Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review

Abstract

IntroductionNon-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies.MethodsWe systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC).ResultsA total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC.ConclusionOverall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare.

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“…32 Implementation research initiatives, for example, are reported to play a role in improving case findings, diagnosis and treatment to meet central programme targets, as part of several national tuberculosis programmes in the Asia Pacific region and are used increasingly to aid programme managers based in low-income and middle-income countries (LMICs) around the world to improve the delivery of programmes to prevent non-communicable diseases. [33][34][35][36] However, deeper forms of learning can also help health systems to embrace change better. Such changes can range from evolving societal expectations, population characteristics and disease patterns to external shifts such as the shocks caused by political and economic upheavals, natural disasters or global ecological trends.…”

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