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

Abstract

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.

The mental health needs of healthcare workers: When evidence does not guide policy. A comparative assessment of selected European countries

“…The article uses a qualitative comparative methodology based on a case study design 49 and a multi-level intersectoral governance matrix. 18 We perform a rapid assessment 50 of HCWF developments. The approach is motivated by previous research carried out by some of the authors 18 and governance studies developed by Greer et al and the European Observatory on Health Systems and Policies that highlight connections, coordination and co-benefits of different policy areas.…”

Rapid reviews methods series: assessing the appropriateness of conducting a rapid review

“…RRs have proven useful in both emergent (eg, COVID-19 pandemic, disaster relief) [10][11][12] and non-emergent yet urgent situations where there is still a need for timely evidence (eg, to inform the development of a new health policy or programme) [13][14][15] or in resource-limited environments (eg, low-income countries). [16][17][18][19] However, there are cases where an RR may not be appropriate. For example, a full SR is likely preferable if the evidence synthesis will be used to make decisions or develop guidelines on a large scale (eg, international, regional), which could have wide-sweeping resource or implementation implications and if time allows to wait for evidence to inform a decision.…”

“…The similarities in the methodologies between RRs and SRs raise the question of when an RR is appropriate to conduct for evidence synthesis. RRs have proven useful in both emergent (eg, COVID-19 pandemic, disaster relief)10–12 and non-emergent yet urgent situations where there is still a need for timely evidence (eg, to inform the development of a new health policy or programme)13–15 or in resource-limited environments (eg, low-income countries) 16–19. However, there are cases where an RR may not be appropriate.…”