TY - JOUR
T1 - Applying stated-preference methods to improve health systems in sub-Saharan Africa
T2 - a systematic review
AU - Brown, Lauren
AU - Lee, Ting hsuan
AU - De Allegri, Manuela
AU - Rao, Krishna
AU - Bridges, John F.P.
N1 - Funding Information:
with a few articles coming from researchers in Asia (n = 3) and the World Bank (n = 1) (Data not shown). Among those 19 African first-authored articles, six were set in Nigeria, six were in South Africa, two were in Ghana, and one each came from Burkina Faso, Egypt, Ethiopia, Mozambique, and Zimbabwe. Forty-three studies (56%) cited receiving support from North American donors, funding agencies, universities, or research organizations, most especially the Bill and Melinda Gates Foundation (n = 12) and USAID (n = 8) (Figure 4). Twenty-one studies (27%) received support from European organizations, eight (10%) from multilateral organizations and initiatives, four from African (5%), and two
Funding Information:
(3%) from Asian organizations. Sixteen articles (21%) made no mention of financial support sources.
Publisher Copyright:
© 2017 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2017/9/3
Y1 - 2017/9/3
N2 - Introduction: Sub-Saharan African health systems must balance shifting disease burdens with desires for robust institutions. Stated-preference methods have been applied extensively to elicit health care workers’ preferences and priorities for rural practice. This systematic review characterizes the range of their applications to African health systems problems. Areas covered: A PRISMA protocol was submitted to PROSPERO. Six databases were queried for peer-reviewed articles using quantitative stated-preference methods to evaluate a health systems-related trade-off. Quality was assessed using the PREFS checklist. Seventy-seven articles published between 1996 and 2017 met review criteria. Methods were primarily choice-based: discrete-choice experiments (n = 46), ranking/allocation techniques (n = 21), conjoint analyses (n = 7), and best-worst scaling (n = 3). Trade-offs fell into six ‘building blocks’: service features (n = 27), workforce incentives (n = 17), product features (n = 14), system priorities (n = 14), insurance features (n = 4), and research priorities (n = 1). Five countries dominated: South Africa (n = 11), Ghana (n = 9), Malawi (n = 9), Uganda (n = 9), and Tanzania (n = 8). Discrete-choice experiments were of highest quality (mean score: 3.36/5). Expert commentary: Stated-preference methods have been applied to many health systems contexts throughout sub-Saharan Africa. Studies examined established strategic areas, especially primary health care for women, prevention and treatment of infectious diseases, and workforce development. Studies have neglected the emerging areas of non-communicable diseases.
AB - Introduction: Sub-Saharan African health systems must balance shifting disease burdens with desires for robust institutions. Stated-preference methods have been applied extensively to elicit health care workers’ preferences and priorities for rural practice. This systematic review characterizes the range of their applications to African health systems problems. Areas covered: A PRISMA protocol was submitted to PROSPERO. Six databases were queried for peer-reviewed articles using quantitative stated-preference methods to evaluate a health systems-related trade-off. Quality was assessed using the PREFS checklist. Seventy-seven articles published between 1996 and 2017 met review criteria. Methods were primarily choice-based: discrete-choice experiments (n = 46), ranking/allocation techniques (n = 21), conjoint analyses (n = 7), and best-worst scaling (n = 3). Trade-offs fell into six ‘building blocks’: service features (n = 27), workforce incentives (n = 17), product features (n = 14), system priorities (n = 14), insurance features (n = 4), and research priorities (n = 1). Five countries dominated: South Africa (n = 11), Ghana (n = 9), Malawi (n = 9), Uganda (n = 9), and Tanzania (n = 8). Discrete-choice experiments were of highest quality (mean score: 3.36/5). Expert commentary: Stated-preference methods have been applied to many health systems contexts throughout sub-Saharan Africa. Studies examined established strategic areas, especially primary health care for women, prevention and treatment of infectious diseases, and workforce development. Studies have neglected the emerging areas of non-communicable diseases.
KW - Africa
KW - Stated preferences
KW - health systems
KW - stated-preference methods
KW - sub-Saharan Africa
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U2 - 10.1080/14737167.2017.1375854
DO - 10.1080/14737167.2017.1375854
M3 - Review article
C2 - 28875767
AN - SCOPUS:85029616799
SN - 1473-7167
VL - 17
SP - 441
EP - 458
JO - Expert Review of Pharmacoeconomics and Outcomes Research
JF - Expert Review of Pharmacoeconomics and Outcomes Research
IS - 5
ER -