Barriers and enablers for health system reform

Danitza Chavez-Montoya, Caitlin Main, Kavya Satish, Borna Müller, Jennifer Gill and Panos Kanavos

LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library

Abstract: Health systems worldwide face escalating pressure from the growing burden of non‑communicable diseases and population ageing, as well as chronic workforce shortages, infrastructure limitations, and structural misalignment between care models designed for acute illness and the long‑term needs of complex patients. Many countries are pursuing comprehensive transformation efforts including shifting care closer to home, enhancing early disease detection and addressing workforce challenges. This study aims to identify examples of transformation across these domains, including specifically service delivery decentralisation, workforce transformation and enhancement of screening and diagnostic services for early detection and treatment – and determine common barriers and enablers in order to make recommendations for improvement. A mixed-methods approach, combining a scoping literature review and semi-structured one-on-one interviews was utilised. Searches of peer-reviewed literature were performed in EMBASE, Global Health, and Ovid MEDLINE databases. The Rayyan platform was used for systematic management of references, deduplication, and screening. Titles and abstracts were independently reviewed by two members of the research team before full-text review and data extraction.153 peer-reviewed papers and 35 grey literature reports were analysed, whilst 17 expert stakeholders, including policy experts, academics, health policy experts and clinicians from six countries were interviewed. 67 transformation case studies were included. Of these, 36 were focused on service delivery decentralisation, 16 on screening and 12 were related to workforce adaptation. A final set of 34 barriers and 27 enablers was identified and grouped empirically into six areas including: political, governance and policy; funding, incentives & resource allocation; workforce capacity, capability & culture; system integration, structure and care coordination; digital infrastructure, technology and data; communication, engagement, and change management. Finally, a set of 25 recommendations, across seven groups, are made for policy makers and other relevant stakeholders. These findings provide practical, evidence-based insights to guide policymakers in designing scalable, context-sensitive health system transformation strategies.

Keywords: health system reform; NCD; screenings; healthcare workforce; service delivery decentralisation (search for similar items in EconPapers)
JEL-codes: J01 R14 (search for similar items in EconPapers)
Date: 2026-09-07
References: Add references at CitEc
Citations:

Published in Frontiers in Health Services, 7, September, 2026. ISSN: 2813-0146

Downloads: (external link)
https://researchonline.lse.ac.uk/id/eprint/140353/ Open access version. (application/pdf)
Our link check indicates that this URL is bad, the error code is: 403 Forbidden

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:ehl:lserod:140353

Access Statistics for this paper

More papers in LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library LSE Library Portugal Street London, WC2A 2HD, U.K.. Contact information at EDIRC.
Bibliographic data for series maintained by LSERO Manager ().