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Table 2 Finding reviews to support the widespread use of artemisinin-based combination therapy to treat malaria

From: SUPPORT Tools for evidence-informed health Policymaking (STP) 7: Finding systematic reviews

Evidence-Informed Policy Network (EVIPNet) teams of both policymakers and researchers from seven African countries wanted to come to grips quickly with several broad categories of health system arrangements that could be used to support the widespread use of artemisinin-based combination therapy (ACT). Their search identified three overviews of systematic reviews. The first overview was still in progress and focused on the impacts of particular governance arrangements related to prescription drugs like ACT [20]. The second overview focused on the impacts of alternative financial arrangements in health systems more generally [21]. And the third completed overview focused on the impacts of alternative human resources for health (HRH) configurations [15]. Their search also identified an overview of systematic reviews of the impacts of implementation strategies targeting healthcare providers [22].
Once they had read the overviews of systematic reviews, the policymaker/researcher teams searched for systematic reviews in domains not covered by the overviews. They found:
1. Two systematic reviews about governance arrangements. One addressed the impacts of consumer involvement in decision making and the second addressed governance arrangements related to the private sector (however, the latter review is not a review of impacts per se)
2. Six systematic reviews of the impacts of specific financial arrangements, including incentives for patients (i.e. conditional cash transfers), incentives for prescribers, physician-remuneration arrangements more generally, contracting with the for-profit sector to improve healthcare delivery, reference pricing and other pricing and purchasing policies, as well as one systematic review about what is known about financial arrangements within the private sector (again, this latter study was not a review of impacts as such), and
3. Five systematic reviews of the impacts of specific HRH configurations, including home-based management, lay health workers, and the expansion of the role of outpatient pharmacists and either nurses or nurse practitioners instead of physicians. In addition, one systematic review was found about the activities of medicine sellers and how their practice can be improved (this, too, was not an actual review of impacts)
Given that the WHO malaria treatment guidelines of 2006 were based on a comprehensive search for systematic reviews about the impacts of anti-malarial drugs, the teams were able to restrict their additional searches to the time period that followed. Six systematic reviews about anti-malarial drugs were found (published in either 2006 or 2007) and one systematic review about unit-dose packaged anti-malarial drugs was also found.
The searches undertaken by the teams also allowed them to supplement the overview of systematic reviews of the impacts of implementation strategies with seven additional systematic reviews of the impacts of different strategies for achieving desired outcomes. These outcomes included the dissemination and implementation of guidelines, the implementation of guidelines among allied health professionals specifically, influencing prescribing and dispensing, changing medication use, improving antibiotic prescribing in ambulatory care and in hospitals, and the enhancement of medication adherence. Seven systematic reviews were also found on the impacts of specific strategies for bringing about change, including audit and feedback, computerised support for determining drug dosage, continuing-education meetings, educational outreach visits, local opinion leaders, mass media campaigns, and tailored efforts to identify identified barriers to change.
The teams found no systematic reviews of studies examining the feasibility and acceptability of ACT for the home-based management of malaria. They therefore conducted a search for single studies on this topic. One study was found which was conducted in four African sites and had been published in Malaria Journal.