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Table 2 Content

From: Health systems guidance appraisal—a critical interpretive synthesis

12. Problem definition The health systems challenge (for example, financial, governance, or delivery arrangements) and its causes are clearly articulated (including any links/integration with other policy problems on the government’s agenda) [5, 75, 83]. The nature, causes, magnitude, frequency, and intensity of the problem, the populations, and jurisdictions that are affected are clearly described [57, 60, 62, 64, 66, 71]. Appropriate rationale exists to justify that either new guidance is needed or existing guidance of acceptable quality can be adapted and used to address the problem [4, 56].
13. Operationalization The recommended “solutions” are operationalized sufficiently with the conceptualization, operational guidance, and the mode of delivery of the options clearly stated [8, 54, 60]. For example, the guidance provides instructional support for their successful operation and staff training that corresponds with the guidance expectations. Training recommendations could be in the form of a course, a workshop, accompanying manuals, or consultancy services that staff can refer to during the implementation phase in order to standardize practice [8, 54, 58, 60, 61, 63, 73, 74]. If technical assistance (research institutes, consulting firms, NGOs) is required, this is identified and documented [8].
14. Costs The guidance clearly documents a tentative budget required to implement the guidance recommendations [8, 64, 65, 74, 77, 84]. The potential financial costs (including downstream costs) of the operation are stated so that decision makers can assess the feasibility of the guidance implementation and evaluate whether the cost of implementing the guidance will be worth its potential impacts [5, 64, 73, 74].
15. Resources The inputs and resources required to implement the recommendations are clearly defined and they have to be proportionate to the health system problem that is being addressed [55, 57, 61, 71, 73, 79]. Some of these resources could be time, infrastructure, administrative capacity, information, equipment, supplies, healthcare professionals, training etc. [55, 56, 58, 59, 61, 69, 76]. The guidance provides a description of the amount, frequency, and duration of the inputs and resources required [54, 57, 71].
16. Effectiveness The guidance reports whether the anticipated goals and objectives have been achieved elsewhere or in a similar setting/condition, either through evidence from evaluation studies done at other sites (if available) or from expert opinion [5456, 69]. In describing this effectiveness, the guidance makes projections on how and why the objectives and goals will be achieved in the current setting [64, 69, 75].
17. Cost-effectiveness The recommendations are attentive to value for money considerations [57, 63, 84]. Sound local or applicable evidence (wherever available) on the cost-effectiveness of the guidance recommendations are provided [54, 57, 60, 63, 79]. These traditionally report costs, direct and indirect program inputs/resources, and outcomes to guide health policy decisions and provide benchmark(s) or threshold(s) that the health system is willing to accept or support in relation to other competing health system priorities [54, 60, 73].
18. Benefits/harms Description of the potential unintended consequences (positive and negative) of the guidance is provided or an assessment/judgment of the potential benefits/harms are made [60, 67, 75]. Descriptions of the populations or institutions that may experience significant impacts are identified [57, 60, 65].
19. Dissemination plan Strategies for communicating the guidance are included with a clear dissemination framework, the mode of delivery, and the integrity of the avenue used for dissemination been properly reported [54, 65, 81]. The proposed strategies for disseminating the guidance are tailored to the relevant audiences (for example, a formal written report, user-friendly summary, oral presentation, poster, press release, booklet, workbook, films, pocket card) [57, 74].
20. Process evaluation This involves recommendations for evaluating the structure and process of implementation as well as corresponding challenges [61, 68, 80]. This evaluation examines the extent to which the guidance recommendations were implemented as planned, and also provides a way to monitor the process and make adjustments and improvements to implementation strategies [74, 79]. It documents the inputs, services, and activities that were implemented, and can identify potential strengths, weaknesses, opportunities, and threats to the implementation process [62, 79].
21. Outcomes/impact evaluation An assessment of the outcome/impact of the guidance is recommended to determine whether the course of action was a success or failure. There are recommendations on measuring the results, or outcomes of the guidance in a way that determines whether the changes observed in relation to the health system challenge being addressed can be attributed to the guidance [58, 61, 80, 82]. There are also recommendations for an impact evaluation to look at the short- and long-term deeper primary and secondary changes that resulted from the guidance [57, 69, 74, 77].
22. Updating Recommendations for periodic updates are made and the procedure to update the guidance is provided with explicit timelines on anticipated review [57, 68], appropriate expiration date of the guidance, and an explanation of the rational for the proposed time frames [80]. Setting time frames for periodic updates ensures that guidance producers revisit the recommendations and respond accordingly to potential health system changes and emerging challenges. Also, the recommendations should be current, and the evidence (for example, systematic reviews) on which they are based is considered recent and up-to-date [76, 80].