Data extraction and framework for synthesis

We used the Rees and colleagues’ appraisal instrument as a guiding tool to appraise the quality of included articles in the review [25]. The quality appraisal instrument is a comprehensive tool designed to assess the quality, rigor of research studies, covers key aspects of research design, data collection, analysis, and reporting. This includes rigour in sampling, rigour in data collection, rigour in data analysis, findings supported by the data, breadth and depth of findings, extent of the study privilege perspectives, reliability or trustworthiness, and usefulness[25]. A template was developed to extract relevant data from each eligible study. After reading the selected studies, key findings were extracted into the template, including information about the first author, year of publication, type of article, study design, and key summary findings. Three independent reviewers (AD, AN and DG) extracted the data. The senior authors (RBK and YA) verified the extracted information. The successes and challenges of RHS for UHC and health security were extracted using health system building blocks.

We analysed the findings using the WHO health system building blocks, including service delivery, health workforce, health information systems, medicines and infrastructures, healthcare financing, and leadership and governance [13]. We analysed the key challenges and successes of RHS for UHC and health security using the WHO health system frameworks. Framework analysis provides a systematic approach to analysing large amounts of textual data using pre-determined framework components. This allows the analyst and those commissioning the research to move between multiple layers of abstraction without losing sight of raw data [26].