Learning health systems in low-income and middle-income countries

Exploring evidence and expert insights

Datos Bibliográficos

ID21880062
AutoresSophie Witter (0000-0002-7656-6188, Queen Margaret University, autor de correspondencia), Kay Sheikh (0000-0003-4755-2075, Alliance for Health Policy and Systems Research), Meike Schleiff (0000-0001-6492-3718, Johns Hopkins University)
Año2022
Volumen7
NúmeroSuppl 7
Páginase008115
Fecha de publicación2022-09-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-008115
PMID36130793
OpenAlexW4296799597
IdiomaEN
Citas recibidas16
Referencias citadas50

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 This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings.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

Accountability · Deliberation · Experiential knowledge · Experiential learning · Grey literature · Knowledge management · MEDLINE · Pedagogy · Political science · Politics · Public relations · Computer Science · Global Health and Surgery · Global Maternal and Child Health · Health Policy Implementation Science · Psychology