Health system description and assessment: a scoping review of templates for systematic analyses

Titelangaben

Waitzberg, Ruth ; Pfundstein, Isabel ; Maresso, Anna ; Rechel, Bernd ; van Ginneken, Ewout ; Quentin, Wilm:
Health system description and assessment: a scoping review of templates for systematic analyses.
In: Health Research Policy and Systems. Bd. 22 (2024) . - 82.
ISSN 1478-4505
DOI: https://doi.org/10.1186/s12961-024-01166-y

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Abstract

Understanding and comparing health systems is key for cross-country learning and health system
strengthening. Templates help to develop standardised and coherent descriptions and assessments of health systems,
which then allow meaningful analyses and comparisons. Our scoping review aims to provide an overview of existing
templates, their content and the way data is presented.

Main body
Based on the WHO building blocks framework, we defined templates as having (1) an overall framework,
(2) a list of indicators or topics, and (3) instructions for authors, while covering (4) the design of the health system, (5)
an assessment of health system performance, and (6) should cover the entire health system. We conducted a scoping
review of grey literature published between 2000 and 2023 to identify templates. The content of the identified
templates was screened, analyzed and compared. We found 12 documents that met our inclusion criteria. The building
block `health financing´ is covered in all 12 templates; and many templates cover ´service delivery´ and ´health
workforce’. Health system performance is frequently assessed with regard to ‘access and coverage’, ‘quality and safety’,
and ‘financial protection’. Most templates do not cover ‘responsiveness’ and ‘efficiency’. Seven templates combine
quantitative and qualitative data, three are mostly quantitative, and two are primarily qualitative. Templates cover
data and information that is mostly relevant for specific groups of countries, e.g. a particular geographical region,
or for high or for low and middle-income countries (LMICs). Templates for LMICs rely more on survey-based indicators
than administrative data.

Conclusions
This is the first scoping review of templates for standardized descriptions of health systems and assessments
of their performance. The implications are that (1) templates can help analyze health systems across countries
while accounting for context; (2) template-guided analyses of health systems could underpin national health policies,
strategies, and plans; (3) organizations developing templates could learn from approaches of other templates; and (4)
more research is needed on how to improve templates to better achieve their goals. Our findings provide an overview
and help identify the most important aspects and topics to look at when comparing and analyzing health
systems, and how data are commonly presented. The templates were created by organizations with different agendas
and target audiences, and with different end products in mind. Comprehensive health systems analyses and comparisons
require production of quantitative indicators and complementing them with qualitative information to build
a holistic picture.