SynthesisBMJ global health2025
Alternative healthcare delivery arrangements in Nepal: a systematic review of comparative effectiveness, safety and cost-effectiveness studies.
Synthesis in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe way that healthcare services are organised and delivered (termed 'healthcare delivery arrangements') is a key aspect of a health system. Changing the way health care is delivered, for example, task shifting that delivers the same care at lower cost, may be one way of improving healthcare system sustainability. We synthesised the existing randomised trial evidence to compare the effects of alternative healthcare delivery arrangements versus usual care in Nepal.
methodsFor eligible studies published since 2005, we searched MEDLINE, Embase, CENTRAL, CINAHL, Scopus, the WHO clinical trials registry and NepJOL on 31 October 2024. Two authors independently assessed studies for eligibility, extracted data and evaluated the risk of bias using the Cochrane risk of bias tool and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluations. We calculated risk ratios (RRs), mean differences (MDs) and percentage points (PPs) with 95% CIs for the outcomes and performed meta-analysis where appropriate.
resultsFour studies met the inclusion criteria. One evaluated task shifting, two information and communication technology, and one care coordination. No meta-analyses were performed. Low certainty evidence indicates task shifting of medical abortion by doctors to midlevel providers may result in equivalent complete abortion (RR: 2.55, 95% CI: 0.82 to 4.27). Similarly, the use of a mobile phone call reminder may improve on-time medicine collection among patients with HIV compared with usual care (RR: 1.29, 95% CI: 1.12 to 1.48), while the integration of postpartum family planning and postpartum intrauterine contraceptive device (PPIUCD) insertion with maternity services may improve PPIUCD uptake compared with usual care (PP: 0.173, 95% CI: 0.098 to 0.246).
conclusionMore evaluation is needed for alternative delivery arrangements due to limited low-certainty evidence from current trials. There was insufficient evidence on outcomes such as cost, safety, and patient and provider perspectives. PROSPERO REGISTRATION NUMBER: CRD42022327298.
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