TY - JOUR
T1 - Learning health systems in low-income and middle-income countries
T2 - exploring evidence and expert insights
AU - Witter, Sophie
AU - Sheikh, Kabir
AU - Schleiff, Meike
N1 - Funding Information:
Acknowledgements We would like to acknowledge the contribution of Charity Jensen, who worked on the two background papers which supported this article. Contributors SW led on the study design, data gathering, analysis and drafting and is guarantor for the work. KS contributed to the study design and drafting of the article. MS contributed to data gathering, analysis and drafting. All authors approved the final article. Funding This article is part of the supplement ‘Learning Health Systems’, a collaboration of the Alliance for Health Policy and Systems Research (the Alliance) and BMJ Global Health. The supplement and this article were produced with financial support from the Alliance. The Alliance is able to conduct its work thanks to the commitment and support from a variety of funders. These include long-term core contributors from national governments and international institutions, as well as designated funding for specific projects within our current priorities. For the full list of Alliance donors, please visit: https://www.who.int/alliance-hpsr/partners/ en/. The Alliance's flagship report on Learning Health Systems can be found here https://ahpsr.who.int/publications/i/item/learning-health-systems-pathways-to-progress.
Publisher Copyright:
©
PY - 2022/9/21
Y1 - 2022/9/21
N2 - Introduction Learning health systems (LHS) is a multifaceted subject. This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings. Methods We adopted an exploratory approach to the literature review, recognising there are limited studies that focus specifically on system-wide learning in LMICs, but a vast set of connected bodies of literature. 116 studies were included, drawn from an electronic literature search of published and grey literature. In addition, 17 interviews were conducted with health policy and research experts to gain experiential knowledge. Results The findings were structured by eight domains on learning enablers. All of these interact with one another and influence actors from community to international levels. We found that learning comes from the connection between information, deliberation, and action. Moreover, these processes occur at different levels. It is therefore important to consider experiential knowledge from multiple levels and experiences. Creating spaces and providing resources for communities, staff and managers to deliberate on their challenges and find solutions has political implications, however, and is challenging, particularly when resources are constrained, funding and accountability are fragmented and the focus is short-term and narrow. Nevertheless, we can learn from countries that have managed to develop institutional mechanisms and human capacities which help health systems respond to changing environments with € best fit' solutions. Conclusion Health systems are knowledge producers, but learning is not automatic. It needs to be valued and facilitated. Everyday governance of health systems can create spaces for reflective practice and learning within routine processes at different levels. This article highlights important enablers, but there remains much work to be done on developing this field of knowledge.
AB - Introduction Learning health systems (LHS) is a multifaceted subject. This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings. Methods We adopted an exploratory approach to the literature review, recognising there are limited studies that focus specifically on system-wide learning in LMICs, but a vast set of connected bodies of literature. 116 studies were included, drawn from an electronic literature search of published and grey literature. In addition, 17 interviews were conducted with health policy and research experts to gain experiential knowledge. Results The findings were structured by eight domains on learning enablers. All of these interact with one another and influence actors from community to international levels. We found that learning comes from the connection between information, deliberation, and action. Moreover, these processes occur at different levels. It is therefore important to consider experiential knowledge from multiple levels and experiences. Creating spaces and providing resources for communities, staff and managers to deliberate on their challenges and find solutions has political implications, however, and is challenging, particularly when resources are constrained, funding and accountability are fragmented and the focus is short-term and narrow. Nevertheless, we can learn from countries that have managed to develop institutional mechanisms and human capacities which help health systems respond to changing environments with € best fit' solutions. Conclusion Health systems are knowledge producers, but learning is not automatic. It needs to be valued and facilitated. Everyday governance of health systems can create spaces for reflective practice and learning within routine processes at different levels. This article highlights important enablers, but there remains much work to be done on developing this field of knowledge.
KW - health policy
KW - health services research
KW - health systems
KW - health systems evaluation
KW - review
UR - http://www.scopus.com/inward/record.url?scp=85141925970&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85141925970&partnerID=8YFLogxK
U2 - 10.1136/bmjgh-2021-008115
DO - 10.1136/bmjgh-2021-008115
M3 - Article
C2 - 36130793
AN - SCOPUS:85141925970
SN - 2059-7908
VL - 7
JO - BMJ Global Health
JF - BMJ Global Health
M1 - e008115
ER -