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Table 5 Summary of results and outcomes

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

Author/year Stakeholder involvement Outcomes of interest Outcome measures Key results Author conclusions/future directions
Amaral et al. [82] None reported Factors associated with the policy adoption Data from state secretariats of health New health interventions tend to be initially adopted by those who need them
Smaller and more distant municipalities were less likely to have IMCI
It is necessary to define health policies in each state that promote the strategy in higher-risk municipalities
Andrade et al. (2017) [75] Pan American Health Organization consulted on data collection methods
Stakeholders involved in implementation included; Government of the State of Minas Gerais; Government of Santo Antonio do Monte; The National Council of Health Secretaries
Macro processes of attention to chronic conditions model (ACCM)
Health outcomes associated with primary healthcare (PHC)
Household surveys and medical records
Focus groups
Increase in community health agent visits
Increase in individuals using public health services only among those with diabetes
A decrease in doctor visits for individuals with diabetes
Having a unified health system as the main provider of primary care in small municipalities was important
Establishing a PHC network in small municipalities was important
Importance in implementation of the macro process
Screening patients to receive treatment at different care levels
Armstrong et al. (2014) [90] Reproductive and child health coordinators, a district laboratory technician, a district nursing officer, district medical officer (DMOs), health secretaries, and zonal maternal and perinatal death reviews (MPDR) medical officers were informants who were professionally involved in MPDR The role and practices of MPDR in district and regional hospitals
Key stakeholders’ involvement in and perspectives regarding the MPDR process
Interviews Implementation of MPDR was dysfunctional
The system still faces a number of challenges, most of which may be related to a lack of clarity in its intended purpose
It is unwise for providers to disengage
Facility-level reviews are an important iterative learning process that should remain the core of any effort to improve care in health facilities
Should Tanzania wish to change the MPDR system at the local level, evaluation, training and supervision are recommended
Bergerot et al. (2017) [79] None reported Patients’ distress, anxiety, depression and quality of life Distress thermometer
Hospital anxiety and depression scale
Functional assessment of cancer therapy
Structured questionnaire
The prevalence of distress was high compared with developed countries Promote the development of strategies that favour equity in cancer care and that offer interventions in a timely manner
Measures used were adequate for the identification of patients’ needs throughout the continuum of cancer
The development of this screening programme achieved the goal of better meeting the psychosocial needs of cancer patients
Blanco-Mancilla (2011) [84] None reported Effectiveness of policy implementation Interviews
Newspaper articles
Official documents
Online news services and publications
Effective implementation in terms of access and capacity shows very different experiences between the policies analysed
More than half of the total number of primary health centres managed by the department of health were still not certified to treat policy beneficiaries, seriously affecting access to services
These policy recommendations may help to improve implementation of the policies, as well as other new or current policies either in Mexico or in other countries
Bryce et al. (2005) [58] None reported Compare findings of the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE-IMCI) relative to the programme expectation reflected in the IMCI impact model 12 country assessments
In-depth studies at five sites
Cross- site analysis
The quality of trained IMCI workers was better than that of the untrained workers, even with no supervision
Improving the quality of care in first-level government health facilities was not sufficient to increase low utilization levels
The model reflected issues directly related to service delivery, but showed insufficiencies with other aspects of the health system such as transition pathways from policy and strategy to operations, human resource issues including supportive supervision, financing and ensuring an equitable coverage of interventions
New attention to child survival, new leadership in key organizations, and a focus on achieving the Millennium Development Goal of reducing child mortality by two thirds all provide the impetus to move quickly, forcefully and in new ways to achieve universal coverage with proven child survival interventions
Callaghan-Koru et al. (2020) [86] Ministry of Health and Family Welfare (MOHFW)’s IMCI unit acted as the resource team coordinating scale-up
A group composed of stakeholders from government, academia and NGOs to made policy recommendations and provided guidance
A local pharmaceutical company supplied single-dose bottles
Local NGOs were contracted to coordinate the training of providers in each district
Facilitators and barriers with respect to the institutionalization and expansion stages Interviews
Focus groups
Documenting facilitators and barriers with respect to scale-up of chlorhexidine (CHX) policy (see Barriers/Enablers Table)
Strong leadership was a huge success factor
Public system was not evaluated given the complexity and limited regulatory control in this sector
Scale-up benchmarks would be useful approaches for identifying key institutionalization changes
Changes should be adapted to reflect the full structure of the health system
CHX counselling and distribution have not been routinely implemented in antenatal care expansion, suggesting that distinct plans and implementation strategies are needed to achieve goals within the two scale-up dimensions
The scale-up of CHX in Bangladesh was influenced by a range of factors from all five CFIR domains
Carneiro et al. (2018) [100] None reported Strategy performance Population coverage estimated by primary care teams
Proportion of live births to mothers with/without prenatal consultations
Hospitalization rates due to primary care-sensitive condition
Infant mortality rate
Resulted in changes to the management and control models used in the region, and introduced universities to the process
The proportion of live births to mothers with/without prenatal consultations increased by 97% on average, predominantly with seven consultations or more and reducing the proportion of live births to mothers without prenatal visits
The infant mortality rate achieved a downward trend
The results indicated the contribution of the more physicians in Brazil programme (MPBP) towards improving primary care based on the selected indicators
Costa et al. (2014) [101] None reported Indication of coverage
Evidence of change and impact
Home visits made by doctors
Requested exams of clinical pathology
Referrals to specialists, and individual care provided by nurses
Number of hospitalizations due to conditions that would respond to outpatient care (i.e. indicator of impact)
A majority of municipalities maintained the coverage level verified in 2004
One municipality presented strong indications of change in 2008 and was reclassified as moderate so as to allow the conduction of the statistical test
An increase of 50% in the proportion of municipalities classified as high-impact
More coverage compared with previous periods
Lower rates of morbidity
The proportion of municipalities with the expected number of requests remained small
There should be revision of work processes in Family Health Strategy (FHS) units, and a more in-depth investigation of the factors driving the small number of medical home visits, referrals to a specialist, requests for clinical pathology exams, and limited nursing care in relation to the number of medical consultations
Ditlopo et al. (2011) [91] None reported The implementation and perceived effectiveness of a rural allowance policy
The motivation and retention of healthcare professionals (HCPs) in rural hospitals
Policy review
Partial effectiveness of rural allowance in recruitment
Almost all policy-makers, hospital managers and HCPs consistently perceived the rural allowance to be divisive because it excluded junior nurses
Remoteness of the area not considered
Financial incentives alone were insufficient
Retention strategies that combined financial and nonfinancial incentives are likely to be more effective than increased remuneration alone, but these would need to be tailored to individual country contexts
Doherty et al. (2017) [92] Stakeholders were involved in determining the reasons and sustainability of the policy Impact of Prevention of mother-to-child transmission of HIV/AIDS (PMTCT) Option B+ implementation on the Uganda health system Interviews
Focus groups
Financial sustainability of the programme was a recurring theme because of funding insecurity
Senior stakeholders voiced concerns about the health system’s readiness to adopt the policy and the rapid pace of scale-up
Uganda has achieved success in scaling up access to ART and reducing the number of children newly infected with HIV
If ongoing investments and technical support for the HIV/AIDS response in Uganda are not allocated to strengthen the health system across programme areas, a significant opportunity may be lost
Ejeta et al. (2020) [107] City/town health offices
Sub-city and district offices
Community leaders
Regional health bureaus
Ethiopian Federal Ministry of Health
Members of the SEUHP programme
Health centres
Lessons learned
Challenges to implementation
Document review
The pilot test enabled the urban health extension professionals (UHE-Ps) to comprehensively focus on the 15 health service packages
Use of tally sheet helped collect high-quality data and report it to city/town health offices
Systematic categorization of households, based on their economic status and health service needs allowed for effective time management and delivery of services to vulnerable populations
Plans are made to scale up the programme to major cities
Febir et al. (2015) [103] None reported Perceptions of healthcare workers (HCWs) regarding the issues faced Interviews Implementation faced challenges given the weak health systems in most developing counties
The perceptions of frontline HCWs on the accuracy and need for the guideline together with the capacity of health systems to support implementation played a crucial role
Guidelines on financing of diagnostics and treatments are influencing clinical decision-making in this setting
Further research is needed to understand the impact of the National Health Interview Survey (NHIS) on the feasibility of integrating test-based management for malaria of the IMCI guidelines
Findings suggest that the problem is heightened by beliefs and habits of frontline health staff in health facilities in developing countries that are used to presumptive treatment and perceive every fever to be malaria
Gueye et al. (2016) [108] None reported Ways in which countries have implemented elimination programmes
The development and adoption of programmes
How programmes operated within their context
Review of case study reports Malaria programmes did not show a high level of capacity for anticipation of threats to elimination
There were many examples of major development projections that combined a potential for increased receptivity and vulnerability
Monitoring and evaluation included monitoring programme outputs and evaluation of impact
Global malaria eradication will require well-managed malaria programmes providing high-quality implementation of evidence-based strategies, founded upon strong surveillance and response strategies tailored to the subnational level transmission context
Adequate funding and human resources to sustain malaria elimination and prevention of reintroduction is also required
Halpern et al. (2010) [77] Stakeholders agreed on the ideal system for Guyana Implementation strategy
Benefits of monitoring national programmes
Cross-sectional reports
Cohort analysis reports
Monthly visits from a member of the working group
Patient charts and registers
A large discrepancy was found between the data provided in the cross-sectional reports submitted prior to the use of the PMS and the data from those submitted after its implementation
79% of a combined national cohort who started ART were alive and on first-line ART regimens. After 6 years, 58% of the first cohort of ART patients in the country were alive and on ART, with only 8% patients on second-line regimens
The lessons learned during implementation can be used to better inform other countries in the region in need of information systems that can both improve patient care and produce high-quality data to inform programmatic and policy decisions
Investigators of WHO Low Birth Weight (LBW) Feeding Study Group (2016) [110] None reported Assessment of facilities, supplies and equipment
Assessment of quality of care
Assessment of knowledge, clinical skills and counselling skills of HCPs
Observation visit by expert paediatrician
Written test
Five objective structured clinical examinations
Interviews with HCPs for feedback (in post-implementation phase only)
30% of nurses reported a significant increase in their workload following implementation of the guidelines
No significant change in key practices like early initiation of breastfeeding, exclusive breastfeeding and prelacteal feeding
Resulted in significant improvement in the knowledge and skills of HCPs and mothers and were instrumental in promoting positive health behaviour at hospital discharge
Needed additional efforts on part of HCWs/additional staff and efforts to promote generic early feeding practice
Kavle et al. (2018) [114] Ministry of Health
UNICEF Kenya Partnerships
Implementation experience of Baby-Friendly Community Initiative (BFCI)
Successes, challenge, and lessons learned
Opportunities for integration
Discuss the future and next steps
Review of key governmental programme documents
Implementation monitoring
Coverage of BFCI was high and it surpassed the government target of 28% of all “community units implementing BFCI” by 2016/2017
Improved early initiation of breastfeeding and exclusive breastfeeding (EBF) were notable during and after implementation for a 3-month period
Buy-in from national leaders is key
Mentorship by trainers played a key role
Social mobilization efforts promote EBF
Implementation can motivate early and frequent antenatal care (ANC) attendance, encourage attendance to health facility for childbirth and may improve immunization uptake
Kihembo et al. (2018) [57] UKAid Department for International Development
United Nations Central Emergency Response Fund (CERF)
Newborn, adolescent and child health
United States Agency for International Development (USAID)
Centers for Disease Control and Prevention (CDC)
Document the IDSR implementation framework
Evaluate planning and monitoring
Understand the design and organization
Understand the logistics and resources deployed in the process
Pre- and post-training scores
Review of published and unpublished guidelines
Review of preparedness and response protocols
Review of training documents
Meeting minutes
Through a coordinated partner support and response, funding, which was not primarily earmarked for IDSR implementation, was mobilized and harnessed to achieve nationwide equipping of multidisciplinary district teams with skill sets and tools necessary for performing relevant functions A collaborative effort results in a coordinated significant impact on public health
The revitalization of the IDSR programme highlights unique features which can be easily adopted and applied by other countries that wished to strengthen their IDSR programmes
Lavôr et al. (2016) [111] None reported Degree of implementation Interviews with nurses
Record book of symptomatic respiratory patients
Record book and monitoring of TB cases
Patient charts
Treatment form
Monthly report activity
In bacteriological diagnosis, classification was partially implemented
Only bacilloscopies for follow-up treatment are carried out in 100% of basic health units (BHU)
There was no relationship between the degree of implementation and effectiveness of the programme
Political organization in the implementation of the direct observation of therapy (DOTS) strategy was impaired and weakened by its implementation
Mobilized community partners with HCPs can be organized in support of a cause and build their own strategies of actions to strengthen public health policies, through the inclusion in the formal social control agencies
The DOTS strategy was classified as partially implemented in the BHU studied
Leethongdee (2007) [83] None reported Influences of implementation Interviews
Focus groups
Documentary analysis
Main changes focused on the role of public organizations, and tensions between the old and new administrative structures
The choice of funding mechanism was an important area of local discretion
Many respondents, especially at lower levels, had a poor understanding of the purchaser/provider split about to be implemented in the Thai system, which highlighted the huge shift in culture that would be required in the new system
There was a macro-level problem concerning the distribution of finance and the workforce across the nation
There was a micro-level problem concerning the distribution of resources by contracting units for primary care (CUPs) to hospitals and health centres
There was a cycle of policy prescriptions, local adaptations and higher-level policy revisions that affected several aspects of the reforms and particularly the financing mechanism, which resulted in the lower-level actors having the most impact
Li et al. (2015) [112] None reported Impact of essential drug policy on primary care services
Effectiveness of implementing essential drug policy
Field observation
Main operation indicators
Implementation was very stable
The health administrative departments should strengthen the choice, confirmation, assessment and control of distribution companies, establish the industry standards of drug distribution industry as soon as possible, and improve the access threshold
Through the investigation of grassroots medical institutions, we can determine the principles, varieties and prices of specifically supplied drugs, and the state can designate specialized manufacturers for drug manufacturing and government can provide financial subsidies
Lovero et al. (2019) [93] None reported The procedures for stepped care management
Perceived challenges to implementation
HCP training
HCP experiences of managing mental illness
Mental health screening should be conducted by nurses for all patients at PHC facilities
Mental healthcare referrals should be made within clinic to MHPs and/or to other facilities based on case severity and availability of mental health personnel within clinic
There is a lack of training and consistency in the uptake of roles and responsibilities by nurses and MHPs
Improved district-level administrative coordination, mental health awareness and financial resources are critical to the success of integration efforts
Miguel-Esponda et al. (2020) [69] None reported The extent to which the programme activities have been integrated into the organization and the PHC clinics Sociodemographic and clinical characteristics
Challenges to delivery of services within the programme included time constraints coupled with the many competing priorities present at the clinics, and the limited availability of specialists to provide mentorship to MDs
All MDs and clinical supervisors perceived a need for more involvement of either psychologists or psychiatrists to improve the training and supervision and also to advise on difficult cases
Integration of mental healthcare services in PHC will require improved financing and resource management of PHC and specialist services, ongoing capacity-building, the development of effective referral systems, further development of community-based services, and linking of PHC with locally relevant social interventions
Mkoka et al. (2014) [94] Involved in implementation Exploring the experience of respondents in implementing emergency obstetric care (EmOC)
Perceived role of partners in EmOC implementation
Focus groups
Facility survey
Documentary reviews
Council health management team (CHMT) took the lead and worked with team spirit
There was increased demand for services
There was resource scarcity in terms of skilled HCPs, funds and time
Working with competing needs
Acknowledging importance of partners, partially because they play different roles
A need for clear working arrangements
A desire for community participation
Progressing towards better service
Advocates working together in partnerships to govern implementation
To have effective partnerships, the roles and responsibilities for each actor should be clearly stipulated in a clear working framework within the district health system
Moshiri et al. (2016) [95] Because the implementation requirements, including staffing, structure and funding, were in the hands of the deputy for health, there was limited collaboration with the other sections of the MOH Details of implementation Interviews The implementation approach better corresponded with a top-down approach that realizes policy change versus a hierarchical process Existence of a working PHC network served as proper infrastructure for its implementation
Mutabazi et al. (2020) [87] Stakeholders included the United States President’s Emergency Plan for AIDS Relief; Global Fund to Fight AIDS, Tuberculosis and Malaria; USAID; CDC; International NGOs Experiences involved in daily activities Interviews
Self-administered questionnaire
Agreement on the importance of guideline integration
Frontline HCPs experienced high workloads, high staff turnover and lack of infrastructure
Additional assistance from HCP and nurses was essential for support
Increased testing from the implementation of PMTCT programme showed a reduction in diagnosed HIV/AIDS in children
Addressing the challenges of integration of PMTCT will help in eliminating mother-to-child transmission of HIV/AIDS
Muthathi et al. (2020) [96] Involved in design and implementation Policy context, rationale and philosophy
Intergovernmental relationships, perceptions of roles and responsibilities in implementation
ICRM programme resourcing
Implementation progress, challenges and constraints
Interviews The central theme was the imperative to improve the quality of PHC in preparation for implementation
Four themes emerged related to structural context: contestations about roles and responsibilities; weak intergovernmental relationships; enabling local leadership; and insufficient resourcing of the ICRM programme
Three themes emerged related to specific context: gaps in the existing NCS; insufficient policy coherence; disjuncture between the NCS and ICRM programme
The design of any health reform should consider policies or initiatives that ensure coherence and the availability of resources
Major change initiative requires involvement of all relevant policy actors in design and implementation
Clear communication strategies and ongoing monitoring and evaluation are prerequisites for the success of policy implementation
Pyone et al. (2017) [104] Qualitative research was carried out using semi-structured interviews with 39 key stakeholders from six countries in Kenya The implications of the implementation of the free maternity services (FMS) policy on health system governance
Strength of the implementation programme
Semi-structured interviews
Institutional analysis as a theoretical framework
The newly introduced formal institutional (re)arrangements were unclear
Implementers faced challenges of accountability, especially adherence to the FMS policy
When resources were constrained, HCPs were less likely to be accountable, as they were not provided with the resources to work
There were discrepancies between formal and informal rules which created a misalignment of incentives for policy implementation
Aligning the objectives of the implementers with new policies, corresponding institutional (re)arrangements, enforcement mechanisms and incentives is crucial
Rahman et al. (2020) [105] Stakeholders discussed the challenges and opportunities for implementation of the WHO recommendations that emerged from the study Facilitators and barriers to implementation Interviews
Documents analysis
Advocacy initiatives should be undertaken to promote policy revisions
Training and instructions should be provided
Incomplete policy adoption can be attributed to insufficient coordination among divisions; lack of central procurement of amoxicillin dispersible tablets (DT); and perceptions of the efficacy of antibiotics and formulations at the national and district levels
Significant progress occurred, but key challenges remain at the national and subnational levels, contributing to slow adoption of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection (PSBI) using amoxicillin DT
Roman et al. (2014) [66] Stakeholders helped inform the development of key informant interview guides
Qualitative data were collected through in-depth interviews among key stakeholders at the national level
Promising practices/strategies that have support programming success
Implementation barriers
Lessons learned
Secondary data (literature review)
Integration—strengthening and creating national groups (stakeholders)
Policy—in line with WHO guidelines and also interpreted in a similar manner across health systems
Commodities—availability in drug resources and stock
Quality assurance—assessment tools to monitor progress and alleviate barriers at the time
Capacity-building—successful when focused on pre-training and in-service training
Community involvement/engagement—linking community- with facility-level care and promoting community engagement and knowledge about MIP programme
Monitoring and evaluating—three case studies did implement this and caused challenges for national synthesis and reporting
Financing—more dedicated support for MIP programme by advocating building of in-country awareness from community to national level
The timing affords countries the opportunity to reprioritize MIP programming to ensure effective technical oversight and programme management
Ryan et al. (2020) [109] Meetings with the CBM mental health advisor for Nigeria; welfare officers from community-based rehabilitation centres, the Bishop of the Methodist Church Diocese of Otukpo in Benue State, the Benue state health management information systems officer, the Benue state director of public health and other state and local government officials Environment and health system in which the programme functions
History of the programme
Programme model and conceptual framework
Engagement with broader systems
Programme resources and management
Client characteristics
Pathways to care
Clinical interventions
Psychosocial interventions
Accessibility of services
Information systems used
Field visits
Service utilization data
It is possible to leverage a public–private partnership (PPP) with not-for-profit partners to rapidly expand mental health services in primary care
Coordinated efforts across primary, secondary and tertiary care is needed
More research is needed to document and evaluate PPPs for mental health in LMICS, with a focus on sustainability
Saddi et al. (2018) [88] None reported Perceptions about primary care access and quality (PMAQ)
Organizational barriers to the implementation of FHS
Semi-structured interviews
Low organizational capacity influenced the perceived impact of the doctors, nurses and community HCPs
Adherence to PMAQ at the front line follows a top-down pattern; 46% of HCPs reported that adherence was the result of the PMAQ being imposed by the municipal health secretary (SMS), and 26% of HCPs reported adherence was due to trying to improve service quality
More contextualized public policy or health policy research, focusing on frontline workers, could be implemented
Sami et al. (2018) [102] None reported Explain the main health system bottlenecks for implementation
Barriers and facilitators
Recommended solutions
Focus groups
Direct observations
Collection of variety of documents
See barriers and enablers in Table 7 Further research to improve the implementation of community- and facility-level newborn interventions in settings with ongoing conflict
Understanding the feasibility of guidelines recommended in context would allow for specific adaptations and innovations
Schneider and Nxumalo (2017) [97] None reported Policy formation/adoption
Reallocation of roles and responsibilities
Development of new systems
How change is led and managed
Document review
Routine and audit data
Negotiating a fit between national mandates, provincial and district histories and strategies of community-based services
Defining new organizational and accountability relationships between CHWs, local health services, communities and NGOs
Revising and developing new aligned and integrated planning, human resources, financing and information systems
Leading change by building new collective visions, mobilizing political support and designing implementation strategies
Contributed to an understanding of leadership and governance functions in strengthening CHW programmes
Suggest the need for multilevel frameworks that provide both direction and flexibility, allowing for emergence and negotiation
Highlighted the multifaceted, negotiated and distributed nature of these functions, spanning analytical, managerial, technical and political roles
Future work includes evaluating the implications of assessing or strengthening the leadership and governance of national CHW programmes
Sheikh et al. (2010) [98] None reported Perspectives of different groups of actors on their own participation in the implementation process Interviews Informed consent was seen as unwelcome obstacles
Physicians typically followed unwritten rules that were based on their own clinical judgement and the best interest of the patient, not necessarily the guideline
Lack of private rooms resulted in physicians disclosing confidential results in front of other patients
Contributed an understanding of health policy implementation in India from the “emic” perspectives of the various participant actors
Shelley et al. (2016) [99] This process evaluation utilized interviews with a variety of stakeholders to explore perspectives and lessons from the first 6 months of community health assistant (CHA) deployment Lessons learned
Barriers to and facilitators of fidelity
Interviews Community acceptance is essential to successful programme implementation
Effective and reliable supervision is considered a cornerstone to success
Findings allowed the government to make informed decisions and adjustments prior to second deployment of CHAs
Stein et al. (2008) [106] None reported Perceptions of those involved in the programme
Value of the training approach
Participants’ observations
Focus groups
Training was interactive and effective
Integrative training approach allowed for supervisory feedback
A horizontal training approach facilitated the implementation process
Training was effective and more likely to be effective within a health system framework which consistently provides PHC services
Improved quality of care was seen in a range of illnesses
Nurses were overstretched and many PHC clinics were understaffed
All levels of healthcare system teams should be engaged in programme implementation
Wingfield et al. (2015) [113] Formative activities included consultations, focus group discussions and questionnaires conducted with the project team, project participants, civil society and key NGO stakeholders Cash delivery strategy
Cash transfer size
Cash transfer timing
Cash transfer conditions, levels and responsiveness
Performed an acceptability assessment
Quantitative and qualitative data from participants, a civil society group of ex-patient community representatives, CRESIPT [community randomized evaluation of a socioeconomic intervention to prevent TB] project staff and local and regional Peruvian TB programme staff and coordinators
A novel TB-specific socioeconomic intervention proved to be feasible in an impoverished, urban environment and is now ready for impact assessment, including by the CRESIPT project
Of potential cash transfers, 74% were achieved, 19% were not achieved, and 7% were yet to be achieved
Of those achieved, 92% were achieved optimally and 8% suboptimally
Cash transfer strategy should be tailored to household needs
Lessons from CRESIPT will aim to assist TB control programmes to effectively implement the recent global policy change of including socioeconomic support as part of TB control activities
Xia et al. (2015) [89] Stakeholders were interviewed and surveyed Service user views on integrated prenatal HIV, syphilis and hepatitis B testing (PHSHT) services
Service users’ knowledge and satisfaction of PHSHT services
Factors affecting how the integration of services was coordinated
Routine monitoring
Focus groups
Pregnant women had little knowledge of PHSHT services and found the service process to be long and complicated
HIV tests were above the national standard, unlike syphilis and Hep B
Lack of referral network between lab results resulted in significant delays
Conducting regular meetings between health agencies could improve information exchange
Establishing a proper client referral system with an integrated information systems could help reduce redundancy
Decentralization of services could help simplify process
Facilitate task-shifting and community participation
Zakumumpa et al. [85] None reported Sustainability of ART scale-up implementation
Access to ART medicines
Interconnections in health system subcomponents
National survey of health facilities
Organizational case studies
Access to ART medicines at the level of frontline health facilities were influenced by information systems, human resources, governance and leadership
Failure to maintain basic ART programme records, owing to health workforce shortages, contributed to chronic ART medicines stock-outs
Health system strengthening interventions, especially targeting lower-level and rural-based health facilities, are recommended to promote ART programme sustainability
Zhou et al. (2019) [67] Consultations with stakeholders Formulation process, content and implementation issues Interviews
Open-ended surveys
Strategies to achieve the four policy objectives were unevenly covered
Two action areas, namely “quality improvement” and “procedure and distribution of essential medicines”, were not covered
The limited human resources made working part-time very common
Considering policy operationality, targets, time frames and evaluation indicated were consistent with national ones, but mainly set for priority strategies
Solid evidence, high-level approval, involvement of multiple stakeholders, detailed and comprehensive arrangements in operational issues, and clear policy focuses will promote successful implementation of mental health policy