Protocol for a realist synthesis of health systems responsiveness in low-income and middle-income countries

Abstract

IntroductionHealth systems responsiveness is a key objective of any health system, yet it is the least studied of all objectives particularly in low-income and middle-income countries. Research on health systems responsiveness highlights its multiple elements, for example, dignity and confidentiality. Little is known, however, about underlying theories of health systems responsiveness, and the mechanisms through which responsiveness works. This realist synthesis contributes to bridging these two knowledge gaps.Methods and analysisIn this realist synthesis, we will use a four-step process, comprising: mapping of theoretical bases, formulation of programme theories, theory refinement and testing of programme theories using literature and empirical data from Ghana and Vietnam. We will include theoretical and conceptual pieces, reviews, empirical studies and grey literature, alongside the primary data. We will explore responsiveness as entailing external and internal interactions within health systems. The search strategy will be purposive and iterative, with continuous screening and refinement of theories. Data extraction will be combined with quality appraisal, using appropriate tools. Each fragment of evidence will be appraised as it is being extracted, for its relevance to the emerging programme theories and methodological rigour. The extracted data pertaining to contexts, mechanisms and outcomes will be synthesised to identify patterns and contradictions. Results will be reported using narrative explanations, following established guidance on realist syntheses.Ethics and disseminationEthics approvals for the wider RESPONSE (Improving health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam) study, of which this review is one part, were obtained from the ethics committees of the following institutions: London School of Hygiene and Tropical Medicine (ref: 22981), University of Leeds, School of Medicine (ref: MREC19-051), Ghana Health Service (ref: GHS-ERC 012/03/20) and Hanoi University of Public Health (ref: 020-149/DD-YTCC).We will disseminate results through academic papers, conference presentations and stakeholder workshops in Ghana and Vietnam.PROSPERO registration numberCRD42020200353. Full record: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200353.

Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam

“…Similar findings are reported in Germany ( Bramesfeld et al ., 2007a ) and Iran ( Forouzan et al ., 2011 ). The finding reinforces the argument that responsiveness is a socially constructed set of interactions between people and their health systems, and strategies to improve responsiveness should address both the ‘people’ and the ‘systems’ sides ( Mirzoev et al ., 2021 ).…”

“…This paper reports Vietnam-specific findings from Phase 1 of a collaborative three-phase realist evaluation of health system responsiveness to the maternal mental health needs in Vietnam and Ghana ( Mirzoev et al ., 2021 ). Phase 1 focused on understanding the local context of maternal mental healthcare provision and utilization, identifying the barriers to maternal mental healthcare provision, as well as utilization and integration strategies in Vietnam.…”

“…Interviews and focus groups were audio-recorded and lasted ∼60 to 90 min. Data were collected using semi-structured topic guides designed to explore the initial theories identified in the realist synthesis ( Mirzoev et al ., 2021 ) and tailored to specific respondents. Health managers and healthcare providers were asked about the structural and organizational levels of maternal mental health at health facilities and sociocultural aspects (health literacy, stigma and awareness of the risks).…”