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Learning health systems in low-income and middle-income countries: exploring evidence and expert insights

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 This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middl...

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Autores principales: Witter, Sophie, Sheikh, Kabir, Schleiff, Meike
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9490579/
https://www.ncbi.nlm.nih.gov/pubmed/36130793
http://dx.doi.org/10.1136/bmjgh-2021-008115
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author Witter, Sophie
Sheikh, Kabir
Schleiff, Meike
author_facet Witter, Sophie
Sheikh, Kabir
Schleiff, Meike
author_sort Witter, Sophie
collection PubMed
description 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 This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings.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.
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spelling pubmed-94905792022-09-22 Learning health systems in low-income and middle-income countries: exploring evidence and expert insights Witter, Sophie Sheikh, Kabir Schleiff, Meike BMJ Glob Health Original Research 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. BMJ Publishing Group 2022-09-20 /pmc/articles/PMC9490579/ /pubmed/36130793 http://dx.doi.org/10.1136/bmjgh-2021-008115 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Witter, Sophie
Sheikh, Kabir
Schleiff, Meike
Learning health systems in low-income and middle-income countries: exploring evidence and expert insights
title Learning health systems in low-income and middle-income countries: exploring evidence and expert insights
title_full Learning health systems in low-income and middle-income countries: exploring evidence and expert insights
title_fullStr Learning health systems in low-income and middle-income countries: exploring evidence and expert insights
title_full_unstemmed Learning health systems in low-income and middle-income countries: exploring evidence and expert insights
title_short Learning health systems in low-income and middle-income countries: exploring evidence and expert insights
title_sort learning health systems in low-income and middle-income countries: exploring evidence and expert insights
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9490579/
https://www.ncbi.nlm.nih.gov/pubmed/36130793
http://dx.doi.org/10.1136/bmjgh-2021-008115
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