We aim to summarise the best and most relevant evidence from systematic reviews of health systems interventions relevant to low-and middle-income countries (LMIC). These summaries extract information from systematic reviews, evaluate the information and present it in a user-friendly manner so that decision-makers can quickly review the evidence and decide whether a particular innovation is likely to be effective in their own context.
Information presented in our summaries is based on systematic reviews because they have several advantages:
We have screened thousands of references to identify relevant systematic reviews. In order to be selected for a SUPPORT Summary a review must
We have searched the Cochrane Effective Practice and Organisation of Care Group’s database of systematic reviews, which contains reviews from the Cochrane Database of Systematic Reviews, DARE, PubMed, and Google Scholar.
After a review has been identified, two or more reviewers independently assess its relevance based on the abstracts and – when potentially relevant – based on the full text. Reviews that only include studies from high-income countries are included if the interventions examined and the results are considered relevant to LMIC. Next we assess the quality of all included reviews using a checklist and extract data about the focus and main results. The quality of evidence for the main comparisons in each review is graded using the GRADE system. Finally, we consider the applicability of the results to LMIC, impacts on equity, economic considerations, and the need for monitoring and evaluation. Completed summaries are peer-reviewed by policymakers and researchers in LMIC, other people with relevant expertise, and authors of the reviews being summarised.
Decisions about how to apply the results of systematic reviews are always located in specific contexts. As such they need to take into account local conditions, needs, values, costs and the local availability of resources. We include a summary of key considerations about the relevance of each review for LMIC. This includes judgements about possible differences between where the research was done and its application in LMIC. For health systems interventions this includes considerations of the following questions:
We address potential impacts on equity by examining the findings of the review and considering possible differential effects of the interventions for disadvantaged populations. The potential for impacts on equity is considered in relationship to economic status, employment or occupation, education, place of residence, gender, and ethnicity. This includes consideration of the following questions:
In settings with limited resources, policymakers are deeply concerned about the economic consequences of an intervention. The costs and cost-effectiveness of an intervention need to be assessed in a specific setting in order to take account of differences in patterns of resource use and prices. To help decision-makers to make these assessments, we consider what the most important economic consequences are that need to be considered prior to rolling out or scaling up an intervention or policy. This includes consideration of:
Finally, because there is often uncertainty about the effects and cost-effectiveness of interventions, we address the need for monitoring and evaluation, including consideration of:
For each SUPPORT Summary we consult people in LMIC regarding these judgements about the relevance of the review for LMIC.