abstract: 'Background: District health managers play a key role in the

  effectiveness of decentralized health systems in low- and middle-income

  countries. Inadequate management and leadership skills often hamper

  their ability to improve quality of care and effectiveness of health

  service delivery. Nevertheless, significant investments have been made

  in capacity-building programmes based on site-based training, mentoring,

  and operational research. This systematic review aims to review the

  effectiveness of site-based training, mentoring, and operational

  research (or action research) on the improvement of district health

  system management and leadership. Our secondary objectives are to assess

  whether variations in composition or intensity of the intervention

  influence its effectiveness and to identify enabling and constraining

  contexts and underlying mechanisms.

  Methods: We will search the following databases: MEDLINE, PsycInfo,

  Cochrane Library, CRD database (DARE), Cochrane Effective Practice and

  Organisation of Care (EPOC) group, ISI Web of Science, Health Evidence.

  org, PDQ-Evidence, ERIC, EMBASE, and TRIP. Complementary search will be

  performed (hand-searching journals and citation and reference tracking).

  Studies that meet the following PICO (Population, Intervention,

  Comparison, Outcome) criteria will be included: P: professionals working

  at district health management level; I: site-based training with or

  without mentoring, or operational research; C: normal institutional

  arrangements; and O: district health management functions. We will

  include cluster randomized controlled trials, controlled

  before-and-after studies, interrupted time series analysis,

  quasi-experimental designs, and cohort and longitudinal studies.

  Qualitative research will be included to contextualize findings and

  identify barriers and facilitators.

  Primary outcomes that will be reported are district health management

  and leadership functions. We will assess risk of bias with the Cochrane

  Collaboration''s tools for randomized controlled trials (RCT) and non RCT

  studies and Critical Appraisal Skills Programme checklists for

  qualitative studies. We will assess strength of recommendations with the

  GRADE tool for quantitative studies, and the CERQual approach for

  qualitative studies. Synthesis of quantitative studies will be performed

  through meta-analysis when appropriate. Best fit framework synthesis

  will be used to synthesize qualitative studies.

  Discussion: This protocol paper describes a systematic review assessing

  the effectiveness of site-based training (with or without mentoring

  programmes or operational research) on the improvement of district

  health system management and leadership.'
affiliation: 'Belrhiti, Z (Corresponding Author), Natl Sch Publ Hlth, Dept Management
  \& Econ, Rabat, Morocco.

  Belrhiti, Zakaria, Natl Sch Publ Hlth, Dept Management \& Econ, Rabat, Morocco.

  Booth, Andrew, Univ Sheffield, Sch Hlth \& Related Res ScHARR, Sheffield, S Yorkshire,
  England.

  Marchal, Bruno, Inst Trop Med, Hlth Serv Org Unit, Antwerp, Belgium.

  Verstraeten, Roosmarijn, Inst Trop Med, Nutr \& Child Hlth Unit, Antwerp, Belgium.'
article-number: '70'
author: Belrhiti, Zakaria and Booth, Andrew and Marchal, Bruno and Verstraeten, Roosmarijn
author-email: drbelrhiti@gmail.com
author_list:
- family: Belrhiti
  given: Zakaria
- family: Booth
  given: Andrew
- family: Marchal
  given: Bruno
- family: Verstraeten
  given: Roosmarijn
da: '2023-09-28'
doi: 10.1186/s13643-016-0239-z
eissn: 2046-4053
files: []
journal: SYSTEMATIC REVIEWS
keywords: 'Site-based training; Mentoring; Operational research; Best fit framework

  synthesis; District health; Management; Leadership; Low- and

  middle-income countries'
keywords-plus: QUALITY; DECENTRALIZATION; CAPACITY
language: English
number-of-cited-references: '38'
orcid-numbers: 'Booth, Andrew/0000-0003-4808-3880

  Belrhiti, Zakaria/0000-0002-0115-682X

  '
papis_id: e31ea1c596a3e446fcb38cc5770950dd
ref: Belrhiti2016whatextent
researcherid-numbers: 'Booth, Andrew/A-7872-2008

  Belrhiti, Zakaria/G-4532-2016

  Marchal, Bruno/ACO-6522-2022'
tags:
- review
times-cited: '10'
title: 'To what extent do site-based training, mentoring, and operational research
  improve district health system management and leadership in low- and middle-income
  countries: a systematic review protocol'
type: article
unique-id: WOS:000453148200069
usage-count-last-180-days: '0'
usage-count-since-2013: '4'
volume: '5'
web-of-science-categories: Medicine, General \& Internal
year: '2016'