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BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

What do we know about the needs and challenges of health systems? A scoping review of the international literature

Authors: Federico Roncarolo, Antoine Boivin, Jean-Louis Denis, Rejean Hébert, Pascale Lehoux

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

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. 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.

Methods

We 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.

Results

292 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.

Conclusions

This 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.
Appendix
Available only for authorised users
Footnotes
1
We initially thought of classifying HSs and considered various taxonomies to this end. This option was discarded because of our intent to include articles that examined HSs in low- and middle-income countries and very few taxonomies can accommodate such diverse HSs. Furthermore, HSs may shift over time and we were reviewing the literature published since 2000.
 
2
Levac et al. [12.] offer a clear step-wise approach to scoping reviews, which builds on and complements the framework developed 5 years earlier by Arksey and O’Malley [11]. Levac et al.’s approach is more operational and provides useful lessons.
 
3
The articles that were excluded because of this criterion were written in Portuguese (n = 5), Spanish (n = 5) and Romanian (n = 1).
 
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Metadata
Title
What do we know about the needs and challenges of health systems? A scoping review of the international literature
Authors
Federico Roncarolo
Antoine Boivin
Jean-Louis Denis
Rejean Hébert
Pascale Lehoux
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2585-5

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