NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Langlois ÉV, Daniels K, Akl EA, editors. Evidence Synthesis for Health Policy and Systems: A Methods Guide. Geneva: World Health Organization; 2018 Oct 8.
ÉTIENNE V. LANGLOIS and KAREN DANIELS .
Decision-makers require a wide array of knowledge to support policy and systems decisions and progress towards universal health coverage.
The need for evidence includes effectiveness of health systems interventions and policies, how and in what settings these interventions work, and their cost effectiveness, as well as stakeholders’ perceptions and views of health system challenges and policy options.
Evidence synthesis is a fundamental component of the evidence-informed approach to decision-making, improving how decision-makers plan, develop and implement policies and health systems interventions.
Evidence syntheses in health policy and systems research often require approaches and methods that embrace the complex nature of the evidence and the use of multiple types and sources of evidence.
Methods for conducting policy-relevant evidence syntheses are evolving swiftly, and there is an increasing interest in novel and complementary approaches, including mixed-methods syntheses.
Around the world, there is growing interest in ensuring that health policies and systems are informed by robust and relevant research evidence (1). Health policy-making and health systems strengthening require a broad evidence base tackling complex and multifaceted challenges. Policy-makers and health system stakeholders (henceforth termed “decision-makers”) thus require access to key insights stemming from a large body of literature that speaks to the realities of different health system settings. Systematic reviews and other types of evidence synthesis are increasingly recognized as having a key role in collating and assessing this knowledge, to inform policy decisions and produce guidance for health systems in various settings (2, 3).
For the purpose of this Methods Guide, we understand evidence synthesis as the contextualization and integration of evidence on a particular topic, including the findings of individual research studies (4). The process of synthesis is defined as the creation of something new from separate elements (5) which can include pulling together findings from multiple studies to answer a defined research question. The findings of evidence syntheses are often described as more reliable and valid than the results of individual studies, especially when the primary research results are conflicting (6). Evidence syntheses help in the collation, appraisal and reporting of research evidence through the use of transparent scientific methods that are detailed and reported in advance and that will be reproducible by others (7). A synthesis can take the form of a systematic review – defined as a review of the literature that uses systematic, explicit and accountable methods (5) – and may collate and integrate quantitative and/or qualitative results (8).
Traditionally, systematic reviews have focused mainly on synthesizing the effect measures of interventions to inform clinical care, health technology assessment and delivery of health care services (9). Increasingly, evidence syntheses of various types are recommended to support complex health policy and systems decisions. More specifically, evidence synthesis is now recognized as a fundamental component of the evidence-informed approach to decision-making, improving how decision-makers manage the research evidence available to them (2). Decision-makers at different levels increasingly acknowledge and demand evidence syntheses applicable to their local context, to improve the performance of the health system (10).
Synthesizing evidence from health policy and systems research (HPSR) is a useful approach to
Health policy-making and health systems strengthening require a broad evidence base tackling complex and multifaceted challenges.
support evidence-informed policy-making and health systems strengthening. For instance, evidence synthesis has the potential to reduce bias in the estimation of the effects of a policy option by identifying all relevant studies, critically appraising their quality, and synthesizing the results using a transparent and reproducible process. Yet evidence synthesis in the field of HPSR poses key challenges, not least those pertaining to the complexity and context-specificity of the knowledge at stake. Health policy and system decision-making is also driven by societal values and norms and is largely influenced by stakeholders’ interests and power. These issues are acknowledged in this chapter as key notions of HPSR, and we discuss how they can be accounted for in HPSR evidence synthesis.
The field of HPSR seeks to understand and improve how societies organize themselves in achieving collective health goals, and how different stakeholders interact in the policy and health system arenas (11). HPSR is often interdisciplinary, blending economics, sociology, anthropology, political science, public health and epidemiology to draw a picture of how health policies and systems function and respond to population health needs (11). HPSR encompasses research on the policies, organizations, programmes and people that make up health systems, and investigates how the interactions among these elements – and broader influences over decision-making practices – influence health system performance (12). It covers a wide range of issues, including health financing and governance, as well as the implementation of services and delivery of care in both the public and private sectors. HPSR enables the identification of gaps in capacity, barriers to efficient functioning and effective performance of the health system, and methods by which existing resources can be optimally utilized (1). HPSR can also cover the roles, interests, values and interactions of key stakeholders at local, national and global levels (11), as illustrated in Figure 1.1.
Interface of research in health policy and health systems.
Because HPSR is interdisciplinary and draws from a broad evidence base, HPSR evidence syntheses often require approaches and methods that embrace the complex nature of the evidence. Addressing this complexity requires, in turn, the use of multiple sources and types of evidence. Decision-makers certainly need reviews on the effectiveness of health policies and health system interventions, yet they also require a proper understanding of the barriers and facilitators to implementation of these interventions at all levels of the health system. For instance, reviews of the effectiveness of mobile health (mHealth) programmes can indicate how mobile telecommunication may increase the reach of health care delivery systems (13, 14). Yet such effectiveness reviews do not address important information gaps related to users’ satisfaction and the integration and sustained use of mHealth in different health system settings, nor do they inform decision-makers about the contexts in which these interventions work best and for whom. This body of evidence can be complemented by a review of stakeholders’ perceptions and experience of mHealth in primary health care systems (15). This example shows that synthesizing policy-relevant evidence often requires a combination of quantitative, qualitative and/or mixed-methods reviews.
Health system frameworks identify key functions and components – sometimes referred to as “building blocks” – that are subject to policy decisions and recognized as important determinants of health system performance (16). These components traditionally cover complex systemic challenges, including human resources for health. By their nature, health system components are intertwined, and understanding their interlinkages is critical to informing system-oriented interventions.
For example, progress in people-centredness and quality of services may depend on improvements in service delivery, management of health care professionals and availability of effective medicines, in addition to the engagement and empowerment of patients and caregivers (17). These complex interdependencies present a challenge in identifying and appraising research evidence to support efforts toward health systems strengthening. Consequently, this complexity offers a strong rationale for the development and use of various types of evidence syntheses to inform policy and systems decisions.
The reviews listed in Box 1.1 show how evidence syntheses can address the components of health systems and their interconnections, as well as health system performance. For instance, evidence syntheses can address the effects of different financial (18), governance (19) or service delivery (20) arrangements for health systems. In performing such syntheses, reviewers must bear in mind that health system components and interventions are often influenced by, or are sensitive to, the system itself and other contextual factors.
An evidence synthesis may configure the findings of studies on an issue of interest to allow a conceptual understanding of health system challenges (27). For instance, Abiiro & De Allegri (28) conducted a synthesis of the definition, perspectives and scope of universal health coverage, outlining various concepts – legal, humanitarian, social, public health and health economic – associated with indicators for measuring progress and long-term sustainability of such coverage. Evidence syntheses of HPSR are also useful for drawing a comprehensive picture of health system performance and the ways in which health policies and interventions can shape − and be shaped by − health systems and the broader determinants of health (11). Health systems settings and arrangements can influence the implementation and effectiveness of health policies and programmes. Syntheses of health systems evidence can thus be of great help in assessing the contextual determinants of health policy-making and implementation. One such example is a review of health system barriers and facilitators to the implementation of antiretroviral therapy for pregnant and postpartum women with HIV infection (29).
Health financing: impact of health insurance in Africa and Asia (21)
Governance arrangements for health systems, for instance decentralization of health systems in low- and middle-income countries (LMICs) (22)
Health system facilitators and barriers to the integration of HIV and chronic disease services (23)
District decision-making for health in low-income settings (24)
Frameworks to assess health system governance (25)
Integration of health systems and social determinants of health (26)
Different approaches to evidence synthesis can be employed to understand complex health systems interventions and to produce guidance for health systems strengthening (30, 31). Health policy and systems decisions require evidence syntheses that often go beyond the question of “what works” (32). Decision-makers are interested in reviews of the effectiveness of health policies and health systems interventions (which may take the form of meta-analyses), but they also require evidence on stakeholders’ perceptions and views of specific health system challenges and policy options. The latter issues are then amenable to a qualitative evidence synthesis or a mixed-methods synthesis, integrating quantitative and qualitative findings.
To address this need for a wide array of knowledge, novel approaches to evidence synthesis have
Policy-relevant evidence syntheses address issues such as the following:
 |  |  |  |  |
| What is the scope of the policy or health system “problem”? | What do we know about the issue? | What are effective solutions to this problem, for whom and in what context? | What are the various policy-making or decision-making options and their characteristics (such as distribution of benefits and costs)? | How can we implement and scale-up the solutions? |
Sources: Oliver, Dickson & Bangpan (27) and Lavis (37).
emerged to complement the traditional systematic review. One such novel approach is the realist review, in which the synthesis addresses how and why complex health systems interventions work in different contexts, going beyond the assumption that an intervention is either effective or ineffective (33); realist reviews are discussed in more detail in a methods commentary elsewhere in this volume. In turn, scoping reviews can be employed to map the concepts underpinning a policy and systems issue and the main sources and types of evidence available (34). Rapid reviews are also increasingly being used to provide actionable and relevant evidence to make informed decisions about health systems in both routine and emergency contexts (35). Similarly, meta-ethnography reviews provide a useful approach to understanding the views and experiences of stakeholders and to informing the implementation of health policy and systems interventions (36). Further information on the various approaches and methods available for evidence synthesis is provided in Chapter 3 of this Methods Guide and in Annex A, which presents a table of resources for conducting, reporting and assessing reviews.
Evidence syntheses can support health policy-making at numerous stages of the policy process, for instance, to illuminate policy problems, to challenge or develop policy assumptions, to offer evidence about the implementation and impacts of policy options, and to take into account a diversity of people and contexts (27). Syntheses are deemed to be “policy-relevant” when a priority question for health policy-making is addressed and the review findings are clearly presented for policy audiences (Box 1.2) (27, 37).
In turn, different phases in the policy-making cycle will require different types of knowledge and different evidence synthesis approaches, as shown in Table 1.1.
HPSR knowledge and evidence synthesis to support health policy-making.
Primary studies included in HPSR evidence syntheses may range from large, quantitative, hypothesis-testing experimental studies to small-scale, in-depth theory-developing qualitative research, and may generate a variety of data, from large-scale administrative data to local feedback and monitoring data (38).
To address these different types of knowledge and the variety of questions confronting health policy and systems decision-makers and researchers, a range of synthesis methods and approaches is needed. For instance, reviewers might conduct a realist review to illuminate what, why and how health policies and health systems interventions work in different contexts (further guidance on, and practical examples of, realist reviews are provided in the methods commentary on realist reviews elsewhere in this Methods Guide). Furthermore, the reliability of the evidence is likely to be greater if studies of different designs are examined together, and if their results are mutually supportive (39), which is crucial for health policy and systems decisions.
One challenge faced by reviewers of health policy and systems evidence is the selection of relevant synthesis methods to address different review questions. Methods for conducting policy-relevant evidence syntheses are evolving swiftly, and there is an increasing interest in novel and complementary approaches, for instance mixed-methods syntheses. The growing body of literature addresses new methods for identifying, interpreting and applying evidence in different decision-making contexts. Further guidance on these novel approaches, as well as the selection of appropriate methods and the integration of quantitative and qualitative evidence, is provided elsewhere in this Methods Guide (see Chapter 3, concerning the selection and application of various methods; Chapter 4, concerning the context for HPSR evidence synthesis; and Chapter 5, concerning reviews of complex interventions).
These challenges have led to attempts at synergizing within the field of health systems research synthesis (10), with the aim of advancing methods for complex knowledge synthesis to inform health policy and systems interventions and reforms. The field of health systems research synthesis evolved from recognition of the various methodological challenges in synthesizing health policy and systems evidence, as well as the need to strengthen capacities for synthesis of HPSR. These efforts supported the establishment of systematic review centres in LMICs, which focus on syntheses to improve the performance of health systems in those countries. Stakeholders involved in health systems research synthesis have also established networks such as the Global Evidence Synthesis Initiative (GESI) (40), to share good practices, provide training and increase collaboration in the field.
In addition, health systems research synthesis is concerned with the integration of review findings in policy and practice. Numerous challenges exist in the uptake of syntheses to support health policy and systems decisions. It is also important to understand that syntheses and research evidence in general constitute only one element in health policy-making and decision-making processes. Many factors beyond scientific findings influence policy- and decision-makers, such as financial constraints, legal issues, strategic fit for health systems, pressure from stakeholders and public opinion (9). Yet innovative approaches exist to promote and stimulate the usefulness of reviews, including the engagement of policy-makers in evidence syntheses, as well as priority-setting methods for evidence synthesis, both of which are addressed in more detail in Chapter 2 of this Methods Guide. In addition, there is an increasing body of knowledge on effective approaches to stimulate the use of evidence synthesis in complex health systems decision-making (41).
Fostering the uptake of evidence syntheses remains an important challenge for health system stakeholders, dependent on issues such as the availability and applicability of evidence, the transparency of evidence-informed policy-making and the presence of systems incentives to support application of the research. Specific challenges exist in LMICs, including the need for more primary studies and enhanced capacities, resources and knowledge systems to support the production and use of evidence syntheses in these settings. All of these factors are critical at a time when decision-makers require robust and context-sensitive evidence to advance health equity and universal health coverage worldwide.
Changing mindsets: strategy on health policy and systems research. Geneva: World Health Organization; 2012 (http://www .who.int/alliance-hpsr /alliancehpsr _changingmindsets_strategyhpsr.pdf, accessed 4 June 2018).
Oxman AD, Lavis JN, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 1: What is evidence-informed policymaking? Health Res Policy Syst. 2009;7 Suppl 1:S1. doi: 10.1186/1478-4505-7-S1-S1. [PMC free article : PMC3271820 ] [PubMed : 20018099 ] [CrossRef]
Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, Røttingen JA, Dröschel D, et al. Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development. PLoS Med. 2012;9(3):e1001185. doi: 10.1371/journal.pmed.1001185. [PMC free article : PMC3295823 ] [PubMed : 22412356 ] [CrossRef]
Grimshaw J. A guide to knowledge synthesis: a knowledge synthesis chapter. Ottawa (ON): Canadian Institutes of Health Research; 2010 (http://www .cihr-irsc.gc.ca/e/41382.html, accessed 4 June 2018).
Gough D, Oliver S, Thomas J, editors. An introduction to systematic reviews. Los Angeles (CA): Sage Publications; 2012.
Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;(10):CD010414. doi: 10.1002/14651858.CD010414.pub2 (https://www .cochranelibrary .com/cdsr/doi/10 .1002/14651858.CD010414.pub2/full). [PMC free article : PMC6396344 ] [PubMed : 24101553 ] [CrossRef]
Akobeng AK. Understanding systematic reviews and meta-analysis. Arch Dis Child. 2005;90(8):845–8. doi: 10.1136/adc.2004.058230. [PMC free article : PMC1720526 ] [PubMed : 16040886 ] [CrossRef]
Moher D, Stewart L, Shekelle P. All in the family: systematic reviews, rapid reviews, scoping reviews, realist reviews, and more. Syst Rev. 2015;4:183. doi: 10.1186/s13643-015-0163-7. [PMC free article : PMC4688988 ] [PubMed : 26693720 ] [CrossRef]
Lavis J, Davies H, Oxman A, Denis JL, Golden-Biddle K, Ferlie E. Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy. 2005;10 Suppl 1:35–48. doi: 10.1258/1355819054308549. [PubMed : 16053582 ] [CrossRef]
Langlois EV, Ranson MK, Bärnighausen T, Bosch-Capblanch X, Daniels K, El-Jardali F, et al. Advancing the field of health systems research synthesis. Syst Rev. 2015;4:90. doi: 10.1186/s13643-015-0080-9. [PMC free article : PMC4498528 ] [PubMed : 26159806 ] [CrossRef]
Bennett S. What is health policy and systems research and why does it matter? [briefing note]. Geneva: World Health Organization, Alliance for Health Policy and Systems Research; 2007 (http://www .who.int/alliance-hpsr /resources /Alliance%20HPSR%20- %20Briefing%20Note%201.pdf?ua=1, accessed 15 January 2017).
Gilson L, editor. Health policy and systems research: a methodology reader. Geneva: World Health Organization, Alliance for Health Policy and Systems Research; 2012 (http://www .who.int/alliance-hpsr /alliancehpsr_reader.pdf, accessed 7 June 2018).
Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care. Cochrane Database Syst Rev. 2012;12:CD007457. doi: 10.1002/14651858.CD007457.pub2 (http: //cochranelibrary-wiley .com/doi/10.1002/14651858 .CD007457.pub2/abstract). [PMC free article : PMC6486007 ] [PubMed : 23235643 ] [CrossRef]
Free C, Phillips G, Watson L, Galli L, Felix L, Edwards P, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med. 2013;10(1):e1001363. doi: 10.1371/journal.pmed.1001363. [PMC free article : PMC3566926 ] [PubMed : 23458994 ] [CrossRef]
Odendaal W, Goudge J, Griffiths F, Tomlinson M, Leon N, Daniels K. Healthcare workers’ perceptions and experiences on using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2015;(11):CD011942. doi: 10.1002/14651858.CD011942 (http: //cochranelibrary-wiley .com/doi/10.1002/14651858 .CD011942/abstract). [PMC free article : PMC4966615 ] [PubMed : 27478408 ] [CrossRef]
de Savigny D, Adam T, editors. Systems thinking for health systems strengthening. Geneva: World Health Organization, Alliance for Health Policy and Systems Research; 2009 (http://apps .who.int/iris /bitstream/10665 /44204/1/9789241563895_eng.pdf?ua=1, accessed 27 January 2017).
Sheikh K, George A, Gilson L. People-centred science: strengthening the practice of health policy and systems research. Health Res Policy Syst. 2014;12(1):19. doi: 10.1186/1478-4505-12-19. [PMC free article : PMC4018943 ] [PubMed : 24739525 ] [CrossRef]
Wiysonge CS, Paulsen E, Lewin S, Ciapponi A, Herrera CA, Opiyo N, et al. Financial arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev. 2017;9:CD011084. doi: 10.1002/14651858.CD011084.pub2 (http: //cochranelibrary-wiley .com/doi/10.1002/14651858 .CD011084.pub2/abstract). [PMC free article : PMC5618470 ] [PubMed : 28891235 ] [CrossRef]
Herrera CA, Lewin S, Paulsen E, Ciapponi A, Opiyo N, Pantoja T, et al. Governance arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev. 2017;9:CD011085. doi: 10.1002/14651858.CD011085.pub2 (http: //cochranelibrary-wiley .com/doi/10.1002/14651858 .CD011085.pub2/full). [PMC free article : PMC5618451 ] [PubMed : 28895125 ] [CrossRef]
Ciapponi A, Lewin S, Herrera CA, Opiyo N, Pantoja T, Paulsen E, et al. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev. 2017;9:CD011083. doi: 10.1002/14651858.CD011083.pub2 (http: //cochranelibrary-wiley .com/doi/10.1002/14651858 .CD011083.pub2/abstract). [PMC free article : PMC5621087 ] [PubMed : 28901005 ] [CrossRef]
Spaan E, Mathijssen J, Tromp N, McBain F, ten Have A, Baltussen R. The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ. 2012;90(9):685–92. doi: 10.2471/BLT.12.102301 (http://www .who.int/bulletin /volumes/90/9/12-102301.pdf). [PMC free article : PMC3442382 ] [PubMed : 22984313 ] [CrossRef]
Cobos Muñoz D, Merino Amador P, Monzon Llamas L, Martinez Hernandez D, Santos Sancho JM. Decentralization of health systems in low and middle income countries: a systematic review. Int J Public Health. 2017;62(2):219–29. doi: 10.1007/s00038-016-0872-2. [PubMed : 27572495 ] [CrossRef]
Watt N, Sigfrid L, Legido-Quigley H, Hogarth S, Maimaris W, Otero-García L, et al. Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review. Health Policy Plan. 2017;32:(Suppl 4):iv13–iv26. doi: 10.1093/heapol/czw149. [PMC free article : PMC5886067 ] [PubMed : 28666336 ] [CrossRef]
Wickremasinghe D, Hashmi IE, Schellenberg J, Avan BI. District decision-making for health in low-income settings: a systematic literature review. Health Policy Plan. 2016;31 Suppl 2:ii12–24. doi: 10.1093/heapol/czv124. [PMC free article : PMC5009221 ] [PubMed : 27591202 ] [CrossRef]
Pyone T, Smith H, van den Broek N. Frameworks to assess health systems governance: a systematic review. Health Policy Plan. 2017;32(5):710–22. doi: 10.1093/heapol/czx007. [PMC free article : PMC5406767 ] [PubMed : 28334991 ] [CrossRef]
Russell E, Johnson B, Larsen H, Novilla ML, van Olmen J, Swanson RC. Health systems in context: a systematic review of the integration of the social determinants of health within health systems frameworks. Rev Panam Salud Publica. 2013;34(6):461–7. [PubMed : 24569976 ]
Oliver S, Dickson K, Bangpan M. Systematic reviews: making them policy relevant. A briefing for policy makers and systematic reviewers. London: University College London, Institute of Education, Social Science Research Unit, EPPI-Centre; 2015 (http://www .who.int/alliance-hpsr /projects/eppibrief15.pdf, accessed 3 February 2017).
Abiiro GA, De Allegri M. Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates. BMC Int Health Hum Rights. 2015;15:17. doi: 10.1186/s12914-015-0056-9. [PMC free article : PMC4491257 ] [PubMed : 26141806 ] [CrossRef]
Colvin CJ, Konopka S, Chalker JC, Jonas E, Albertini J, Arnzel A, et al. A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women. PLoS One. 2014;9(10):e108150. doi: 10.1371/journal.pone.0108150. [PMC free article : PMC4193745 ] [PubMed : 25303241 ] [CrossRef]
WHO recommendations: Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva: World Health Organization; 2012 (http://optimizemnh .org/, accessed 7 June 2018). [PubMed : 23844452 ]
WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016 (http://www .who.int/reproductivehealth /publications /maternal_perinatal_health /anc-positive-pregnancy-experience/en/, accessed 7 June 2018). [PubMed : 28079998 ]
Lavis JN, Davies HT, Gruen RL, Walshe K, Farquhar RL. Working within and beyond the Cochrane Collaboration to make systematic reviews more useful to healthcare managers and policy makers. Healthc Policy. 2006;1(2):21–33. [PMC free article : PMC2585325 ] [PubMed : 19305650 ]
Wong G. Getting to grips with context and complexity - the case for realist approaches. Gac Sanit. 2018;32(2):109–10. doi: 10.1016/j.gaceta.2017.05.010. [PubMed : 28735621 ] [CrossRef]
Tricco AC, Lillie E, Zarin W, O’Brien K, Colquhoun H, Kastner M, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16:15. doi: 10.1186/s12874-016-0116-4. [PMC free article : PMC4746911 ] [PubMed : 26857112 ] [CrossRef]
Tricco AC, Langlois EV, Straus SE, editors. Rapid reviews to strengthen health policy and systems: a practical guide. Geneva: World Health Organization, Alliance for Health Policy and Systems Research; 2017 (http://www .who.int/alliance-hpsr /resources /publications/rapid-review-guide/en/, accessed 7 June 2018).
France EF, Wells M, Lang H, Williams B. Why, when and how to update a meta-ethnography qualitative synthesis. Syst Rev. 2016;5:44. doi: 10.1186/s13643-016-0218-4. [PMC free article : PMC4791806 ] [PubMed : 26979748 ] [CrossRef]
Lavis JN. How can we support the use of systematic reviews in policymaking? PLoS Med. 2009;6(11):e1000141. doi: 10.1371/journal.pmed.1000141. [PMC free article : PMC2777391 ] [PubMed : 19936223 ] [CrossRef]
Gough D, Thomas J, Oliver S. Clarifying differences between review designs and methods. Syst Rev. 2012;1:28. doi: 10.1186/2046-4053-1-28. [PMC free article : PMC3533815 ] [PubMed : 22681772 ] [CrossRef]
Sheldon TA. Making evidence synthesis more useful for management and policy-making. J Health Serv Res Policy. 2005;10 Suppl 1:1–5. doi: 10.1258/1355819054308521. [PubMed : 16053579 ] [CrossRef]
Global Evidence Synthesis Initiative [homepage]. GESI Secretariat; 2016 (http://www .gesiinitiative.com/).
Langlois EV, Becerril Montekio V, Young T, Song K, Alcalde-Rabanal J, Tran N. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches. Health Res Policy Syst. 2016;14:20. doi: 10.1186/s12961-016-0089-0. [PMC free article : PMC4794922 ] [PubMed : 26983405 ] [CrossRef]
© World Health Organization 2018.Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.
Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.
Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.
Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization.
