Muho Altiona, Brugger Curdin, Salzmann Talia, Wyss Kaspar, Steinmann Peter
University of Basel, Basel, Switzerland
Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
BMJ Open. 2025 Apr 25;15(4):e095516. doi: 10.1136/bmjopen-2024-095516.
Considerable resources are invested in health system innovation and strengthening. This calls for efforts to ensure the sustainability of such interventions. We conducted a scoping review to identify factors influencing the sustainability of externally funded health system strengthening interventions targeting primary healthcare, the sustainability outcomes observed in such interventions and the methods used to measure sustainability.
Scoping review following the Joanna Briggs Institute scoping review guidelines.
Web of Science, Ovid Medline and Embase databases were searched through 11 March 2024.
Studies in English with no restriction on study type or country. Externally funded health system strengthening interventions targeting primary health systems and measuring sustainability.
One reviewer screened all titles and abstracts, and two independent pairs of reviewers read full texts. Relevant study data were extracted from the articles and descriptively analysed.
From the 6439 titles retrieved, eight eligible studies were identified and included in the final analysis. Only four studies presented a sustainability definition. Institutionalisation and continued programme activities were described four times as sustainability outcomes, followed by capacity building twice and continued health impact and benefits once. Sustainability was assessed in five studies after intervention completion and in three studies during the implementation period. The sustainability factors were mostly related to processes (n=19), inner context (n=18), intervention characteristics (n=12) and outer context (n=11), with stakeholder engagement and partnership (n=6) as well as funding (n=3) being the most reported factors.
This review highlights the limited documentation on the sustainability of externally funded health system strengthening interventions. Sustainability was mainly assessed retrospectively. Influencing factors spanned over all categories of the integrated sustainability framework, with stakeholder engagement and funding playing key roles. Planning for sustainability assessments with clear definitions, methods and timeframes can enhance evidence on achieving lasting impacts of health system strengthening interventions.
Open Science Framework, https://osf.io/hazqp/?view_only=d53472afbba447e790049d81ca60aa29.
在卫生系统创新和强化方面投入了大量资源。这就需要努力确保此类干预措施的可持续性。我们进行了一项范围综述，以确定影响外部资助的针对初级卫生保健的卫生系统强化干预措施可持续性的因素、此类干预措施中观察到的可持续性结果以及用于衡量可持续性的方法。
遵循乔安娜·布里格斯研究所范围综述指南进行范围综述。
检索了截至2024年3月11日的科学网、Ovid Medline和Embase数据库。
英文研究，对研究类型或国家无限制。针对初级卫生系统且衡量可持续性的外部资助的卫生系统强化干预措施。
一名评审员筛选所有标题和摘要，两对独立的评审员阅读全文。从文章中提取相关研究数据并进行描述性分析。
从检索到的6439个标题中，确定了8项符合条件的研究并纳入最终分析。只有4项研究给出了可持续性的定义。制度化和持续的项目活动被描述为可持续性结果的次数为4次，其次是能力建设2次，持续的健康影响和效益1次。5项研究在干预完成后评估了可持续性，3项研究在实施期间进行了评估。可持续性因素大多与过程（n = 19）、内部环境（n = 18）、干预特征（n = 12）和外部环境（n = 11）相关，利益相关者参与和伙伴关系（n = 6）以及资金（n = 3）是报告最多的因素。
本综述强调了关于外部资助的卫生系统强化干预措施可持续性的文献记录有限。可持续性主要是回顾性评估。影响因素涵盖了综合可持续性框架的所有类别，利益相关者参与和资金发挥着关键作用。通过明确的定义、方法和时间框架来规划可持续性评估，可以增强关于实现卫生系统强化干预措施持久影响的证据。
开放科学框架，https://osf.io/hazqp/?view_only=d53472afbba447e790049d81ca60aa29 。
