Akl Elie A, El-Jardali Fadi, Bou Karroum Lama, El-Eid Jamale, Brax Hneine, Akik Chaza, Osman Mona, Hassan Ghayda, Itani Mira, Farha Aida, Pottie Kevin, Oliver Sandy
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Research, Advocacy and Public Policy-making Program, Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Beirut, Lebanon.
PLoS One. 2015 Sep 2;10(9):e0137159. doi: 10.1371/journal.pone.0137159. eCollection 2015.
Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes.
We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach.
Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality.
This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field.
在人道主义危机中，提供或资助卫生服务的各组织、机构和团体之间需要进行有效的协调，以确保服务效率、避免重复并增进公平性。本综述的目的是评估在人道主义危机期间及之后，提供或资助卫生服务的各组织、机构和团体之间不同的协调机制和模式在获得卫生服务和健康结果方面的比较情况。
我们在国际前瞻性系统评价注册库PROSPERO中注册了本综述的方案，注册号为PROSPERO2014:CRD42014009267。符合条件的研究包括随机和非随机设计、过程评估和定性方法。我们通过电子方式检索了Medline、PubMed、EMBASE、Cochrane对照试验中心注册库、CINAHL、PsycINFO、世界卫生组织全球卫生图书馆以及相关组织的网站。我们遵循标准的系统评价方法进行选择、数据提取和偏倚风险评估。我们使用GRADE方法评估证据质量。
在从数据库和组织网站中识别出的14309条引文中，我们确定了四项符合条件的研究。两项研究采用了混合方法，一项采用了定量方法，一项采用了定性方法。现有证据表明，在人道主义危机背景下提供卫生服务的机构之间的信息协调可能有助于改善卫生系统投入。还有证据表明，诸如群组模式等管理/指令协调除了能改善获得卫生服务的情况外，还可能改善卫生系统投入。纳入的研究均未评估通过共同代表和框架协调进行的协调。证据质量被判定为极低。
本系统评价提供了证据，表明在人道主义危机中提供或资助卫生服务的各组织、机构和团体之间进行信息协调和管理/指令协调可能具有有效性。我们的研究结果可为研究议程提供参考，并突出改善该领域研究的开展和报告的必要性。
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