Embedding rapid reviews in health policy and systems decision-making: Impacts and lessons learned from four low- and middle-income countries.

BACKGROUND: Demand for rapid evidence-based syntheses to inform health policy and systems decision-making has increased worldwide, including in low- and middle-income countries (LMICs). To promote use of rapid syntheses in LMICs, the WHO's Alliance for Health Policy and Systems Research (AHPSR) created the Embedding Rapid Reviews in Health Systems Decision-Making (ERA) Initiative. Following a call for proposals, four LMICs were selected (Georgia, India, Malaysia and Zimbabwe) and supported for 1 year to embed rapid response platforms within a public institution with a health policy or systems decision-making mandate. METHODS: While the selected platforms had experience in health policy and systems research and evidence syntheses, platforms were less confident conducting rapid evidence syntheses. A technical assistance centre (TAC) was created from the outset to develop and lead a capacity-strengthening program for rapid syntheses, tailored to the platforms based on their original proposals and needs as assessed in a baseline questionnaire. The program included training in rapid synthesis methods, as well as generating synthesis demand, engaging knowledge users and ensuring knowledge uptake. Modalities included live training webinars, in-country workshops and support through phone, email and an online platform. LMICs provided regular updates on policy-makers' requests and the rapid products provided, as well as barriers, facilitators and impacts. Post-initiative, platforms were surveyed. RESULTS: Platforms provided rapid syntheses across a range of AHPSR themes, and successfully engaged national- and state-level policy-makers. Examples of substantial policy impact were observed, including for COVID-19. Although the post-initiative survey response rate was low, three quarters of those responding felt confident in their ability to conduct a rapid evidence synthesis. Lessons learned coalesced around three themes - the importance of context-specific expertise in conducting reviews, facilitating cross-platform learning, and planning for platform sustainability. CONCLUSIONS: The ERA initiative successfully established rapid response platforms in four LMICs. The short timeframe limited the number of rapid products produced, but there were examples of substantial impact and growing demand. We emphasize that LMICs can and should be involved not only in identifying and articulating needs but as co-designers in their own capacity-strengthening programs. More time is required to assess whether these platforms will be sustained for the long-term.

Characteristics of successful government-led interventions to support healthier populations: a starting portfolio of positive outlier examples.

Despite progress on the Millennium and Sustainable Development Goals, significant public health challenges remain to address communicable and non-communicable diseases and health inequities. The Healthier Societies for Healthy Populations initiative convened by WHO's Alliance for Health Policy and Systems Research; the Government of Sweden; and the Wellcome Trust aims to address these complex challenges. One starting point is to build understanding of the characteristics of successful government-led interventions to support healthier populations. To this end, this project explored five purposefully sampled, successful public health initiatives: front-of-package warnings on food labels containing high sugar, sodium or saturated fat (Chile); healthy food initiatives (trans fats, calorie labelling, cap on beverage size; New York); the alcohol sales and transport ban during COVID-19 (South Africa); the Vision Zero road safety initiative (Sweden) and establishment of the Thai Health Promotion Foundation. For each initiative a qualitative, semistructured one-on-one interview with a key leader was conducted, supplemented by a rapid literature scan with input from an information specialist. Thematic analysis of the five interviews and 169 relevant studies across the five examples identified facilitators of success including political leadership, public education, multifaceted approaches, stable funding and planning for opposition. Barriers included industry opposition, the complex nature of public health challenges and poor interagency and multisector co-ordination. Further examples building on this global portfolio will deepen understanding of success factors or failures over time in this critical area.

Defining and conceptualising the commercial determinants of health.

Although commercial entities can contribute positively to health and society there is growing evidence that the products and practices of some commercial actors-notably the largest transnational corporations-are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the commercial determinants of health. The climate emergency, the non-communicable disease epidemic, and that just four industry sectors (ie, tobacco, ultra-processed food, fossil fuel, and alcohol) already account for at least a third of global deaths illustrate the scale and huge economic cost of the problem. This paper, the first in a Series on the commercial determinants of health, explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so. Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests. This power imbalance leads to policy inertia; although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving health-care systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.

Commercial determinants of health: future directions.

This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health-the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.

Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review.

BACKGROUND: While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS: On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS: Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.

Normalizing the political economy of improving health

Probleme Les facteurs liés a l'économie politique jouent un rôle crucial dans l'adoption et la mise en Å“uvre de mesures sanitaires. Pourtant, ces facteurs sont souvent négligés lors de l'élaboration de politiques susceptibles d'avoir un impact sur la santé. Approche Analyser l'économie politique représente un moyen de tenir compte des réalités politiques et sociales au niveau communautaire, infranational, national, régional ou international. Nous voulons démontrer l'importance de l'analyse de l'économie politique et promouvoir son usage dans les programmes techniques de travail. Environnement local Nous donnons des exemples issus d'une série de domaines traités par l'Organisation mondiale de la Santé, parmi lesquels la gouvernance participative, le financement de la santé, les taxes sanitaires, la prévention et la lutte contre la malaria, le renforcement des capacités et l'appui direct aux pays. Changements significatifs Les exemples portant sur l'intégration de l'analyse de l'économie politique dans l'appui technique illustrent la variabilité de cette approche analytique, mais aussi sa potentielle contribution aux progres politiques. Appliquer une analyse de l'économie politique a des programmes de travail spécifiques a permis de fournir un soutien technique adapté au contexte, augmentant ainsi les chances d'avancement des pays vers la réalisation des objectifs en matiere de santé. Leçons tirées Incorporer l'économie politique dans le travail technique comporte de nombreux avantages: amélioration de la représentation et de la participation dans le cadre des mesures sanitaires;meilleures possibilités d'adoption et de mise en Å“uvre de politiques solides sur le plan technique;et enfin, renforcement des capacités afin de comprendre et d'inclure les facteurs politiques qui ont une influence sur les priorités relatives a la santé.Alternate :Проблема Факторы политической экономии играют важную роль в определении принятия и осуществления политики в области охраны и укрепления здоровья. Однако эти факторы часто упускаются из виду при разработке политики, которая способна повлиять на охрану здоровья. Подход Политэкономический анализ позволяет учитывать политические и социальные реалии как на уровне сообщества, так и на субнациональном, национальном, региональном или глобальном уровне. Авторы ставят перед собой цель продемонстрировать ценность политэкономического анализа и способствовать его более широкому использованию в технических программах работы. Местные условия Ð’ статье приводятся примеры из различных областей деятельности Всемирной организации здравоохранения, включая управление на основе широкого участия, финансирование здравоохранения, налоги на здравоохранение, профилактику малярии и борьбу с ней, наращивание потенциала и прямую поддержку стран. Осуществленные перемены Существующие примеры того, как политэкономический анализ может быть включен в техническую поддержку, свидетельствуют об изменчивости этого аналитического подхода, а также о его потенциале для поддержки прогресса ² политике. Применение политэкономического анализа в рамках указанных программ работы позволило получить техническую поддержку, более соответствующую контексту, для повышения вероятности достижения странами целей, связанных со здравоохранением. Выводы Внедрение политэкономии в техническую работу имеет ряд преимуществ, в том числе повышение роли и участия в политике здравоохранения, поддержка принятия и реализации технически обоснованной политики, наращивание потенциала для учета и понимания политических факторов, оказывающих влияние на приоритеты в области здравоохранения.Alternate :Situación Los factores de economía política son importantes para determinar la adopción y aplicación de las políticas sanitarias. Sin embargo, se suelen ignorar estos factores cuando se elaboran políticas que pueden influir en la salud. Enfoque El análisis de economía política permite tener en cuenta las realidades políticas y sociales, ya sea a nivel local, subnacional, nacional, regional o mundial. El objetivo de este proyecto es demostrar el valor del análisis de la economía política y promover su uso generalizado en los programas técnicos de trabajo. Marco regional Se ofrecen ejemplos de diversas áreas de trabajo de la Organización Mundial de la Salud, como la gobernanza participativa, la financiación sanitaria, los impuestos sanitarios, la prevención y la contención del paludismo, la creación de capacidades y el apoyo directo a los países. Cambios importantes Los ejemplos existentes de cómo se puede incorporar el análisis de economía política al apoyo técnico demuestran la variabilidad de este enfoque analítico, así como su potencial para apoyar el progreso de las políticas. La aplicación del análisis de la economía política en los programas de trabajo especificados ha permitido que el apoyo técnico sea más pertinente según el contexto para aumentar la probabilidad de avanzar en los objetivossanitarios de los países. Lecciones aprendidas Integrar la economía política en el trabajo técnico tiene muchos beneficios, entre los que se incluyen: potenciar las opiniones y la participación en las políticas sanitarias;apoyar la adopción y la viabilidad de la aplicación de políticas técnicamente sólidas;y crear capacidad para incorporar y comprender los factores políticos que influyen en las prioridades sanitarias.Alternate :Problem Political economy factors are important in determining the adoption and implementation of health policies. Yet these factors are often overlooked in the development of policies that have the potential to influence health. Approach Political economy analysis provides a way to take into consideration political and social realities, whether at the community, subnational, national, regional or global levels. We aim to demonstrate the value of political economy analysis and to promote its wider use in technical programmes of work. Local setting We provide examples from across a range of World Health Organization areas of work, including participatory governance, health financing, health taxes, malaria prevention and control, capacity-building and direct country support. Relevant changes Existing examples of how political economy analysis can be incorporated into technical support demonstrate the variability of this analytical approach, as well as its potential to support policy progress. Applying political economy analysis within the specified programmes of work has enabled more contextually relevant technical support to enhance the likelihood of advancing countrie ' health-related objectives. Lessons learnt Embedding political economy into technical work has many benefits, including: enhancing voice and participation in health policies;supporting the adoption and implementation feasibility of technically sound policies;and building capacity to incorporate and understand political factors that influence health-related priorities.

Defining Priorities for Action and Research on the Commercial Determinants of Health: A Conceptual Review.

In recent years, the concept of commercial determinants of health (CDoH) has attracted scholarly, public policy, and activist interest. To date, however, this new attention has failed to yield a clear and consistent definition, well-defined metrics for quantifying its impact, or coherent directions for research and intervention. By tracing the origins of this concept over 2 centuries of interactions between market forces and public health action and research, we propose an expanded framework and definition of CDoH. This conceptualization enables public health professionals and researchers to more fully realize the potential of the CDoH concept to yield insights that can be used to improve global and national health and reduce the stark health inequities within and between nations. It also widens the utility of CDoH from its main current use to study noncommunicable diseases to other health conditions such as infectious diseases, mental health conditions, injuries, and exposure to environmental threats. We suggest specific actions that public health professionals can take to transform the burgeoning interest in CDoH into meaningful improvements in health. (Am J Public Health. 2021;111(12):2202-2211. https://doi.org/10.2105/AJPH.2021.306491).

A health systems resilience research agenda: moving from concept to practice.

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.

Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context.

Since the Alma Ata Declaration of 1978, countries have varied in their progress towards establishing and sustaining comprehensive primary health care (PHC) and realizing its associated vision of 'Health for All'. International health emergencies such as the coronavirus-19 (COVID-19) pandemic underscore the importance of PHC in underpinning health equity, including via access to routine essential services and emergency responsiveness. This review synthesizes the current state of knowledge about PHC impacts, implementation enablers and barriers, and knowledge gaps across the three main PHC components as conceptualized in the 2018 Astana Framework. A scoping review design was adopted to summarize evidence from a diverse body of literature with a modification to accommodate four discrete phases of searching, screening and eligibility assessment: a database search in PubMed for PHC-related literature reviews and multi-country analyses (Phase 1); a website search for key global PHC synthesis reports (Phase 2); targeted searches for peer-reviewed literature relating to specific components of PHC (Phase 3) and searches for emerging insights relating to PHC in the COVID-19 context (Phase 4). Evidence from 96 included papers were analysed across deductive themes corresponding to the three main components of PHC. Findings affirm that investments in PHC improve equity and access, healthcare performance, accountability of health systems and health outcomes. Key enablers of PHC implementation include equity-informed financing models, health system and governance frameworks that differentiate multi-sectoral PHC from more discrete service-focussed primary care, and governance mechanisms that strengthen linkages between policymakers, civil society, non-governmental organizations, community-based organizations and private sector entities. Although knowledge about, and experience in, PHC implementation continues to grow, critical knowledge gaps are evident, particularly relating to country-level, context-specific governance, financing, workforce, accountability and service coordination mechanisms. An agenda to guide future country-specific PHC research is outlined.