Scoping Review

Scoping Review

What do we know about the needs and challenges of health systems?

As part of Research Stream A (Design of RIH), this secondary research relies on a scoping review of the scientific literature and aims to better understand what are the needs and challenges of healthcare systems worldwide —needs and challenges that RIH should seek to address.

While health services research is increasingly concerned about the way health systems can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. This project thus explores the “demand” for RIH by, firstly, reviewing the available body of scientific knowledge on the challenges health systems across the world face and, secondly, by analyzing the ways in which the principles of RIH help to address these challenges and support more sustainable technological development in health systems.

This project began in September 2015. In order to gather a multidisciplinary scientific literature, we performed a structure search on 8 bibliographic databases covering health services and policy research, public health, management, public administration and political science. We screened all scientific papers published between January 2000 and April 2016 and included 292 articles in our scoping review.

The challenges reported in the articles were classified using the dynamic framework of van Olmen and colleagues (2012), which connects the key components that influence how a health system successfully reaches its goals.

HS_Analysis_modelFigure 1 – Analytical model for health system analysis

Figure adapted from: van Olmen et al. (2012). The health system dynamics framework: The introduction of an analytical model for health system analysis and its application to two case-studies. Health Culture and Society, 2(1):1-21.


The countries where these studies were conducted were classified using the Human Development Index (HDI), which combines indicators that are relevant to population health: life expectancy at birth, mean years of schooling and expected years of schooling, and gross national income per capita.

A 1st article identified the kind of research that has been conducted on health system challenges, where it was performed, in which health sectors and on which populations. This article provides a quantitative description of the categories of challenge that have been researched, illustrate the key challenges reported by researchers and examines how these challenges vary across countries whose HDI is very high, high, medium or low. This article is available open access here:

We are currently working on a 2nd article in which the challenges that are specific to technological innovation are examined in greater depth as well as the principles of RIH that may better support the sustainability of health systems.

Project lead : Federico RoncaroloProject contact : Pascale Lehoux