Search

Objective To conduct a systematic review on the effects of multisectoral interventions for health on health system performance. Methods We conducted a systematic review according to the preferred reporting items for systematic review and meta- analysis protocols. We searched for peer-reviewed journal articles in PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews on 31 August 2023 (updating on 28 February 2024). We removed duplicates, screened titles and abstracts, and then conducted a full-text eligibility and quality assessment. Findings We identified an initial 1118 non-duplicate publications, 62 of which met our inclusion and exclusion criteria. The largest proportions of reviewed studies focused on multisectoral interventions directly related to specific health outcomes (66.1%; 41 studies) and/or social determinants of health (48.4%; 30 studies), but without explicit reference to overall health system performance. Most reviewed publications did not address process indicators (83.9%; 52/62) or discuss sustainability for multisectoral interventions in health (72.6%; 45/62). However, we observed that the greatest proportion (66.1%; 41/62) considered health system goals: health equity (68.3%; 28/41) and health outcomes (63.4%; 26/41). Although the greatest proportion (64.5%; 40/62) proposed mechanisms explaining how multisectoral interventions for health could lead to the intended outcomes, none used realistic evaluations to assess these. Conclusion Our review has established that multisectoral interventions influence health system performance through immediate improvements in service delivery efficiency, readiness, acceptability and affordability. The interconnectedness of these effects demonstrates their role in addressing the complexities of modern health care. [phrase omitted] [phrase omitted] Objectif Realiser une revue systematique consacree a l'impact des interventions multisectorielles sur la performance des systemes de sante. Methodes Nous avons procede a une revue systematique en appliquant les elements de rapport privilegies dans les protocoles de revues systematiques et meta-analyses. Nous avons explore PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature, ainsi que la Base de donnees Cochrane des revues systematiques le 31 aout 2023 (mise a jour le 28 fevrier 2024), a la recherche d'articles de revue evalues par des pairs. Ensuite, nous avons supprime les doublons, passe les titres et resumes au crible, puis determine la qualite et l'admissibilite des articles complets. Resultats Nous avons initialement identifie 1118 publications non dupliquees; 62 d'entre elles repondaient a nos criteres d'inclusion et d'exclusion. Une grande partie des etudes examinees portaient sur des interventions multisectorielles en lien direct avec des resultats de sante specifiques (66,1%; 41 etudes) et/ou des determinants sociaux de la sante (48,4%; 30 etudes), sans toutefois faire explicitement reference a la performance globale des systemes de sante. La majorite des publications ne mentionnaient aucun indicateur de processus (83,9%; 52/62) et n'abordaient pas la durabilite des interventions multisectorielles dans le domaine de la sante (72,6%; 45/62). Nous avons neanmoins constate qu'en general, elles tenaient compte des objectifs relatifs aux systemes de sante (66,1%; 41/62): l'equite en sante (68,3%; 28/41) et les resultats de sante (63,4%; 26/41). Bien que la plupart (64,5%; 40/62) proposent des mecanismes visant a expliquer comment les interventions multisectorielles en matiere de sante pourraient amener aux resultats escomptes, aucune n'avait recours a des evaluations realistes pour les mesurer. Conclusion Notre revue nous a permis d'etablir que les interventions multisectorielles influencaient la performance des systemes de sante a travers des ameliorations immediates en termes d'efficacite, de disponibilite, d'acceptation et d'abordabilite des prestations de services. L'interdependance entre ces effets temoigne de l'importance qu'ils revetent lorsqu'il s'agit d'apprehender les rouages complexes des soins de sante modernes. [phrase omitted] Objetivo Realizar una revision sistematica sobre los efectos de las intervenciones multisectoriales en favor de la salud sobre el rendimiento de los sistemas sanitarios. Metodos Se realizo una revision sistematica de acuerdo con los items de informe preferidos para los protocolos de revision sistematica y metanalisis. Se realizaron busquedas de articulos de revistas con revision por pares en PubMed[R], Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature y la Base de Datos Cochrane de Revisiones Sistematicas el 31 de agosto de 2023 (actualizacion el 28 de febrero de 2024). Se eliminaron los duplicados, se examinaron los titulos y los resumenes y, a continuacion, se realizo una evaluacion de la elegibilidad y la calidad del texto completo. Resultados Se identificaron 1118 publicaciones iniciales no duplicadas, 62 de las cuales cumplian los criterios de inclusion y exclusion. El mayor porcentaje de estudios revisados se centro en intervenciones multisectoriales directamente relacionadas con resultados sanitarios especificos (66,1%; 41 estudios) o determinantes sociales de la salud (48,4%; 30 estudios), pero sin referencia explicita al rendimiento general del sistema sanitario. La mayoria de las publicaciones revisadas no abordaron indicadores de proceso (83,9%; 52/62) ni discutieron la sostenibilidad de las intervenciones multisectoriales en salud (72,6%; 45/62). Sin embargo, se observo que el mayor porcentaje (66,1%; 41/62) tenia en cuenta los objetivos del sistema sanitario: equidad sanitaria (68,3%; 28/41) y resultados sanitarios (63,4%; 26/41). Aunque el mayor porcentaje (64,5%; 40/62) propuso mecanismos que explicaban como las intervenciones multisectoriales para la salud podian conseguir los resultados previstos, ninguno empleo evaluaciones realistas para evaluarlos. Conclusion La revision que se realizo ha demostrado que las intervenciones multisectoriales influyen en el rendimiento de los sistemas sanitarios a traves de mejoras inmediatas en la eficiencia, la disponibilidad, la aceptabilidad y la asequibilidad de la prestacion de servicios. La interconexion de estos efectos demuestra su funcion a la hora de abordar las complejidades de la atencion sanitaria moderna., Introduction There is unequivocal recognition that health and well-being are determined by non-medical factors, including structural, social and commercial determinants of health. (1) Addressing those determinants is a task for [...]

Background: Extreme weather events affect health by directly and indirectly increasing illness burdens and changing healthcare usage patterns. These effects can be especially severe in rural and remote areas, exacerbating existing health disparities, and necessitating urgent mitigation or adaptation strategies. Despite increased research on health and climate change, studies focusing on rural and remote populations remain limited. This study aimed to review the relationships among extreme weather events, healthcare utilization, and health outcomes in rural and remote populations, identify research gaps, and inform policy development for adaptation and disaster management in these settings., Methods: A systematic scoping review was registered and conducted following the PRISMA-ScR guidelines. The search databases included PubMed, Web of Science, Scopus, the Cochrane Library, ProQuest, and the WHO IRIS. The included studies were primary research, focused on rural or remote areas, and investigated the effects of extreme weather events on either health outcomes or healthcare utilization. There were no methodological, date or language restrictions. We excluded protocols, reviews, letters, editorials, and commentaries. Two reviewers screened and extracted all data, other reviewers were invited to resolve conflicts. Findings are presented numerically or narratively as appropriate., Results: The review included 135 studies from 31 countries, with most from high-income countries. Extreme weather events exacerbate communicable and noncommunicable diseases, including cardiorespiratory, mental health, and malnutrition, and lead to secondary impacts such as mass migration and increased poverty. Healthcare utilization patterns changed during these events, with increased demand for emergency services but reduced access to routine care due to disrupted services and financial constraints., Conclusions: The results highlighted the essential role of community and social support in rural and remote areas during extreme weather events and the importance of primary healthcare services in disaster management. Future research should focus on developing and implementing effective mitigation and adaptation programs tailored to the unique challenges faced by these populations., (© 2024. The Author(s).)