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dc.contributor.authorWitter, Sophie; orcid: 0000-0002-7656-6188
dc.contributor.authorSheikh, Kabir; orcid: 0000-0003-4755-2075
dc.contributor.authorSchleiff, Meike
dc.date.accessioned2022-09-22T11:06:04Z
dc.date.available2022-09-22T11:06:04Z
dc.date.issued2022-09-20
dc.date.submitted2021-11-26
dc.identifierpublisher-id: bmjgh-2021-008115
dc.identifierdoi: 10.1136/bmjgh-2021-008115
dc.identifier.citationBMJ Global Health, volume 7, issue Suppl_7, article-number e008115
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/12588
dc.descriptionFrom BMJ via Jisc Publications Router
dc.descriptionHistory: received 2021-11-26, accepted 2022-02-16, ppub 2022-09, epub 2022-09-20
dc.descriptionPeer reviewed: True
dc.descriptionAcknowledgements: We would like to acknowledge the contribution of Charity Jensen, who worked on the two background papers which supported this article.
dc.descriptionPublication status: Published
dc.descriptionFunder: Alliance for Health Policy and Systems Research; FundRef: http://dx.doi.org/10.13039/100007855; Grant(s): Not applicable
dc.description.abstractIntroduction: 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 This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings.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.
dc.languageen
dc.publisherBMJ Publishing Group
dc.rightsLicence for this article starting on 2022-09-20: http://creativecommons.org/licenses/by-nc/4.0/
dc.rightsEmbargo: ends 2022-09-20
dc.sourceeissn: 2059-7908
dc.subjectOriginal research
dc.subject1506
dc.subjecthealth policy
dc.subjecthealth systems
dc.subjecthealth services research
dc.subjectreview
dc.subjecthealth systems evaluation
dc.titleLearning health systems in low-income and middle-income countries: exploring evidence and expert insights
dc.typearticle
dcterms.dateAccepted2022-02-16
dc.date.updated2022-09-22T10:00:30Z


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