Impact Of Health System Strengthening Interventions On Child Survival In Sub-Saharan Africa: A Systematic Review Protocol

Abstract

Background Strengthening healthcare systems is a practical approach to enhancing healthcare delivery and services. Although there has been a rise in the number of health systems strengthening (HSS) interventions in sub-Saharan In Africa (SSA), there is limited evidence on the causal effect of these activities on child survival. Furthermore, the findings reported so far have been varied, and how they relate to each other remains unclear. This systematic review study aims to assess all available evidence to understand the impact of HSS activities on child survival in SSA. Methods: We developed a search strategy to retrieve all relevant studies from electronic databases such as PubMed. MEDLINE, Web of Science, and African Journals Online. We will use a combination of search terms, such as under-fve mortality,” “child mortality,” “infant mortality,” “neonatal mortality,” “child survival,” and health systems strengthening." The review will include studies that establish a causal relationship between HSS interventions and child survival. This will include studies with designs such as randomized controlled trials and quasi-experimental methods like difference-in-difference. Two reviewers will independently screen all citations, abstracts, and full-text data and a third The reviewer will act as a tiebreaker in cases of disagreement. The primary outcome of interest is the impact of HSS activities on under-five survival. We will evaluate the quality of each study using the Bradford Hill criteria for causation. Discussion Our systematic review will identify and evaluate all relevant evidence that establishes a causal relationship between HSS activities and the survival of children under five years old in SSA. The review’s findings regarding the impact of HSS activities on child survival could be of significant interest to the donor community and policy actors in the region. We also anticipate that the review’s conclusions could serve as a valuable guide for the development of future health system interventions and strategies in SSA.