Oliver Sandy, Bangpan Mukdarut, Stansfield Claire, Stewart Ruth
UCL Institute of Education, 20 Bedford Way, London, WC1H 0AL, UK.
University of Johannesburg, House 2, Research Village, Bunting Road Campus, Auckland Park, Johannesburg, South Africa.
Health Res Policy Syst. 2015 Apr 26;13:23. doi: 10.1186/s12961-015-0012-0.
Systematic reviews of research are increasingly recognised as important for informing decisions across policy sectors and for setting priorities for research. Although reviews draw on international research, the host institutions and countries can focus attention on their own priorities. The uneven capacity for conducting research around the world raises questions about the capacity for conducting systematic reviews.
A rapid appraisal was conducted of current capacity and capacity strengthening activities for conducting systematic reviews in low- and middle-income countries (LMICs). A systems approach to analysis considered the capacity of individuals nested within the larger units of research teams, institutions that fund, support, and/or conduct systematic reviews, and systems that support systematic reviewing internationally.
International systematic review networks, and their support organisations, are dominated by members from high-income countries. The largest network comprising a skilled workforce and established centres is the Cochrane Collaboration. Other networks, although smaller, provide support for systematic reviews addressing questions beyond effective clinical practice which require a broader range of methods. Capacity constraints were apparent at the levels of individuals, review teams, organisations, and system wide. Constraints at each level limited the capacity at levels nested within them. Skills training for individuals had limited utility if not allied to opportunities for review teams to practice the skills. Skills development was further constrained by language barriers, lack of support from academic organisations, and the limitations of wider systems for communication and knowledge management. All networks hosted some activities for strengthening the capacities of individuals and teams, although these were usually independent of core academic programmes and traditional career progression. Even rarer were efforts to increase demand for systematic reviews and to strengthen links between producers and potential users of systematic reviews.
Limited capacity for conducting systematic reviews within LMICs presents a major technical and social challenge to advancing their health systems. Effective capacity in LMICs can be spread through investing effort at multiple levels simultaneously, supported by countries (predominantly high-income countries) with established skills and experience.
研究的系统评价对于为各政策部门的决策提供信息以及确定研究重点日益重要。尽管评价借鉴了国际研究成果，但主办机构和国家可能会将注意力集中在自身的优先事项上。全球开展研究的能力参差不齐，这引发了关于进行系统评价能力的问题。
对低收入和中等收入国家（LMICs）开展系统评价的当前能力及能力加强活动进行了快速评估。一种系统分析方法考虑了嵌套在研究团队、资助、支持和/或开展系统评价的机构以及国际上支持系统评价的系统等更大单位中的个人能力。
国际系统评价网络及其支持组织主要由高收入国家的成员主导。拥有熟练劳动力和成熟中心的最大网络是Cochrane协作网。其他网络虽然规模较小，但为解决有效临床实践之外问题的系统评价提供支持，这些问题需要更广泛的方法。在个人、评价团队、组织和全系统层面，能力限制都很明显。每个层面的限制都会限制其内部嵌套层面的能力。如果个人技能培训没有与评价团队实践技能的机会相结合，其效用就会有限。语言障碍、学术组织缺乏支持以及更广泛的沟通和知识管理系统的局限性进一步制约了技能发展。所有网络都开展了一些加强个人和团队能力的活动，尽管这些活动通常独立于核心学术项目和传统职业发展路径。增加对系统评价的需求以及加强系统评价生产者与潜在使用者之间联系的努力则更为罕见。
低收入和中等收入国家开展系统评价的能力有限，这对推进其卫生系统构成了重大的技术和社会挑战。低收入和中等收入国家的有效能力可以通过在多个层面同时投入努力来传播，并得到具备既定技能和经验的国家（主要是高收入国家）的支持。
