Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

Abstract

Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

Business Improvement Districts: A Systematic Review of an Urban Governance Model towards City Center Revitalization

“…In the last decade, systematic reviews have been increasing in number and PRISMA has been widely acknowledged as a valid protocol for this methodological approach [46]. Not discarding its application in other research fields, this protocol has received particular attention from health sciences researchers [47][48][49]. The acceptance of this protocol within the scientific community can be explained by its meticulous process, with a checklist that guarantees, at least, the methodological validity of the given research.…”

An assessment of the quality of care provided at primary health care centres in camps for internally displaced persons in Iraq in 2018

“…There is an evidence gap in the quality of care in primary health care facilities in IDP camp settings [4], which this research attempts to fill. In 2018, the Health Cluster, led by WHO, initiated assessments of the quality of primary health care services provided at primary health care centres (PHCCs) in IDP camps in Iraq.…”

“…Jordan et al point at the large gap in measuring quality both at the point of care and at the health system level [4]. In humanitarian contexts globally, many aspects of health have been assessed in the literature for refugee or internally displaced persons (IDPs), camps setting (e.g., health status, access, acceptability) [5][6][7][8][9], however quality of care has not been directly assessed.…”

Assessing respectful maternity care in a fragile, conflict-affected context: Observations from a 2016 national assessment in Afghanistan

“…Understanding socio-cultural and contextual factors underpinning acceptance of mistreatment in childbirth, related to conflict, insecurity, gender and power dynamics, is critical for improving the quality of maternity care in afghanistan and similar fragile and conflict affected settings.The number of women and children affected by armed conflict has grown steadily since 2000; during this period, at least 630 million women and children-10% of women and 16% of children worldwide-have either been displaced by conflict or living dangerously close to armed conflict events (Bendavid et al, 2021). With this shifting global landscape, there is growing attention to quality of health services in crisis-affected settings, with efforts to review evidence on health system quality (Jordan et al, 2021), understand context-specific challenges to delivery of quality care (Munyuzangabo et al, 2021), and develop operational guidance for improving quality of care (Syed et al, 2020) in areas affected by conflict and fragility.As authors of the Lancet Maternal Series in 2016 emphasize: Every woman, every newborn, everywhere has the right to appropriate, timely, evidence-based, respectful care (The Lancet, 2016). Mistreatment during childbirth has been highlighted as a significant obstacle in reducing maternal and newborn mortality around the globe -it contributes to negative user experiences and can be a significant deterrent to the uptake of facility-based childbirth (…”

“…The number of women and children affected by armed conflict has grown steadily since 2000; during this period, at least 630 million women and children-10% of women and 16% of children worldwide-have either been displaced by conflict or living dangerously close to armed conflict events (Bendavid et al, 2021). With this shifting global landscape, there is growing attention to quality of health services in crisis-affected settings, with efforts to review evidence on health system quality (Jordan et al, 2021), understand context-specific challenges to delivery of quality care (Munyuzangabo et al, 2021), and develop operational guidance for improving quality of care (Syed et al, 2020) in areas affected by conflict and fragility.…”