Effectiveness of interventions to strengthen national health service delivery on coverage, access, quality, and equity in the use of health services in low and lower middle income countries.
Findings from a systematic review
Low coverage of effective and cost-effective interventions that could save lives has been partially attributed to weak and inefficient health systems, leading to the identification and promotion of health system strengthening as a global health priority. Front-line health workers are key to delivering health services. The effectiveness of supply-side interventions to improve their ability to deliver health services was assessed.
- Studies which strengthened other elements of the health service delivery in addition to technical guidance, as well as community mobilisation and interventions at the health sector policy and strategic management level showed more consistent improvement on quality of care and counselling than those using technical guidance alone.
Supply-side interventions that appeared to have a positive effect on quality of care included:
- text message reminders (with motivational quotes) for malaria case management;
- training for malaria case management when combined with community awareness, supervision and referral mechanisms;
- job aids for antenatal counselling when combined with supervision and a focus on institutional adaptations required to incorporate the use of these job aids;
- IMCI (integrated management of childhood illnesses) training, when implemented in combination with enhanced supervision that incorporated training of supervisors, job aids, use of data and face-to-face supportive supervision, in repeated cycles of assessment, examination/feedback and planning;
- implementation of guidelines, when delivered using training, enhanced supportive supervision, a focal person to troubleshoot problems on site, and repeated progress surveys with face-to-face feedback and planning sessions;
- quality improvement, when combined with training, supervision, repeated progress surveys with time frames and named individuals identified against decisions/plans made during face-to-face meetings with all health facility staff, and district level representation;
- implementation of full IMCI guidelines, incorporating training, supervision and discussion of how to overcome barriers to implementation, wider health system strengthening at the health sector policy and strategic management level, and community mobilisation.
There is a protocol for this systematic review
Willey, B.; Smith Paintain, L.; Mangham-Jefferies, L.; Car, J.; Armstrong Schellenberg, J. Systematic Review. Effectiveness of interventions to strengthen national health service delivery on coverage, access, quality, and equity in the use of health services in low and lower middle income countries. EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK (2013) iii + 132 pp. ISBN 978-1-907345-55-5
Systematic Review. Effectiveness of interventions to strengthen national health service delivery on coverage, access, quality, and equity in the use of health services in low and lower middle income countries.