Moving towards universal health coverage: The need for a strengthened planning process

Evolution of health sector strategic planning in Tanzania: What have we learnt and how can we improve?

Progressive realization of Universal Health Coverage is inevitable given resource constraints. The incremental approach must be reflected in health sector strategic plans which serve as roadmaps. Using a matrix based on the health systems building blocks to extract data, we reviewed three successive sector strategies to assess priority issues addressed. We undertook a thematic synthesis to draw lessons and conclusion reported in this paper. Our review shows good practice as well as areas desiring attention if health sector strategic plans are to serve the intended purpose. Although all strategies were aligned to global and national development aspirations, were developed in a participatory manner they did not reflect the required incremental approach. The challenges to be addressed and the priorities remained largely the same over a 15-year period. The strategies and key results areas to be implemented in the different strategies were numerous with funding gaps. Improving the utility of strategic plans requires improving both the process and content. Implied in this approach is the need for prioritised and affordable strategic plans that reflect incremental efforts to attaining long term targets coupled with strong trend analysis and monitoring. Additionally, we advocate for strategic plan with a longer timeframe perhaps 10 years with adjustments at regular intervals.

Alignment in implementation of evidence-based interventions: a scoping review

Background

Alignment (i.e., the process of creating fit between elements of the inner and outer context of an organization or system) in conjunction with implementation of an evidence-based intervention (EBI) has been identified as important for implementation outcomes. However, research evidence has so far not been systematically summarized. The aim of this scoping review is therefore to create an overview of how the concept of alignment has been applied in the EBI implementation literature to provide a starting point for future implementation efforts in health care.

Methods

We searched for peer-reviewed English language articles in four databases (MEDLINE, Cinahl, Embase, and Web of Science) published between 2003 and 2019. Extracted data were analyzed to address the study aims. A qualitative content analysis was carried out for items with more extensive information. The review was reported according to the preferred reporting items for systematic reviews and meta-analyses extension for scoping review (PRISMA-ScR) guidelines.

Results

The database searches yielded 3629 publications, of which 235 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. In this review, the results of 53 studies are presented. Different definitions and conceptualizations of alignment were found, which in general could be categorized as structural, as well as social, types of alignments. Whereas the majority of studies viewed alignment as important to understand the implementation process, only a few studies actually assessed alignment. Outcomes of alignment were focused on either EBI implementation, EBI sustainment, or healthcare procedures. Different actors were identified as important for creating alignment and five overall strategies were found for achieving alignment.

Conclusions

Although investigating alignment has not been the primary focus of studies focusing on EBI implementation, it has still been identified as an important factor for the implementation success. Based on the findings from this review, future research should incorporate alignment and put a stronger emphasize on testing the effectiveness of alignment related to implementation outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-021-01160-w.