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Objective To conduct a systematic review on the effects of multisectoral interventions for health on health system performance. Methods We conducted a systematic review according to the preferred reporting items for systematic review and meta- analysis protocols. We searched for peer-reviewed journal articles in PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews on 31 August 2023 (updating on 28 February 2024). We removed duplicates, screened titles and abstracts, and then conducted a full-text eligibility and quality assessment. Findings We identified an initial 1118 non-duplicate publications, 62 of which met our inclusion and exclusion criteria. The largest proportions of reviewed studies focused on multisectoral interventions directly related to specific health outcomes (66.1%; 41 studies) and/or social determinants of health (48.4%; 30 studies), but without explicit reference to overall health system performance. Most reviewed publications did not address process indicators (83.9%; 52/62) or discuss sustainability for multisectoral interventions in health (72.6%; 45/62). However, we observed that the greatest proportion (66.1%; 41/62) considered health system goals: health equity (68.3%; 28/41) and health outcomes (63.4%; 26/41). Although the greatest proportion (64.5%; 40/62) proposed mechanisms explaining how multisectoral interventions for health could lead to the intended outcomes, none used realistic evaluations to assess these. Conclusion Our review has established that multisectoral interventions influence health system performance through immediate improvements in service delivery efficiency, readiness, acceptability and affordability. The interconnectedness of these effects demonstrates their role in addressing the complexities of modern health care. [phrase omitted] [phrase omitted] Objectif Realiser une revue systematique consacree a l'impact des interventions multisectorielles sur la performance des systemes de sante. Methodes Nous avons procede a une revue systematique en appliquant les elements de rapport privilegies dans les protocoles de revues systematiques et meta-analyses. Nous avons explore PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, ainsi que la Base de donnees Cochrane des revues systematiques le 31 aout 2023 (mise a jour le 28 fevrier 2024), a la recherche d'articles de revue evalues par des pairs. Ensuite, nous avons supprime les doublons, passe les titres et resumes au crible, puis determine la qualite et l'admissibilite des articles complets. Resultats Nous avons initialement identifie 1118 publications non dupliquees; 62 d'entre elles repondaient a nos criteres d'inclusion et d'exclusion. Une grande partie des etudes examinees portaient sur des interventions multisectorielles en lien direct avec des resultats de sante specifiques (66,1%; 41 etudes) et/ou des determinants sociaux de la sante (48,4%; 30 etudes), sans toutefois faire explicitement reference a la performance globale des systemes de sante. La majorite des publications ne mentionnaient aucun indicateur de processus (83,9%; 52/62) et n'abordaient pas la durabilite des interventions multisectorielles dans le domaine de la sante (72,6%; 45/62). Nous avons neanmoins constate qu'en general, elles tenaient compte des objectifs relatifs aux systemes de sante (66,1%; 41/62): l'equite en sante (68,3%; 28/41) et les resultats de sante (63,4%; 26/41). Bien que la plupart (64,5%; 40/62) proposent des mecanismes visant a expliquer comment les interventions multisectorielles en matiere de sante pourraient amener aux resultats escomptes, aucune n'avait recours a des evaluations realistes pour les mesurer. Conclusion Notre revue nous a permis d'etablir que les interventions multisectorielles influencaient la performance des systemes de sante a travers des ameliorations immediates en termes d'efficacite, de disponibilite, d'acceptation et d'abordabilite des prestations de services. L'interdependance entre ces effets temoigne de l'importance qu'ils revetent lorsqu'il s'agit d'apprehender les rouages complexes des soins de sante modernes. [phrase omitted] Objetivo Realizar una revision sistematica sobre los efectos de las intervenciones multisectoriales en favor de la salud sobre el rendimiento de los sistemas sanitarios. Metodos Se realizo una revision sistematica de acuerdo con los items de informe preferidos para los protocolos de revision sistematica y metanalisis. Se realizaron busquedas de articulos de revistas con revision por pares en PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature y la Base de Datos Cochrane de Revisiones Sistematicas el 31 de agosto de 2023 (actualizacion el 28 de febrero de 2024). Se eliminaron los duplicados, se examinaron los titulos y los resumenes y, a continuacion, se realizo una evaluacion de la elegibilidad y la calidad del texto completo. Resultados Se identificaron 1118 publicaciones iniciales no duplicadas, 62 de las cuales cumplian los criterios de inclusion y exclusion. El mayor porcentaje de estudios revisados se centro en intervenciones multisectoriales directamente relacionadas con resultados sanitarios especificos (66,1%; 41 estudios) o determinantes sociales de la salud (48,4%; 30 estudios), pero sin referencia explicita al rendimiento general del sistema sanitario. La mayoria de las publicaciones revisadas no abordaron indicadores de proceso (83,9%; 52/62) ni discutieron la sostenibilidad de las intervenciones multisectoriales en salud (72,6%; 45/62). Sin embargo, se observo que el mayor porcentaje (66,1%; 41/62) tenia en cuenta los objetivos del sistema sanitario: equidad sanitaria (68,3%; 28/41) y resultados sanitarios (63,4%; 26/41). Aunque el mayor porcentaje (64,5%; 40/62) propuso mecanismos que explicaban como las intervenciones multisectoriales para la salud podian conseguir los resultados previstos, ninguno empleo evaluaciones realistas para evaluarlos. Conclusion La revision que se realizo ha demostrado que las intervenciones multisectoriales influyen en el rendimiento de los sistemas sanitarios a traves de mejoras inmediatas en la eficiencia, la disponibilidad, la aceptabilidad y la asequibilidad de la prestacion de servicios. La interconexion de estos efectos demuestra su funcion a la hora de abordar las complejidades de la atencion sanitaria moderna., Introduction There is unequivocal recognition that health and well-being are determined by non-medical factors, including structural, social and commercial determinants of health. (1) Addressing those determinants is a task for [...]

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 countries' 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. Probleme Lesfacteurs llesa l'economie polltlquejouent un role crucial dans l'adoptlon et la mise en ceuvre de mesures sanitaires. Pourtant, ces facteurs sont souvent negllges lors de l'elaboration de politiques susceptibles d'avoir un Impact sur la sante. Approche Analyser l'economie politique represente un moyen de tenir compte des realites politiques et sociales au niveau communautaire, infranational, national, regional ou International. Nous voulons demontrer l'importance de l'analyse de l'economie politique et promouvolr son usage dans les programmes techniques de travail. Environnement local Nous donnons des exemples Issus d'une serie de domalnes traites par l'Organisation mondlale de la Sante, parmi lesquels la gouvernance participative, le financement de la sante, les taxes sanltalres, la prevention et la lutte contre la malaria, le renforcement des capacltes et l'appul direct aux pays. Changements significatifs Les exemples portant sur l'integration de l'analyse de l'economie politique dans l'appul technique illustrent la variabilite de cette approche analytique, mais aussi sa potentielle contribution aux progres politiques. Appliquer une analyse de l'economie politique a des programmes de travail specifiques a permls de fournir un soutien technique adapte au contexte, augmentant ainsi les chances d'avancement des pays vers la realisation des objectifs en matierede sante. Lecons tirees Incorporer l'economie politique dans le travail technique comporte de nombreux avantages: amelloration de la representation et de la participation dans le cadre des mesures sanitalres; mellieures possibilites d'adoption et de mise en ceuvre de politiques solides sur le plan technique; et enfin, renforcement des capacites afin de comprendre et d'inclure les facteurs politiques qui ont une influence sur les priorites relatives a la sante. Situacion Los factores de economia politica son Importantes para determinar la adopcion y aplicacion de las politicas sanitarias. Sin embargo, se suelen Ignorar estos factores cuando se elaboran politicas que pueden Influir en la salud. Enfoque El analisis de economia politica permite tener en cuenta las realidades politicas y sociales, ya sea a nivel local, subnaclonal, nacional, regional o mundial. El objetivo de este proyecto es demostrar el valor del analisis de la economia politica y promover su uso generalizado en los programas tecnicos de trabajo. Marco regional Se ofrecen ejemplos de diversas areas de trabajo de la Organizacion Mundial de la Salud, como la gobernanza participativa, la financiacion sanitaria, los Impuestos sanitarios, la prevencion y la contencion del paludismo, la creacion de capacidades y el apoyo directo a los paises. Cambios importantes Los ejemplos existentes de como se puede Incorporarei analisis de economia politica al apoyo tecnico demuestran la variabilidad de este enfoque analitico, asi como su potencial para apoyar el progreso de las politicas. La aplicacion del analisis de la economia politica en los programas de trabajo especificados ha permitido que el apoyo tecnico sea mas pertinente segun el contexto para aumentar la probabilidad de avanzar en los objetivos sanitarios de los paises. Lecciones aprendidas Integrar la economia politica en el trabajo tecnico tiene muchos beneficios, entre los que se Incluyen: potenciar las opiniones y la participacion en las politicas sanitarias; apoyar la adopcion y la viabilidad de la aplicacion de politicas tecnicamente solldas;y crear capacidad para Incorporar y comprender los factores politicos que Influyen en las prioridades sanitarias., Introduction As the coronavirus disease 2019 pandemic has demonstrated, policies that impact health and well-being are not only influenced by scientific evidence, but also by the political views and underlying [...]

The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.

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., Author(s): Celestin Hategeka 1,*, Prince Adu 2, Allissa Desloge 3, Robert Marten 4, Ruitai Shao 5, Maoyi Tian 6,7, Ting Wei 6, Margaret E. Kruk 1 Introduction Noncommunicable diseases (NCDs) [...]

As countries transition from external assistance while pursuing ambitious plans to achieve universal health coverage (UHC), there is increasing need to facilitate knowledge sharing and learning among them. Country-led and country-owned knowledge management is foundational to sustainable, more equitable external assistance for health and is a useful complement to more conventional capacity-building modalities provided under external assistance. In the context of external assistance, few initiatives use country-to-country sharing of practitioner experiences, and link learning to receiving guidance on how to adapt, apply and sustain policy changes. Dominant knowledge exchange processes are didactic, implicitly assuming static technical needs, and that practitioners in low- and middle-income countries require problem-specific, time-bound solutions. In reality, the technical challenges of achieving UHC and the group of policymakers involved continuously evolve. This paper aims to explore factors which are supportive of experience-based knowledge exchange between practitioners from diverse settings, drawing from the experience of the Joint Learning Network (JLN) for UHC—a global network of practitioners and policymakers sharing experiences about common challenges to develop and implement knowledge products supporting reforms for UHC—as an illustration of a peer-to-peer learning approach. This paper considers: (1) an analysis of JLN monitoring and evaluation data between 2020 and 2023 and (2) a qualitative inquiry to explore policymakers' engagement with the JLN using semi-structured interviews (n = 14) with stakeholders from 10 countries. The JLN's experience provides insights to factors that contribute to successful peer-to-peer learning approaches. JLN relies on engaging a network of practitioners with diverse experiences who organically identify and pursue a common learning agenda. Meaningful peer-to-peer learning requires dynamic, structured interactions, and alignment with windows of opportunity for implementation that enable rapid response to emerging and timely issues. Peer-to-peer learning can facilitate in-country knowledge sharing, learning and catalyse action at the institutional and health system levels. [ABSTRACT FROM AUTHOR]

Large-scale industries do not operate in isolation, but have tangible impacts on human and planetary health. An often overlooked actor in the fight against noncommunicable diseases is the palm oil industry. The dominance of palm oil in the food processing industry makes it the world's most widely produced vegetable oil. We applied the commercial determinants of health framework to analyse the palm oil industry. We highlight the industry's mutually profitable relationship with the processed food industry and its impact on human and planetary health, including detrimental cultivation practices that are linked to respiratory illnesses, deforestation, loss of biodiversity and pollution. This analysis illustrates many parallels to the contested nature of practices adopted by the alcohol and tobacco industries. The article concludes with suggested actions for researchers, policy-makers and the global health community to address and mitigate the negative impacts of the palm oil industry on human and planetary health. [phrase omitted] [phrase omitted] Les grandes industries ne fonctionnent pas en vase clos; elles ont des effets tangibles sur la sante des individus et de la planete. Un acteur souvent neglige dans la lutte contre les maladies non transmissibles est l'industrie de l'huile de palme. Etant donne sa predominance dans l'industrie alimentaire, l'huile de palme est l'huile vegetale la plus largement produite au monde. Nous avons applique les determinants commerciaux de la sante pour analyser l'industrie de l'huile de palme. Nous mettons en evidence la relation mutuellement profitable entre cette industrie et l'industrie des aliments transformes ainsi que ses effets sur la sante des individus et de la planete, et notamment des pratiques culturales nefastes liees a des maladies respiratoires, la deforestation, la diminution de la diversite biologique et la pollution. Cette analyse etablit de nombreux paralleles avec la nature contestee de pratiques adoptees par les industries de l'alcool et du tabac. Larticle se conclut par des propositions d'action pour que les chercheurs, les responsables politiques et la communaute mondiale de la sante examinent et attenuent les effets negatifs de l'industrie de l'huile de palme sur la sante des individus et de la planete. [phrase omitted] Las industrias a gran escala no operan de forma aislada, sino que tienen un impacto tangible en la salud humana y del planeta. Un agente que a menudo se ignora en la lucha contra las enfermedades no contagiosas es la industria del aceite de palma. El predominio del aceite de palma en la industria del procesamiento de alimentos lo convierte en el aceite vegetal mas producido del mundo. Se han aplicado los determinantes comerciales del marco de la salud para analizar la industria del aceite de palma. Cabe destacar la relacion mutuamente beneficiosa de la industria con la industria de los alimentos procesados y su impacto en la salud humana y del planeta, incluidas las practicas de cultivo perjudiciales que estan relacionadas con las enfermedades respiratorias, la deforestacion, la perdida de biodiversidad y la contaminacion. Este analisis ilustra muchos paralelismos con la naturaleza controvertida de las practicas adoptadas por las industrias del alcohol y el tabaco. El articulo concluye con varias sugerencias de posibles medidas para que los investigadores, los responsables de la formulacion de politicas y la comunidad mundial de la salud aborden y mitiguen los impactos negativos de la industria del aceite de palma en la salud humana y del planeta., Abstracts in [phrase omitted] Francais, [phrase omitted] and Espanol at the end of each article. Introduction Public health discourse increasingly focuses on the role of alcohol, tobacco and sugar in [...]

The health community recognizes the climate crisis as an existential threat to humanity and human health, (1) requiring immediate and effective action across all sectors. However, global-level policy guidance reveals [...]

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. [ABSTRACT FROM AUTHOR]

Governments in low-and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation's resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost-effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities--implicitly or explicitly--it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC. Les gouvernements des pays a revenu faible et intermediaire sont en train de legitimer la mise en place de la couverture sanitaire universelle (CSU), suite a une resolution des Nations Unies de 2012 sur la CSU et a son enterinement dans les objectifs de developpement durable fixes en 2015. La CSU variera selon les pays, en fonction de leur contexte et de leurs besoins, ainsi qu'en fonction de la demande et de l'offre de soins. Des questions fondamentales ont ainsi ete soulevees par les responsables politiques et les parties prenantes, portant notamment sur les objectifs, les utilisateurs et le rapport cout-efncacite de la CSU. Si les autorites sanitaires determinent quotidiennement des priorites, de facon implicite ou explicite, la marche a suivre pour definir les priorites en matiere de CSU n'a pas ete clairement etablie. Nous justifions ici la necessite de definir explicitement les priorites dans le domaine de la sante tout en donnant des orientations aux pays pour definir les priorites en matiere de CSU. Los gobiernos de paises con ingresos bajos y medios estan legitimando la implementacion de una cobertura sanitaria universal (CSU) tras un acuerdo de las Naciones Unidas acerca de la cobertura sanitaria universal en 2012 y su consolidacion en los objetivos de desarrollo sostenible establecidos en 2015. Cada pais tendra una cobertura sanitaria universal distinta, segun el contexto y las necesidades de cada uno, asi como la oferta y la demanda de atencion sanitaria. Por tanto, los responsables politicos y partes interesadas han abordado los asuntos fundamentales como los objetivos, los usuarios y la rentabilidad de la cobertura sanitaria universal. A pesar de que las autoridades sanitarias han establecido prioridades diarias (deforma implicita o explicita), no se ha aclarado como se deberia gestionar el establecimiento de prioridades para la cobertura sanitaria universal. Se ofrece una justificacion para el establecimiento de prioridades sanitarias explicitas y orientacion a los paises en la definicion de prioridades para la cobertura sanitaria universal., Introduction Universal health coverage (UHC) has been defined as 'the desired outcome of health system performance whereby all people who need health services receive them, without undue financial hardship.' (1) [...]

Primary health care is the cornerstone of a strong health system and accelerates progress towards universal health coverage (UHC) and the sustainable development goals (SDGs). A primary healthcare approach includes [...]