newborn screening is critical to the success of GNBS programs, both from a practical perspective and also in order to maintain public trust in an important public health initiative.

The human functioning revolution: implications for health systems and sciences

The World Health Organization (WHO) concept of human functioning represents a new way of thinking about health that has wide-ranging consequences. This article explicates this paradigm shift, illustrates its potential impact, and argues that societies can profit by implementing functioning as the third indicator of health, complementing morbidity and mortality. Human functioning integrates biological health (the bodily functions and structures that constitute a person’s intrinsic health capacity) and lived health (a person’s actual performance of activities in interaction with their environment). It is key to valuing health both in relation to individual well-being and societal welfare—operationalizing the United Nations Sustainable Development Goal (SDG) 3 principle that health is a public good. Implementing functioning as defined and conceptualized in the International Classification of Functioning, Disability and Health (ICF) could profoundly benefit practices, research, education, and policy across health systems and health strategies and help integrate health and social systems. It also offers a foundation for reconceptualizing multidisciplinary health sciences and for augmenting epidemiology with information derived from peoples’ lived experiences of health. A new interdisciplinary science field—human functioning sciences—itself holds the promise to integrate research inputs and methods from diverse biomedical and social disciplines to provide a more comprehensive understanding of human health. To realize these opportunities, we must address formidable methodological, implementation, and communication challenges throughout health systems and broader society. This endeavor is vital to orientate health systems toward what matters most to people about health, to unlock the societal economic investment in health that is essential for individual and population-level well-being, and to drive progress toward achieving the SDGs.

Level of Professional Awareness among Health Record Officers in Bayelsa State and Their Implications for Patient Care, Health Systems, and Health Policy

As Electronic health records (EHRs) become more commonplace, and are expected to play a key role in improving the quality of Nigeria health care. Thus, EHRs can improve quality of care delivery in numerous ways such as providing accurate and up-to-date patient information and medical knowledge, rapid retrieval of health information, ability to exchange health information to all authorized participants within or across organizations, automated clinical reminders, improved adherence to treatment guidelines, and accumulation of data for quality monitoring and improvement. Based on regulatory and governmental recommendations, the EHR is being adapted in an increasing number of academic institutions (NDUTH), government hospitals (FMC) and private practice settings. It is incumbent upon HIM leadership to ensure students are skillful users of the technologies that will be in place as they care for patients. The study aimed to explore, identify and understand critical awareness of electronic health records management level to ensure confidentiality in public health care sector (FMC &amp; NDUTH) in Bayelsa State, Nigeria. The cross-sectional descriptive design was used and a total of 159 health professionals who represented a variety of user groups across different specialties within the hospital completed the questionnaire. The collected data were analyzed. both descriptively and inferentially. Frequency and percentages were used to analyse the data and the result presented in tables. Data analysis was facilitated using the Statistical Package for Social Sciences (SPSS version 20.0). Majority of the respondents (90.6%) were aware of the electronic health record management among health record officers. To ensure continuity of care, it is necessary to develop educational and manageable program to improve EHR awareness. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality, confidentiality, safety of patient care and improve the chance of successful implementation.

From non-specific low back pain to chronic primary musculoskeletal low back pain: the evolving concept

Background: Low back pain (LBP) for many years is considered one of the most common conditions causing work absenteeism and long-term disability, with important implications for public health systems and economies. Pain generators of LBP are various, being distinguished specific and non-specific causative mechanisms. The term “non-specific” LBP remains ambiguous as potential sources of pain are supposed to be muscles or joints, but supplementary investigations do not correlate enough to explain the pain intensity and disability. The nociceptive and/or neuropathic mechanisms characteristic for acute pain tend to be influenced by central sensitization while pain chronification occurs, leading to new descriptor as nociplastic pain. Chronic low back pain, considered mostly non-specific, was mechanistically referred to primary musculoskeletal low back pain, the concept introduced in the new ICD-11 classification. The process of acceptance by the scientific medical community raised debates and discussions. The aim of the study was to analyze the evolving concept of non-specific low back pain to chronic primary musculoskeletal low back pain. A narrative literature review was carried out. Conclusions: The term non-specific low back pain is used when the pain generators have not been accurately determined or cannot fully explain the existing symptomatology. Chronic primary musculoskeletal low back pain is better explained by central sensitization mechanisms and altered nociception, named nociplastic pain. Because of raised ambiguities regarding this concept further studies are expected to shed light on the problem.

Through the looking glass: Confronting health care management's biggest challenges in the wake of a crisis.

The challenges brought on by the pandemic triggered a renewed scholarly focus on managing during crises. Now, 3 years on, having covered the initial crisis response, it is important to reevaluate what the crisis has taught us about health care management more generally. In particular, it is useful to consider the persistent challenges that continue to face health care organizations in the wake of a crisis. The present article aims to identify the biggest challenges that currently face health care managers in order to formulate a postcrisis research agenda. We employ an exploratory qualitative study, utilizing in-depth interviews with hospital executives and management to explore the persistent challenges facing managers in practice. Our qualitative inquiry reveals three key challenges that extend beyond the crisis and are salient for health care managers and organizations in the years to come. Specifically, we identify the centrality of human resource constraints (amidst increasing demand), the necessity of collaboration (amidst competition), and a need to reconsider the approach to leadership (utility of humility). We conclude by drawing upon relevant theories such as paradox theory to formulate a research agenda for health care management scholars that can support the creation of novel solutions and approaches to persistent challenges in practice. We identify several implications for organizations and health systems, including the need to eliminate competition and the importance of building human resource management capacities within organizations. In highlighting areas for future research, we provide organizations and managers with useful and actionable insights to address their most persistent challenges in practice.

Australian Women's Responses to Breast Density Information: A Content Analysis.

Content analysis was used to assess responses from a written questionnaire undertaken in conjunction with focus groups on BD involving 78 Australian women aged 40-74. Half the women reported that they would feel a little anxious if notified they had dense breasts, while 29.5% would not feel anxious. The most common theme (29.5%) related to anxiety was the psychosocial impact of the possibility of developing cancer, and women believed that being better informed could help with anxiety (26.9%). When asked what they would do if notified of having dense breasts, the most common response was to consult their doctor for information/advice (38.5%), followed by considering supplemental screening (23%). Consequently, when asked directly, 65.4% were interested in undergoing supplemental screening, while others (10.3%) said they "wouldn't worry about it too much". These findings have important implications for health systems with population-based breast screening programs that are currently considering widespread BD notification in terms of the impact on women, health services and primary care.

Evaluating the Relationship between Body Mass Index and Heart Disease: An Analysis of Smoking’s Modifying Role

Background and Aims: Heart disease is a global health concern, with risk factors such as age, sex, diabetes, hypertension, high cholesterol, body mass index, and smoking playing a major role in its development. The study aims to examine the impact of smoking on heart disease risk, particularly in underweight individuals, and to assess how other factors such as age, sex, diabetes, hypertension, and high cholesterol levels can modify this risk. Methods: This study uses a cross-sectional approach and employs Python libraries such as Pandas, Matplotlib, and Scipy to analyze data. The relationship between smoking and heart disease in different Body Mass Index (BMI) groups was investigated using a chi-square test. Results: The results of the study suggest that smoking is a major contributor to the risk of heart disease or heart attack, regardless of body mass index (BMI). The findings emphasize the need for individuals to quit smoking in order to reduce their risk of heart disease or attack, particularly for those who are underweight. Conclusions: The results have implications for public health and healthcare systems and may require increased efforts to promote healthy lifestyle habits that maintain a normal BMI.

Global Ophthalmic Health Initiatives in Ebola and Emerging Infectious Disease Outbreaks: Implications for Vision Health Systems, Program Implementation, and Disease Surveillance.

Global Ophthalmic Health Initiatives in Ebola and Emerging Infectious Disease Outbreaks: Implications for Vision Health Systems, Program Implementation, and Disease Surveillance.

The impact of criminalisation on abortion-related outcomes: a synthesis of legal and health evidence

Abortion is criminalised to at least some degree in most countries. International human rights bodies have recognised that criminalisation results in the provision of poor-quality healthcare goods and services, is...

Use of interrupted Time Series Design in COVID-19 data of Nepal

Introduction: Nepal was hit hard by COVID-19 pandemic and is still struggling with its implications for individuals, societies, and health systems. We applied Interrupted Time Series (ITS) analysis to see if the government's decision to end two nationwide lockdowns had an impact on the average daily new cases of COVID-19 reported in Nepal.&#x0D; &#x0D; Method: ITS analysis on daily new cases of COVID-19 was performed for first and second nationwide lockdown on data of Nepal from data depository for 2019 Novel Coronavirus Visual Dashboard operated by Johns Hopkins University Center for Systems Science and Engineering. Impact of ''ending nationwide lockdown'' and possible associated factors were investigated.&#x0D; Result: The impact of removing first nationwide lockdown contributed to statistically significant rise of an average difference of 899 daily new cases due to community transmission of COVID-19. During second lockdown, even after imposing lockdown, cases overwhelmed existing healthcare system due to high infectivity of new Delta variant followed by a lack of adherence to public health measures and delayed decision to impose lockdown due to economic reasons. Whereas significant decline of cases was observed with an average difference of 2970 daily new cases after ending second nationwide lockdown mostly due to vaccine acceptance.&#x0D; &#x0D; Conclusion: First lockdown was imposed early due to uncertainty about progression of disease, curative measures and unavailability of vaccines. Ending of first lockdown was done untimely due to economic reasons and festive seasons. The unusual decline in cases after ending second lockdown could be contributed to increased vaccination in the country.&#x0D;

Surgeon Gender and Performance Outcomes for Hysterectomies: Retrospective Cohort Study

To evaluate whether there are differences in several performance metrics between male and female surgeons for hysterectomies. Multicenter retrospective cohort study. We matched surgeries performed by female surgeons to those by male surgeons using a propensity score and compared outcomes by gender after adjusting for years in practice and fellowship training. A total of 6 hospitals (3 academic, 3 community) in Ontario, Canada, between July 2016 and December 2019. All consecutive patients. Hysterectomy. Primary outcome was a composite of any complication or return to emergency room (ER) within 30 days. Secondary outcomes were grade II or greater complications, return to ER, and operative time. We included 2664 hysterectomies performed by 77 surgeons. After propensity matching, 963 surgeries performed by females were compared with 963 performed by males. There were no differences in the primary (relative risk [RR], 0.92; 95% confidence interval [CI], 0.71-1.20; p=.56) or secondary outcomes of grade II or greater complication (RR, 1.01; 95% CI, 0.71-1.45; p=.96) or return to ER (RR, 0.81; 95% CI, 0.55-1.20; p=.30). However, surgeries performed by males were 24.72 minutes shorter (95% CI, 18.09-31.34 minutes; p <.001). Entire cohort post hoc regression analysis confirmed these findings. E-value analysis indicated that it is unlikely for an unmeasured confounder to undo the observed difference. Although complication and readmission rates are similar, male surgeons may have a shorter operating time than female surgeons for hysterectomies, which may have implications for health systems and inequalities in surgeon renumeration.

Changes in the utilisation of acute hospital care in Ireland during the first wave of the COVID-19 pandemic in 2020.

Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.

Using Health Systems and Policy Research to Achieve Universal Health Coverage in Ghana.

Ghana is positioned to become the first country in sub-Saharan Africa to implement universal health coverage based on nationwide expansion of geographic access through the Community-based Health Planning and Services initiative. This achievement is the outcome of 3 decades of implementation research that health authorities have used for guiding the development of its primary health care program. This implementation research process has comprised Ghana's official endorsement of the 1978 Alma Ata Declaration, leading to the institutionalization of evidence relevant to the strategic design of primary health care and national health insurance policies and services. Rather than relying solely upon the dissemination of project results, Ghana has embraced a continuous and systemic process of knowledge capture, curation, and utilization of evidence in expanding geographic access by a massive expansion in the number of community health service points that has taken decades. A multisectoral approach has been pursued that has involved the creation of systematic partnerships that included all levels of the political system, local development officials, community groups and social networks, multiple university-based disciplines, external development partners, and donors. However, efforts to achieve high levels of financial access through the roll-out of the National Health Insurance Scheme have proceeded at a less consistent pace and been fraught with many challenges. As a result, financial access has been less comprehensive than geographical access despite sequential reforms having been made to both programs. The legacy of activities and current research on primary health care and national health insurance are reviewed together with unaddressed priorities that merit attention in the future. Factors that have facilitated or impeded progress with research utilization are reviewed and implications for health systems strengthening in Ghana and elsewhere in Africa and globally are discussed.

Factors associated with women's supplemental screening intentions following dense breast notification in an online randomised experimental study.

Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts.

Tranexamic Acid for Postpartum Hemorrhage Treatment in Low-Resource Settings: A Rapid Scoping Review

Tranexamic acid (TXA) effectively reduces bleeding in women with postpartum hemorrhage (PPH) in hospital settings. To guide policies and practices, this rapid scoping review undertaken by two reviewers aimed to examine how TXA is utilized in lower-level maternity care settings in low-resource settings. Articles were searched in EMBASE, MEDLINE, Emcare, the Maternity and Infant Care Database, the Joanna Briggs Institute Evidence-Based Practice Database, and the Cochrane Library from January 2011 to September 2021. We included non-randomized and randomized research looking at the feasibility, acceptability, and health system implications in low- and lower-middle-income countries. Relevant information was retrieved using pre-tested forms. Findings were descriptively synthesized. Out of 129 identified citations, 23 records were eligible for inclusion, including 20 TXA effectiveness studies, two economic evaluations, and one mortality modeling. Except for the latter, all the studies were conducted in lower-middle-income countries and most occurred in tertiary referral hospitals. When compared to placebo or other medications, TXA was found effective in both treating and preventing PPH during vaginal and cesarean delivery. If made available in home and clinic settings, it can reduce PPH-related mortality. TXA could be cost-effective when used with non-surgical interventions to treat refractory PPH. Capacity building of service providers appears to need time-intensive training and supportive monitoring. No studies were exploring TXA acceptability from the standpoint of providers, as well as the implications for health governance and information systems. There is a scarcity of information on how to prepare the health system and services to incorporate TXA in lower-level maternity care facilities in low-resource settings. Implementation research is critically needed to assist practitioners and decision-makers in establishing a TXA-inclusive PPH treatment package to reduce PPH-related death and disability.