The Astronomy of Africa’s Health Systems Literature During the MDG Era: Where Are the Systems Clusters?

Abstract

The volume of literature on health systems in sub-Saharan Africa has been expanding since the 2000 MDG era. Focus has remained generally on categorical health themes rather than systems concepts. Topics such as scaling-up, organizational development, data use for decision making, logistics, and financial planning remain underrepresented. And quite surprisingly, implementation science remains something of a “black hole.” But bibliometric evidence suggests there is a shift in focus that may soon address these gaps.

Measuring health systems strength and its impact: experiences from the African Health Initiative

“…There was consistency across Partnerships in terms of measures of health information, medical technologies and service delivery, collected via facility surveys that are expensive, inconsistently conducted, and in the examples presented here were not representative in multiple countries (either not reflective of the level of Partnership intervention, or did not include both intervention and comparison areas). The lack of scientifically valid and appropriate measures for the building block of ‘governance and leadership,’ (including indicators related to leadership and management at sub-national levels, beyond the existence of up-to-date national policies, that can be operationalized for analysis), has been noted elsewhere [ 37 , 38 ]. This gap is especially worrisome given that leadership and governance is critical to strong, effective health systems, and likely reverberates across all other building blocks [ 39 ].…”

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa

“…118 A review of gaps in health systems research identifies corruption as an area where there has been remarkably little research relative to its impact on subSaharan health systems. 119 Corruption is an important area to address in any recommendations for the future of health in Africa. 120,121 Tackling corruption in the health sector requires a stronger stance from sub-Saharan governments and local health leaders that translates beyond rhetoric and into implementation.…”

How concentrated are academic publications of countries' progression towards universal health coverage?

“…6,7 South Africa's domestic political drive for UHC was reinforced with the publication of the White Paper on National Health Insurance in June, 2018, and is supported by strong domestic capacity for health systems research. 8 Exploratory correlation and regression analyses broadly do not suggest an association between how frequently a country is mentioned in the literature and measures of service coverage (service coverage index calculated as the geometric mean of 16 tracer indicators across four areas: reproductive, maternal, new-born, and child health; infectious diseases; noncommunicable diseases; and service capacity and access, 2 financial protection (percentage of households spending more than 10% of income on health care), 2 and external health expenditure per capita (purchasing power parity international dollars), in 2015; 9 however, more detailed analyses are needed to establish whether some form of publication bias is apparent.…”