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Impact of economic recessions on healthcare workers and their crises’ responses: study protocol for a systematic review of the qualitative and quantitative evidence for the development of an evidence-based conceptual framework

authors: Tiago Silva Jesus, Elias Kondilis, Jonathan Filippon, Giuliano Russo


Introduction During economic recessions, health professionals face reduced income and labour opportunities, hard conditions often exacerbated by governments’ policy responses to crises. Growing evidence points to non-negligible effects on national health workforces and health systems—decrease in motivation, burnout, migration—arising from the combination of crisis-related factors. However, no theoretical conceptualisation currently exists framing the impacts recessions have on human resources for health (HRH), or on their reactions.

Methods and analysis This paper lays out a protocol for a systematic review of the existing qualitative, quantitative and mixed-method evidence on the economic recessions and HRH; results from the review will be used to develop a conceptual framework linking existing theories on recessions, austerity measures, health systems and population health, with a view of informing future health policies. Eight relevant databases within the health, health systems, multidisciplinary and economic literature will be searched, complemented by secondary searches and experts’ input. Eligible studies will present primary quantitative or qualitative evidence on HRH impacts, or original secondary analyses. We will cover the 1970–2019 period—the modern age of global economic recessions—and full texts in English, Spanish, Italian, French, Portuguese or Greek. Two reviewers will independently assess, perform data extraction and conduct quality appraisal of the texts identified. A ‘best-fit’ framework synthesis will be applied to summarise the findings, using an a priori, theoretically driven framework. That preliminary framework was built by the research team to inform the searches, and will be appraised by external experts.

Ethics and dissemination In addition to peer-reviewed publications, the new framework will be presented in global health systems research conferences and inform regional policy dialogue workshops in Latin America on economic recessions and health systems.

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