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Improving health system performance

This section contains RHL summaries of published systematic reviews on a wide variety of interventions and strategies to improve health system performance. This includes interventions to improve delivery of healthcare services, financial arrangements and leadership and governance arrangements. Also included are summaries prepared by the SUPPORT project.

Implementation strategies

Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes

Recent community-based studies on interventions aimed at women of reproductive age have raised doubts whether these strategies provide consistent benefit across the continuum of maternal and newborn care. This review sought to evaluate the effectiveness of community-based intervention packages in...

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WHO recommendation on facilitated participatory learning and action cycles with women`s groups during pregnancy

The implementation of community mobilization through facilitated participatory learning and action (PLA) cycles with women’s groups is recommended to improve maternal and newborn health, particularly in rural settings with low access to health services. Participatory women’s groups represent an...

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WHO recommendation on midwife-led continuity of care during pregnancy

Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for pregnant women in settings with well functioning midwifery programmes.

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Interprofessional education: effects on professional practice and health-care outcomes

Citation: Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD002213. DOI:10.1002/14651858.CD002213.pub3

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WHO recommendation on woman-held case notes during pregnancy

It is recommended that each pregnant woman carries her own case notes during pregnancy to improve continuity, quality of care and her pregnancy experience.

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WHO recommendation on group antenatal care

Group antenatal care provided by qualified health-care professionals may be offered as an alternative to individual antenatal care for pregnant women in the context of rigorous research, depending on a woman’s preferences and provided that the infrastructure and resources for delivery of group...

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WHO recommendation on antenatal care contact schedules

Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care

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Leadership and governance arrangements

Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes

Interventions to overcome challenges in inter-professional collaboration can potentially improve professional practice and health-care outcomes. This review assessed the impact of practice-based interventions designed to improve collaboration. Of the five included studies, two had examined inter-...

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Financial arrangements

An overview of reviews evaluating the effectiveness of financial incentives in changing health-care professional behaviours and patient outcomes

This overview of systematic reviews evaluates the impact of financial incentives provided to health-care professionals on their behaviour and patient outcomes. The four included reviews report on 32 studies (adjudged by the authors to be of low to moderate quality). Payments for work for a...

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Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians

Methods of remuneration for health care have been used to influence health-policy outcomes (e.g. cost reduction or improved quality of care), but little is known about how different payment systems affect health policy objectives. This review sought to evaluate the impact of different methods of...

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Pharmaceutical policies: effects of cap and co-payment on rational drug use

An updated version of this systematic review has been published and can be found online at www.cochrane.org . We will soon update the below RHL summary to reflect the updated findings of the systematic review. Cap and cost-sharing policies were introduced to reduce the use of unnecessary...

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Paying for performance to improve the delivery of health interventions in low- and middle-income countries

Paying health-care workers for higher performance is a complex intervention that has been suggested to improve public health goals. This review assesses the current evidence for the effects of paying for performance on the provision of health-care services and health outcomes in low- and middle-...

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Delivery of healthcare services

WHO recommendation on community mobilization and antenatal home visits

Packages of interventions that include household and community mobilization and antenatal home visits are recommended to improve antenatal care utilization and perinatal health outcomes, particularly in rural settings with low access to health services.

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Alternative packages of antenatal care for low-risk pregnant women

Reduced visits programmes of antenatal care are associated with an increase in perinatal mortality compared to standard care. Women are less satisfied with the reduced visits schedule and gaps between visits. Reduced visits schedule may be associated with lower costs.

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Doctors or mid-level providers for abortion

The review assessed safety and/or effectiveness for any type of first trimester abortion procedure by any type of mid-level provider, compared to doctors.

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Strategies for communicating contraceptive effectiveness

Effectively communicating contraceptive effectiveness is critical to making informed choices. There is currently no evidence to suggest that any one counselling strategy is superior to others. More well-designed and explicitly described studies are needed to further guide practitioners.

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Effect of outpatient pharmacists' non-dispensing roles on patient outcomes and prescribing patterns

Citation: Nkansah N, Mostovetsky O, Yu C, Chheng T, Beney J, Bond CM, Bero L. Effect of outpatient pharmacists’ non-dispensingroles on patient outcomes and prescribing patternsCochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD000336. DOI:10.1002/14651858.CD000336.pub2

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Standardised formal neonatal resuscitation training (SFNRT) programmes for reducing mortality and morbidity in newborn infants

The review assessed whether SNFRT programmes can reduce neonatal mortality and morbidity, improve knowledge and skills, or change teamwork and resuscitation behaviour (compared to no SNFRT).

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Vacuum aspiration for induced abortion in the first trimester

The WHO recommendations for health worker roles in providing safe abortion care and post-abortion contraception (2015) provide a range of options of types of health workers who can perform specific abortion care and post-abortion contraception tasks safely and effectively.

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