Figure 1.
Conceptual Framework of Pathways between Strategies, Quality and Outcomes.
Solid lines represent presumed direct relationships while indirect relationships are represented by dashed lines. Broad determinants of quality that may be targeted by strategies are shown at the bottom of the figure. Health system strategies lead to improved quality which can either (a) directly lead to improved outcomes or (b) lead to improved health service utilisation which may indirectly lead to improvements in outcomes. An example of pathway (a) may be a maternal death audit, targeting the competency of staff, resulting in higher use of correct management techniques leading to lower mortality. An example of pathway (b) might be renovation of primary care facilities leading to higher community acceptability, resulting in more children being brought for treatment and thus a reduction in deaths due to treatable causes.
Figure 2.
Study selection process.
Figure 3.
Proportion of Studies Reporting Positive Effects for Given Outcomes by Strategy Type.
Notes: Effects were considered positive if the authors reported the result as being beneficial. If multiple indicators existed for the same type of outcome it was only considered positive if all results were reported as being beneficial.