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Background: Health policymakers in low- and middle-income countries continue to face difficulties in accessing and using research evidence for decision-making. This study aimed to identify and provide a refined categorisation of the policy documents necessary for building the content of a one-stop shop for documents relevant to health policy and systems in Uganda. The on-line resource is to facilitate timely access to well-packaged evidence for decision-making. Methods: We conducted a scoping review of Uganda-specific, health policy, and systems-relevant documents produced between 2000 and 2014. Our methods borrowed heavily from the 2005 Arksey and O’Malley approach for scoping reviews and involved five steps, which that include identification of the research question; identification of relevant documents; screening and selection of the documents; charting of the data; and collating, summarising and reporting results. We searched for the documents from websites of relevant government institutions, non-governmental organisations, health professional councils and associations, religious medical bureaus and research networks. We presented the review findings as numerical analyses of the volume and nature of documents and trends over time in the form of tables and charts. Results: We identified a total of 265 documents including policies, strategies, plans, guidelines, rapid response summaries, evidence briefs for policy, and dialogue reports. The top three clusters of national priority areas addressed in the documents were governance, coordination, monitoring and evaluation (28%); disease prevention, mitigation, and control (23%); and health education, promotion, environmental health and nutrition (15%). The least addressed were curative, palliative care, rehabilitative services and health infrastructure, each addressed in three documents (1%), and early childhood development in one document. The volume of documents increased over the past 15years; however, the distribution of the different document types over time has not been uniform. Conclusion: The review findings are necessary for mobilising and packaging the local policy-relevant documents in Uganda in a one-stop shop; where policymakers could easily access them to address pressing questions about the health system and interventions. The different types of available documents and the national priority areas covered provide a good basis for building and organising the content in a meaningful way for the resource.
We reviewed published documents relevant for health policy and decision-making about the Uganda health system and interventions produced from January 1, 2000, to December 31, 2014. The year 2000 marked the beginning of implementation of key health sector reforms in Uganda [20]. Of interest was to identify and characterise documents produced since then to the beginning of this study. Our methods borrowed heavily from the 2005 Arksey and O’Malley methodological framework for scoping reviews [21]. Since the research question guides the subsequent steps, including the search strategy, the Arksey and O’Malley methodological framework recommends considering all aspects of the research area to ensure a breadth of coverage and to define the relevant aspects of the research question [21]. In light of this, we developed our research questions as: What are the available types of documents relevant for health policy and systems that are specific to Uganda? What is the volume and nature (i.e. type, coverage of national priority areas, frequency of health-system topics) of these documents? From the onset, we were aware that such documents could be available as printed copies, published on websites of relevant non-governmental organisations (NGOs) and national institutions or just in the form of soft copies on personal computers that are not yet uploaded on websites. We focused on identifying and characterising the available documents relevant for health policy and systems published on websites. We conducted the search for Uganda-specific health policy and systems-relevant documents in January 2015. We selected the websites of relevant government institutions, international and national NGOs, health professional councils and associations, religious medical bureaus and research networks (Table 1). We used the search engine Google to locate such websites, which we then navigated by the tabs and menus available on the homepage (such as policy documents and guidelines, e-library, resources, publications, legislation). The fact that different websites are organised differently, we developed specific search strategies for each website depending on its individual navigability. In addition, we searched Google Scholar using the following keywords in various combinations with Boolean operators (and, or) [22]: Uganda, health policy, health system, guidelines, strategies, plans, and reports. We checked the reference lists of the documents found to expand our list of included documents. Importantly, we used the websites as an entry point to other repositories for national policy documents (Tables 2 and and33). Institutions/organisations whose websites were searched Type of documents mapped by the national health priority areas aNational health priority areas in the Second National Development Plan II (2015/16–2019/2020) & Second National Health Policy (18) Type of the document by health systems domains, implementation strategy within the health systems and the crosscutting domain (10) aOthers include documents about public or population issues and clinical issues To minimise selection bias, two independent reviewers (BM and RB) screened all documents and selected those that were appropriate for our research question. Our selection involved the use of a pre-determined inclusion and exclusion criteria. We included all Uganda-specific published documents relevant to health policy and systems produced between 2000 and 2014. We borrowed from the Hoffman et al. [23] model shown in Fig. 1, which depicts the boundaries of health policy and systems research, to determine if documents were relevant to health policy and systems in order for us to include them. We therefore included all documents that addressed (1) issues related to health systems (i.e. on governance, financial, and delivery arrangements and implementation strategies); (2) policy about clinical issues that include essential medicines, diagnostics and medical supplies; and (3) policy about public/population issues such as policies on immunisation and family planning. Conceptual issues related to health systems research to inform a WHO Global Strategy on Health Systems Research. Adapted with permission from Hoffman et al. [20] We excluded documents that (1) did not have national coverage (such as NGO project reports that covered only a few districts), (2) were at the draft stage, (3) covered less than a year (such as quarterly or semi-annual reports), or (4) described primary studies and systematic reviews. The two independent reviewers used a specially developed data-charting form (Table 4) to extract data from each document on the title/topic, document type, coverage of national priority areas, coverage of health system topics, year published and the source of the document. We developed a tailored index of health policy documents based on the national priority issues, types of documents emerging from the search results and health system topics borrowed from the Health System Evidence [15, 24, 25]. We specifically categorised the documents as policies, strategies, plans, guidelines, rapid response summaries, and evidence briefs for policy, dialogue reports and other reports. We also coded the documents for national health priority areas as identified in the Second National Development Plan (NDPII 2015/16–2019/20) [24] and Second Health Policy (NHPII) [25]. The NDPII stipulates the Country’s medium term strategic direction, priorities (including health priorities) and implementation strategies up to the year 2020. The national health priority areas are disease prevention, mitigation and control; health education, promotion, environmental health and nutrition; governance, coordination, monitoring and evaluation; maternal and child health; reproductive health; human resources for health; health financing; health infrastructure; early childhood development; essential medicines and supplies; palliative care services; rehabilitation services; and curative services [24, 25]. Documents reviewed We further classified these documents as governance, financial and delivery arrangements, and as implementation strategies within the health systems [15]. The governance arrangements category includes documents on centralisation/decentralisation of health services, registration and accreditation of the services, consumer and stakeholder involvement in service delivery, stewardship of the non-state actors in health financing and delivery, among other topics [15]. The financial arrangements category includes documents on financing systems, funding organisations, remunerating providers, purchasing products and services, and incentives targeted at consumers [15]. The delivery arrangements category covers documents on how care is designed to meet consumer needs, human resources for health, and support systems for the provision of care, plus where care is provided [15]. The implementation strategies category includes documents on consumer-, provider- and organisation-targeted strategies [15]. The third reviewer (EO) arbitrated areas that BM and RB disagreed on. After charting the information from the evidence documents, we presented the review findings as numerical analyses of the volume of documents, their nature (i.e. type, coverage of national priority areas, the frequency of health system topics) and trends over time in the form of tables and charts. The data were summarised using descriptive statistics, including for the type of the documents included, the national health priority areas/issues covered in the documents, the extent of coverage of the health priority for the different health policy and system domains, and the trends over time in the nature and distribution of the documents.
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