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Table 2 Health system guideline/recommendation overview

From: Strategies to adapt and implement health system guidelines and recommendations: a scoping review

Author/year Guideline/recommendation name Study aim and objectives Description Health system building block
Amaral et al. (2008) [82] Integrated management of childhood illnesses (IMCI) Describe factors associated with the implementation of IMCI in north-eastern Brazil IMCI aims to reduce mortality and morbidity associated with childhood diseases by improving three key components: (1) performance of health professionals using standardized protocols; (2) improving the health system organization by means of adequate support for the availability of resources; (3) health promotion practices through family and community-based activities Service delivery
Andrade et al. (2017) [75] Attention to chronic conditions model (ACCM) was adapted to create lab for innovations in chronic conditions (LIACC) Address implementation of LIACC
Document the main challenges and lessons learned to suggest a more suitable chronic care model at the municipal level
Adapted from the seven steps of ACCM, LIACC implements four macro processes used as a management tool in primary healthcare (PHC) for chronic conditions: (1) evaluation of infrastructure; (2) focus on primary care to acute health services; (3) management and monitoring of chronic conditions; (4) management and monitoring of home healthcare visits Service delivery
Armstrong et al. (2014) [90] Maternal and perinatal death reviews (MPDR) Explore the current implementation of MPDRs in Tanzania MPDR encourages multidisciplinary team discussions from staff involved in the patients’ care as well as a review of the patients’ documentation to identify avoidable factors and opportunities for improvement Health workforce
Bergerot et al. (2017) [79] Psycho-oncology programme Characterize the use of screening measures for psychologists from different oncology services
Present the preliminary results from this programme implementation and development
The programme was subdivided into six actions: screening of distress, anxiety, depression, quality of life; classification of risk criteria; discussion by the psychology team; synthesis and discussion with healthcare team; evidence-based results analysis; treatment plan and record in medical records Service delivery
Blanco-Mancilla (2011) [84] Popular health insurance (PHI) programme Understand why health policies differ across Mexico City
Identify issues that contribute to the success or failure of translating policy into practice
Providing healthcare coverage to previously excluded populations Service delivery
Bryce et al. (2005) [58] MCI strategy Compare the programme (IMCI) expectation findings of the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE-IMCI) to the five most important programme expectations from the IMCI impact model IMCI is a strategy for reducing mortality among children under the age of 5 years
UNICEF, WHO and their technical partners developed the strategy in a stepwise fashion, seeking to address limitations identified through experience with disease-specific child health programmes, and those addressing diarrhoeal disease and acute respiratory infections
Service delivery
Callaghan-Koru et al. (2020) [86] Chlorhexidine (CHX) cleansing policy Identify and compare facilitators of and barriers to the institutionalization and expansion strategies of the national scale-up of CHX Prioritizes several newborn health interventions such as kangaroo mother care, management of newborn infections and ensuring essential newborn care including the application of CHX to the umbilical cord Service delivery
Carneiro et al. (2018) [100] More physicians for Brazil programme (MPBP) as part of the Family Health Strategy (FHS) To evaluate the performance of the FHS, through the deployment of MPBP in Marajó-Pa-Brazil Broadening the access to basic healthcare services and connecting the teams to individuals, families and communities in the complex task of taking care of life Access to essential medicine
Costa et al. (2014) [101] FHS To re-evaluate the implementation of the FHS in the state of Santa Catarina between 2004 and 2008 by considering indicators of potential coverage, evidence of change in the care model, and the impact on hospitalizations Characteristics of the FHS are teamwork and ascribed distribution of patients, with a forecasted number of families/individuals under its responsibility
Proactive approach to the health of the community ascribed which relies on territorialization, family registers, diagnoses of health situations and health initiatives developed in partnership with the community
Service delivery
Ditlopo et al. (2011) [91] Rural allowance policy Analyse policy implementation and effectiveness and its influence on motivation and retention Attract and retain health professionals to work full-time in public health services in rural, underserved and other inhospitable areas identified by provincial health departments Financing
Doherty et al. (2017) [92] Prevention of mother-to-child transmission of HIV/AIDS (PMTCT) (Option B+) Present findings from a rapid assessment of PMTCT Option B+ implementation in Uganda 3 years after policy adoption PMTCT evolved progressively from single-dose nevirapine prophylaxis in 2000 to the current recommendation that all pregnant and breastfeeding women, irrespective of CD4 count, should receive lifelong antiretroviral treatment (ART), known as Option B+ Service delivery
Ejeta et al. (2020) [107] Strengthening Ethiopia’s Urban Health Promotion (SEUHP) implemented the Urban Community Health Information System (UCHIS) Document the challenges and lessons learned in the UCHIS implementation process Each of the 15 health service packages identified contained service cards and tally sheets to help improve data collection and standardization Health information system
Febir et al. (2015) [103] Integration of rapid diagnostic test (RDT) in IMCI Evaluate and report the issues health workers faced in integrating RDT management into their working practices In 2010 IMCI was adapted wherein case management of malaria should be a test-based approach, and therefore the integration of a rapid diagnostic test (RDT)-based intervention was undertaken Service delivery
Gueye et al. (2016) [108] Malaria elimination programmes:
Global technical strategy for malaria (GTS)
Action and Investment to defeat Malaria (AIM)
Global Malaria Eradication Programme (GMEP)
Examine countries in different socioeconomic, political and ecological contexts and evaluate how the health system has operated within the context of different political, financial and human resources activities
Identify how countries have implemented elimination programmes, and adapted their malaria elimination strategies
GTS: provided the framework for achievement of elimination and establishing an elimination goal for 35 countries. Programme to reach global goals for malaria control, elimination and eventually eradication
AIM: an action framework to reduce malaria through the Roll Back Malaria Partnership
GMEP: based on vertical time-limited interventions deployed through centralized health systems at the national level
Service delivery
Halpern et al. (2010) [77] The patient monitoring system (PMS) for patients with HIV Describe the process used to implement PMS
Provide examples of the programme-level data
Highlight benefits for national programmes
PMS is used for patient care and data collection
The physical components of the WHO HIV care and ART PMS include a patient chart, two patient registers, and cross-sectional and cohort analysis reporting form
Health information system
Investigators of WHO Low Birth Weight (LBW) Feeding Study Group (2016) [110] LBW feeding guidelines in first-referral-level health facilities Evaluate the effect of implementing WHO LBW feeding guidelines Guidelines aim to improve knowledge and skills of health workers
Guidelines for optimal feeding of LBW infants, to improve care and survival of LBW infants
Health workforce
Kavle et al. (2018) [114] Baby-Friendly Community Initiative (BFCI) Describe the implementation process
Discuss success, challenges, lessons learned and opportunities for integration into other health areas
Through mother-to-mother community support groups, BFCI addresses breastfeeding and nutrition challenges by providing educational interventions in community gardens, water, sanitation and hygiene Service delivery
Kihembo et al. (2018) [57] Integrated Disease Surveillance and Response (IDSR) Describe the design and process of IDSR revitalization, highlighting the rollout of the revised IDSR guidelines through structured training of the health workforce up to the operational level nationwide Strategy aimed at strengthening integrated, action-oriented public health surveillance and response at all levels of the health system
Focused on detection, registration, conformation, reporting, data analysis and provision of feedback
Service delivery
Lavôr et al. (2016) [111] Directly observed treatment, short-course (DOTS) Assess the degree of implementation of the DOTS strategy for tuberculosis (TB) in a large city DOTS is based on five fundamental components: sustained political and financial commitment; diagnosis through quality-ensured sputum-smear microscopy; standardized short-course anti-TB treatment; a management system for uninterrupted supply of anti-TB drugs; information system that allows monitoring and evaluation of actions and their impacts Access to essential medicine
Leethongdee (2007) [83] Universal coverage (UC) healthcare reform Understand the factors influencing the implementation at a local level
Build a general account of the reforms that fit each of three individual provincial cases
UC reform objective was to reduce geographical inequalities in funding and workflow distribution, problems in resource allocation, lack of progress in developing primary care, and tension between curative and preventative care approaches Financing
Li et al. (2015) [112] WHO essential drugs policy Analyse the impact on village-level and township-level health service system
Summarize the effectiveness of implementing essential drugs policy; identify the problems of various aspects
Conduct an in-depth analysis of the causes, and provide ways to improve the essential drugs policy
Essential drug policy aims to improve the availability of essential drugs and to promote rational drug use Access to essential medicine
Lovero et al. (2019) [93] The National Mental Health Policy Framework and Strategic Plan 2013–2020 (the Strategic Plan) Gain knowledge on stepped-care procedures for management of mental illness in primary care services
Determine the degree to which integrated procedures have been implemented
Identify challenges encountered in coordination of integration efforts
The Strategic Plan aims to fully integrate mental health assessment and management services, including screening, management of mental disorders, referral pathways and training, into all aspects of primary care, with an emphasis on TB, HIV and antenatal care services
The strategic plan was to be coordinated at the district administrative level
Service delivery
Miguel-Esponda et al. (2020) [69] Compañeros En Salud (CES) mental health programme Assess the implementation of the CES programme to understand the extent of success in integrating mental health into PHC
Determine strengths and limitations of the success or failure of integration
To determine managers’ and providers’ perspectives on the programme
Determine the key strengths and remaining challenges to the implementation of the CES mental health programme
CES aims to strengthen the PHC system to improve access to quality healthcare
The organization facilitates the delivery of general health services (including mental health) in 10 PHC clinics. For mental health, a coordinator oversees the delivery of mental health services and capacity-building activities and provides support for the management of complex cases
All mental health services are delivered by medical doctors (MDs)
Services are designed according to adapted clinical guidelines and include case identification, diagnosis, pharmacological treatments, individual and group talk-based interventions, and home visits
Service delivery
Mkoka et al. (2014) [94] Emergency obstetric care (EmOC) Explore the experiences and perceptions of a council health management team (CHMT) in working with multiple partners while illuminating some governance aspects that affect implementation of EmOC at the district level Strategy aims to strengthen all dispensaries and health centres through provision of basic EmOC (BEmOC) by strengthening the capacity of district hospital and upgrade by 50% health centres to provide comprehensive EmOC and strengthening health workers competencies Service delivery
Moshiri et al. (2016) [95] PHC Investigation of context, content, actors and process of PHC implementation
Investigation of the referral system situation in Iran from 1982 to 1989
In order to tackle physician shortages, foreign doctors were being hired en masse to support PHS implementation Service delivery
Mutabazi et al. (2020) [87] PMTCT Explore the perspective of experts and other key informants on the PMTCT integration into PHC Strategy involving the integration of testing to reduce mother-to-child transmission during different phases of pregnancy Service delivery
Muthathi et al. (2020) [96] Ideal clinic realization and maintenance (ICRM) programme Generate knowledge on the policy implementation
Examine the influence of motivation, cognition and perceived power of the policy actors and how it influenced ICRM implementation
Explore policy coherence in the ICRM programme
Explore the perceptions of stakeholders at the national, provincial and local government levels
The goal of the ICRM programme is to prepare all PHC facilities to meet the quality standards set by the Office of Health Standards Compliance (OHSC)
An ideal clinic is defined as a clinic with good infrastructure, adequate staff, adequate medicines and supplies, and good administrative processes, with sufficient bulk supplies; it uses applicable clinical policies, protocols and guidelines, and it harnesses partner and stakeholder support
Health workforce
Pyone et al. (2017) [104] Free maternity services (FMS) policy Understand how the policy changed health system governance in Kenya and use the insights to inform policy implementation in Kenya and in other LMICs FMS was part of a national strategy to reduce maternal and neonatal mortality, alleviate poverty and achieve the Millennium Development Goal targets; abolish user fees for all health services and dispensaries, and provide FMS in all levels of care of the government health sector Financing
Rahman et al. (2020) [105] Maternal, neonatal, child and adolescent health (MNC&AH) and community-based healthcare (CBHC), reproductive and adolescent health (MCR&AH) Understand key drivers for implementation of WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection (PSBI) with amoxicillin dispersible tablets (DT)
Generate evidence to strengthen newborn and child health programmes in Bangladesh
The Ministry of Health and Family Welfare (MOHFW) in Bangladesh provides healthcare services for childhood pneumonia and PSBI in the PHC setting through both the directorate of health services and directorate of family planning, under three operational plans
Incorporate child-friendly amoxicillin DT for the case management of childhood pneumonia and PSBI when referral for oral amoxicillin is not feasible
Service delivery
Roman et al. (2014) [66] Malaria in pregnancy (MIP) Assess how three countries in Africa were able to achieve greater progress in MIP control
Identify the practices and strategies that supported the success of the MIP programme
Identify bottlenecks in MIP programme implementation processes
Share lessons learned
The MIP framework aims to prevent and control malaria during pregnancy by focusing on three methods that stabilize transmission: (1) intermittent preventative treatment with sulfadoxine/pyrimethamine (SP) antimalarial drug; (2) use of physical insecticide nets; (3) effective case management based on signs and symptoms Service delivery
Ryan et al. (2020) [109] Comprehensive community mental health programme (CCMHP) Aims to help inform the utilization of public–private partnerships (PPPs) for mental health policy implementation in Nigeria and other low-resource settings by documenting a promising example from Benue Two community-based rehabilitation facilities operate under CCMHP
CCMHP procures medicines from CHAN Medi-Pharm and sets up Drug Revolving Fund at each health centre to ensure constant supply
Referrals are made directly between the community psychiatric nurse (CPN) or community health extension worker (CHEW) and specialists at Federal Medical Centre Makurdi or Benue State University Teaching Hospital
CPNs receive formal training, retraining and accreditation, funded by CCMHP
CCMHP trains people as community-level mental health advocates for promotion, identification and referral. CPNs and CHEWs conduct community outreach for follow-up
Service delivery
Saddi et al. (2018) [88] Brazilian national programme for improving primary care access and quality (PMAQ) To determine frontline worker adherence to PMAQ and their perception of the impact of the programme
Determine the relationship between the impact of the PMAQ as perceived by frontline workers and the way they evaluate the organizational capacity of the FHS at the front line
This programme was adopted in 2011 to improve the quality and performance of PHC in Brazil, which is broadly known through its main policy: the FHS
PMAQ objectives are (1) to promote quality and innovation in primary care management, strengthening self-assessment, monitoring and assessment, institutional support and permanent education processes; (2) to improve the use of information systems as a primary care management tool; (3) to institutionalize a primary care assessment and management culture; (4) to stimulate the focus of primary care on the service user, promoting management processes and transparency
Service delivery
Sami et al. (2018) [102] WHO standards for community- and health facility-based newborn care Examines the feasibility of implementing a package of community- and facility-based neonatal interventions WHO standards for community- and health facility-based newborn care prioritized the most critical services (neonatal interventions for reducing mortality) during a humanitarian crisis Service delivery
Schneider and Nxumalo (2017) [97] Ward-based outreach team (WBOT) strategy—adaptation for community health worker programme Understand the leadership and governance structure
Assess the provincial experiences with adoption and implementation of the WBOT strategy
Established set of proposals for the reorganization of community-based services Leadership/governance
Sheikh et al. (2010) [98] HIV testing policies Investigate problems in the implementation of standardized public health practice guidelines from the perspective of the participant actors Focused on the following aspects of the policy: (1) informed consent; (2) HIV testing as a precondition to preforming a medical procedure; (3) strict confidentiality Health workforce
Shelley et al. (2016) [99] National community health worker (NCHW) strategy Evaluate implementation process
Determine barriers and facilitators
Assess how evidence was used to guide ongoing implementation and scale-up decisions
A strategy developed to recruit community health assistants for assistance with disease burden through a comprehensive PHC curriculum
Strategy aimed to reduce maternal and child mortality by providing PHC services as close to the family as possible
Health workforce
Stein et al. (2008) [106] Practical Approach to Lung Health in South Africa (PALSA) PLUS programme Explore the value of PALSA PLUS guideline training approach from a PHC nurse perspective
Evaluate the strategies used for adoption
Health system-based approach to training for primary care providers with two components: (1) a comprehensive set of algorithm-based syndromic guidelines for PHC nurse clinical management of respiratory disease and HIV/AIDS; (2) a training programme to facilitate guideline implementation Service delivery
Wingfield et al. (2015) [113] CRESIPT: community randomized evaluation of a socioeconomic intervention to prevent TB Evaluate a socioeconomic intervention to support prevention and cure of TB in TB-affected households
Describe the challenges of implementation, lessons learned and refinement of TB intervention
The CRESIPT project aimed to evaluate a socioeconomic intervention (via cash transfers) to support prevention and cure of TB in TB-affected households and, ultimately, improve community TB control Financing
Xia et al. (2015) [89] PMTCT; prenatal HIV, syphilis and hepatitis B testing (PHSHT) Examine the challenges and effectiveness of integrating PHSHT services A priority strategy (promoted by WHO) involving the integration of services including testing to reduce mother-to-child transmission (MTCT) Service delivery
Zakumumpa et al. [85] ART scale-up Explore how different health system components interact in influencing the sustainability of ART scale-up implementation Provision of free antiretroviral drugs, workforce training in ART management, enhancing laboratory capacity and strengthening ART programme reporting Access to essential medicine
Zhou et al. (2019) [67] The mid- and long-term policy and development plan for mental health in Liuyang Municipality (Liuyang policy and Liuyang plan) Address the gap in China’s mental health policy literature with respect to local-level promotion and implementation
Provide a deeper understanding of China’s problems and general lessons for implementing mental health policy at the local level
The four main objectives of Liuyang policy and Liuyang plan include (1) establishing a leadership and coordination mechanism for mental health work; (2) constructing a three-level network of mental health services; (3) management and intervention for patients with psychosis (PWP); and (4) improving the public’s awareness and knowledge of mental health Leadership/governance