Background: The increasing global prevalence of multimorbidity poses major challenges for primary healthcare systems because its treatment and prevention require coordinated, patient-centered, and interprofessional models of care. In Nova Scotia, Canada, one response has been the implementation of interprofessional team-based primary healthcare. This study evaluated the implementation of multimorbidity care program components in three interprofessional primary healthcare teams. The aim was to describe programs and identify enablers, barriers, and lessons learned to guide future implementation of similar programs in primary healthcare settings. Methods: A qualitative case study design was used, involving in-depth semi-structured interviews and focus groups with 12 team members across two rural and one urban primary healthcare practices in Nova Scotia, Canada. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) to explore contextual and organizational factors influencing implementation. Thematic analysis identified common enablers, barriers, and recommendations across the CFIR framework’s domains: Innovation, Outer and Inner Settings, Characteristics of Individuals, and Implementation Processes. Results: Implementation was supported by several enablers, including strong leadership engagement, interprofessional collaboration, and effective use of Information Technology systems that enhanced workflow and communication. Providers reported that team-based care improved job satisfaction and enabled patients to receive more coordinated, accessible care. Community partnerships and blended models of virtual and in-person care also facilitated implementation. However, programs faced multiple barriers, including staffing shortages, limited funding for key roles, high costs and complexity of Electronic Medical Records (EMR), and patient discomfort with virtual care. Additional challenges included limited training, competing provider priorities, and difficulties coordinating across multiple sites. Participants recommended expanding training on EMR systems, increasing funding for navigator roles and infrastructure, streamlining technology, and fostering leadership and team engagement. Conclusions: The implementation of multimorbidity care programs in primary healthcare settings is influenced by both systemic and contextual factors. While interprofessional teamwork, leadership support, and community partnerships are essential enablers, sustainable funding, structured training, and user-friendly technology are critical for program scalability and success. These findings offer actionable guidance for policymakers, healthcare leaders, and researchers seeking to strengthen integrated multimorbidity care, enhance provider satisfaction, and improve patient outcomes in primary healthcare.

Primary care is crucial for reducing health disparities and enhancing population health. The COVID-19 pandemic exacerbated long-standing challenges for Canada in maintaining robust primary care; however, it also presented opportunities for health system transformation. One such transformation was the rapid implementation of Mobile Primary Care Clinics (MPCCs) in the Atlantic Canadian province of Nova Scotia to enhance healthcare accessibility and alleviate pressure on emergency departments (EDs). This evaluation aimed to assess the impact, implementation, and partner experiences of MPCCs as another point of primary care access for Nova Scotians. The evaluation involved a mixed-methods approach (September 2022–October 2023) guided by implementation outcomes of effectiveness, efficiency, acceptability, and feasibility. Data sources included clinic utilization and cost records, administrative data, patient and provider surveys, and a questionnaire from the implementation team. A scenario-based economic analysis with probabilistic sensitivity analysis (PSA) was performed from a third-party payer perspective. ED diversion estimates were derived by combining survey-reported counterfactual care-seeking behaviour with observed ED utilization within 72 h of an MPCC visit, identified through linkage to provincial administrative data. Across 157 clinic days, 13,019 visits were recorded. The most common presentations were respiratory or dermatological complaints and prescription renewals. Among 1,888 patient survey respondents, 23.7

The Virtual Urgent Nova Scotia (VUNS) program was introduced to address emergency department (ED) overcrowding and improve access to urgent care through virtual health services. This study captures the perspectives, sentiment, and attitudes toward the implementation of VUNS from rural ED providers. VUNS staff from seven different sites across the province of Nova Scotia were invited to focus groups to explore the implementation of VUNS in their local context. Focus groups were facilitated by members of the Implementation Science Team at Nova Scotia Health from November 2024 to January 2025. Focus group transcripts were coded deductively, and results were presented in a narrative and descriptive fashion. Key findings highlight recurrent issues, including staff confusion over inclusion and exclusion criteria, inconsistent VUNS physician decision-making, workflow disruptions influenced by staffing shortages, and patient bounce-backs from the VUNS triage nurses or physician. While initial implementation demonstrated potential for reducing lower acuity patients’ wait times and enhancing care delivery, operational challenges limited its effectiveness for some sites. Despite these barriers, success stories from specific sites emphasize the program’s value, particularly in underserved rural areas. Recommendations for improvement focus on stabilizing criteria, enhancing staff training, optimizing workflows, and fostering consistent communication between stakeholders. Findings indicate that VUNS should be scaled cautiously within current sites, addressing identified challenges before spreading to new locations. Lessons learned stress the importance of staff engagement, clear workflows, and patient education. These findings provide a roadmap for refining VUNS operations and contribute to the broader discourse on scaling digital healthcare innovations and streamlining patient flow in EDs.

Background: Promoting government efforts to transition to team-based care models in Canada is essential; it aligns with the imperative of ensuring health equity within primary healthcare (PHC) settings. By addressing the fundamental principle of fairness and striving to mitigate disparities in access, quality, and outcomes, these team-based care initiatives can foster a more inclusive and effective healthcare system. This study, part of a larger study, examines health equity initiatives within team-based primary healthcare (TBPHC) policies in British Columbia (BC), Ontario (ON), and Nova Scotia (NS), highlighting key policies, strategies, and challenges faced in fostering equitable care along with implementation and sustainment of TBPHC. Approach:This longitudinal case study used mixed-methods to analyze 3 ON, 7 BC and 7 NS PHC policies from 202 onward. Data sources include provincial and local level policies including strategic direction documents and white papers. The analysis employs the Input-Mediators-Outcome (IMO) framework to systematically direct these major components, alongside the policy triangle that considers the content, process, actors, and context integral for policy formulation, implementation and evaluation. Moreover, the policy analysis is facilitated by the conceptual framework meticulously developed by the TBPHC research team, concentrating on critical areas such as patient engagement, alignment of patient needs, structure of PHC teams, and fostering collaboration among both internal and external shareholders. To enrich this analytical process, interviews will be conducted with patients, providers, and policymakers. Results:Preliminary analyses showed: In BC, a notable shift towards prioritizing health equity in PHC delivery has been observed, particularly through initiatives focusing on Indigenous communities and equity-deserving groups. The emphasis on expanding Community Health Centres, especially those governed by First Nations, demonstrates a targeted approach to address the healthcare needs of equity-deserving groups. However, challenges remain, including workforce diversity and access to digital health resources. In NS, a strong commitment to community-based care and social determinants of health underscores the province's focus on promoting health equity. Despite this commitment, challenges persist, such as limited workforce capacity (e.g., shortage of family physicians) in collaborative practice teams. ON's adoption of transformative PHC models, like Family Health Teams and Nurse Practitioner-Led Clinics, target equity-deserving groups and aims to address systemic disparities in access to care. These models have shown tangible benefits, including reduced emergency room visits and improved care transitions. However, barriers such as limited access to healthcare for uninsured individuals and gaps in care coordination persist. Across all provinces, significant strides are being made to fortify the alignment between PHC and its dedicated teams. PHC teams facilitate integrated health services delivery by coordinating care, serving as care navigators, ensuring continuity, managing population health, fostering collaboration, and leveraging health information systems. Further in-depth analysis will be included in the presentation. Implications:This study underscores the critical need for targeted interventions aimed at addressing inequities in healthcare access and outcomes among equity-deserving groups. The findings suggest that policymakers and healthcare decision-makers must prioritize initiatives that address workforce shortages crucial for fulfilling commitments to patient-centered care, promoting health equity, and overcoming barriers to equitable healthcare delivery.

BACKGROUND:The ongoing impacts of the COVID-19 pandemic on Canada's healthcare workforce and service delivery necessitate focused health system planning and delivery that prioritizes coordination, collaboration, and evidence-based strategies. A rapid evidence synthesis was commissioned by Health Canada to determine the impacts of the pandemic on the healthcare workforce and to identify promising strategies and innovations that mitigate these challenges. METHODS:Two, sequential rapid evidence syntheses were conducted between October 2022 and March 2023 using methodologies aligned with Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S) guidelines. The first review (October-November 2022) focused on the impacts of COVID-19 on Canadian healthcare workers and mitigation strategies, while the second (November 2022-March 2023) broadened the scope to international interventions. Findings were organized by impact level (individual, organizational, system). Quality assessment of sources was not performed. RESULTS:We included 176 and 31 sources, respectively in the analysis. Sources identifying impacts of the COVID-19 pandemic described significant mental health impacts on healthcare workers, alongside changes in demand and supply of services, physical health challenges, and shifts in scopes of practice or care models. Interventions were primarily targeted at the individual or organizational level and included mental health support, training and upskilling, enhanced organizational communication and workforce planning initiatives. System-level interventions were less common, and most interventions lacked robust evaluation or evidence-informed design. CONCLUSIONS:This review highlights a significant gap in literature regarding evaluated interventions to address healthcare workforce challenges during the pandemic. While numerous sources document the adverse impacts on healthcare workers, detailed reports on specific interventions are scarce. Most interventions focus on workforce planning, education, practice scopes, recruitment and technology integration. The research underscores the need for comprehensive recommendations addressing social and mental health support, workplace safety, organizational communication and pandemic preparedness. These recommendations are vital for developing future workforce strategies, thus enabling policymakers and healthcare leaders to effectively respond to current and future healthcare challenges. This strategic approach will enhance system resilience and improve healthcare delivery across Canada.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the crucial role of robust health research systems (HRSs) in supporting effective public health responses. Understanding the responses and lessons learned from HRS during the pandemic is vital for future preparedness. This environmental scan examined high income Countries with a HRS that responded to the COVID-19 pandemic using both academic and grey literature sources to gather comprehensive insights into these areas. The analysis was structured using an organizing framework to facilitate systematic extraction and synthesis of relevant information. A total of 5336 sources were identified of which 3609 were screened following duplicate removal. A total of 117 full-text sources were reviewed leading to 65 being included. Effective interdisciplinary and cross-sector collaborations significantly enhanced the capacity to respond to the pandemic. Clear and streamlined governance structures were essential for coordinated efforts across various entities, facilitating swift decision-making and resource allocation. The robustness of pre-existing research infrastructures played a crucial role in the rapid mobilization of resources and execution of large-scale research projects. Knowledge mobilization efforts were vital in disseminating research findings promptly to inform public health responses. Continuous tracking and evaluation of health research activities enabled real-time adjustments and informed decision-making. Rapid identification and funding of research priorities, including vaccine and therapeutic development, were critical in addressing urgent public health needs. Effective resource allocation and capacity-building efforts ensured focused and accelerated research responses. Comprehensive strategic planning, involving stakeholder engagement and robust monitoring tools, was essential for aligning research efforts with health system needs. The findings underscore the necessity of flexible funding mechanisms, enhanced data-sharing practices and robust strategic planning to prepare for future health emergencies. Policy implications emphasize the need for sustained investments in health policy and systems research (HPSR) and the development of comprehensive governance frameworks. Research implications highlight the importance of community engagement and interdisciplinary partnerships. For decision-makers, the study stresses the importance of rapid response mechanisms and evidence-based policy making. Health research systems must prioritize maintaining adaptable infrastructures and strategic planning to ensure effective crisis response. Despite potential biases and the rapidly evolving context, this comprehensive analysis provides valuable lessons for strengthening HRSs to address future public health challenges.

Introduction/Objectives: Health equity is increasingly being recognized as an important aspect of healthcare. A focus on health equity allows everyone to reach their full potential. Yet there are gaps in healthcare to address health equity. The aim of this Canadian study was to assess how policy facilitates and hinders health equity within team-based primary healthcare settings in 3 provinces: British Columbia (BC), Ontario (ON), and Nova Scotia (NS), identify the similarities and differences across the Canadian provinces, and provide recommendations and actions to advance health equity at policy and systems levels. Methods: We used the OPTIC-PHC conceptual framework developed by the study team to better understand the implementation of primary healthcare teams. The Systemic Equity Action-Analysis Framework was used as the theoretical foundation for the work. The study used a policy scan approach to identify, review, and analyze primary healthcare policy documents in the 3 participating provinces. Sixty-two documents were included in the study. Results: Health equity did not appear in policy documents consistently until 2018. Four key themes were identified in the policy scan: partner engagement; Community Health Centres, Indigenous health, and equity initiatives. Conclusions: Health equity is now much more prevalent in policy documents. What is unknown, is whether equity approaches/initiatives have been implemented and/or evaluated. There is significant opportunity for collaboration between patients, caregivers, community members, healthcare providers, decision-makers, and policy-makers to develop health equity initiatives, to implement clearly articulated principles and initiatives to drive health equity, and to measure outcomes of these initiatives in primary healthcare settings.

Background: Industrialized countries are facing pressure to address the complexity of populations who experience high needs with significant costs to the health system. Interprofessional team-based care (TBC) is an essential component of integrated care strategies to respond to these complex needs. However, TBC models operate within complex policy environments that can facilitate or constrain their activities. The main goal of this project is to develop deeper insights on the manner in which system-level policies contributed in shaping TBC in three Canadian provinces - Ontario (ON), British Columbia (BC) and Nova Scotia (NS). Approach: This research consisted of an analysis of provincial policy documents (3 ON, 7 BC and 4 NS). Data was extracted using an innovative framework, based on a concept mapping exercise completed by the research team. Qualitative description and matrix comparative analysis for similarities and differences were used for data analysis. Results: Across the provinces, government investments encouraged the development of various models of TBC models (physician clinics, interprofessional team clinics, nurse practitioner led clinics, Community Health Centers). Government support was often tied to changes in the operations of TBC models such as increasing the number of services or extending opening hours. To enhance TBC, some policies expanded the roles and competencies of allied health professionals or shifted services from hospital to community settings. Patient engagement and participation in policy development and implementation was more salient in BC policies than ON. Implications: Provincial policymakers play a key role in creating the conditions in which TBC models are created and operate. This policy analysis highlights successful strategies that can contribute to improving the development and operations of TBC. These findings can inform the development of public polices and avenues for adopting practices so as to foster TBC in Canada.

BackgroundAchieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions.MethodsPurposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration.ResultsEleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed.ConclusionOur findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems.

Kasaai and colleagues examine the career outcomes of alumni from the Canadian Institutes of Health Research’s (CIHR’s) Health System Impact Fellowship (HSIF), which embeds emerging scholars in health system organizations. The study of the 2017-2019 cohort shows all alumni are employed, with 92% working in Canada, and highlights their presence in academia, public service, healthcare, and private industry. Notably, 37% hold "hybrid" roles, blending academic and other sector work. While the fellowship effectively prepares fellows for impactful careers, the prevalence of hybrid roles raises concerns about sustaining academic partnerships post-fellowship. This commentary explores risks to embedded scholars, such as decentralization, competing innovations, and limited ongoing training, using the Diffusion of Innovations framework. It suggests strategies like strengthening network connectivity, focusing on high-impact innovations, increasing organizational embeddedness, and maintaining adaptability to ensure the long-term success of embedded scholars and the integration of evidence-based innovations in health systems.

Kasaai et al describe the career trajectories of embedded scientists trained through the Health System Impact Fellowship (HSIF), showing that 37% of 2017-2019 HSIF alumni continue as embedded researchers in health systems. These findings suggest that the HSIF program effectively supports career readiness in health services and policy research (HSPR). Similarly, the Network of Scholars (NoS) program, launched post-pandemic in Nova Scotia, mirrors these results, with alumni continuing in embedded roles and mentoring a new cohort of learners from undergraduate to postgraduate levels. NoS has incorporated competencies in quality, project management, and innovation to strengthen training for embedded scientists, aligning with the mandate of the Institute of Health Services Policy and Research. Since 2021, NoS has supported over 100 learners, contributing to over 300 rapid reviews and 100 rapid evaluations addressing top health system priorities while enhancing learner competencies and advancing Nova Scotia's Learning Health System (LHS) vision.

OBJECTIVE The purpose of this review is to describe how health service and delivery systems support health equity and to identify strategies and indicators being used to measure health equity. INTRODUCTION It is widely acknowledged that a population health and equity approach is needed to improve the overall health of the population. The health service and delivery system plays an important role in this approach. Despite this, system transformation to address health inequities has been slow. This is due, in part, to the lack of evidence-based guidance on how health service and delivery systems can address and measure health equity integration. Most studies focus on health equity integration in the public health sector at a provincial or national level, but less is known about integration within the health service and delivery system. More information is needed to understand how that transformation is occurring, or could occur, to make a meaningful contribution toward improving population health outcomes. INCLUSION CRITERIA This scoping review will identify studies that describe the strategies and indicators that health service and delivery systems are using to integrate health equity and how progress is measured. Evidence from qualitative, quantitative, mixed method studies, and gray literature will be included. METHODS This review will be conducted in accordance with JBI methodology for scoping reviews. A comprehensive search strategy, developed with a librarian scientist, will be used to identify relevant sources. Titles, abstracts, and full texts will be evaluated against inclusion criteria. Information will be extracted by two independent reviewers. Data will be synthesized and presented narratively, with tables and figures where appropriate.

Background: The COVID-19 pandemic has brought immense disruption worldwide, dramatically altering the ways we live, work and learn on a day-to-day basis; however, few studies have investigated this from the perspective of primary care providers. In this study, we sought to explore the experiences of primary care providers in the province of Nova Scotia, with the intention of understanding the impact of the COVID-19 pandemic on primary care providers’ ability to provide care, their information pathways, and the personal and professional impact of the pandemic. Methods: We conducted an exploratory qualitative research study involving semistructured interviews conducted via Zoom videoconferencing or telephone with primary care providers (physicians, nurse practitioners and family practice nurses) who self-identified as working in primary health care in Nova Scotia from June 2020 to April 2021. We performed a thematic analysis involving coding and classifying data according to themes. Emergent themes were then interpreted by seeking commonalties, divergence, relationships and overarching patterns in the data. Results: Twenty-four primary care providers were interviewed. Subsequent analysis identified 4 interrelated themes within the data: disruption to work–life balance, disruptions to “non-COVID-19” patient care, impact of provincial and centralized policies, and filtering and processing an influx of information. Interpretation: Our findings showed that managing a crisis of this magnitude requires coordination and new ways of working, balancing professional and personal life, and adapting to already implemented changes (i.e., virtual care). A specific primary care pandemic response plan is essential to mitigate the impact of future health care crises.

The saying "horses for courses" refers to the idea that different people and things possess different skills or qualities that are appropriate in different situations. In this paper, we apply the analogy of "horses for courses" to stimulate a debate about how and why we need to get better at selecting appropriate implementation research methods that take account of the context in which implementation occurs. To ensure that implementation research achieves its intended purpose of enhancing the uptake of research-informed evidence in policy and practice, we start from a position that implementation research should be explicitly connected to implementation practice. Building on our collective experience as implementation researchers, implementation practitioners (users of implementation research), implementation facilitators and implementation educators and subsequent deliberations with an international, inter-disciplinary group involved in practising and studying implementation, we present a discussion paper with practical suggestions that aim to inform more practice-relevant implementation research.

Abstract Background Testing is a foundational component of any COVID-19 management strategy; however, emerging evidence suggests that barriers and hesitancy to COVID-19 testing may affect uptake or participation and often these are multiple and intersecting factors that may vary across population groups. To this end, Health Canada’s COVID-19 Testing and Screening Expert Advisory Panel commissioned this rapid review in January 2021 to explore the available evidence in this area. The aim of this rapid review was to identify barriers to COVID-19 testing and strategies used to mitigate these barriers. Methods Searches (completed January 8, 2021) were conducted in MEDLINE, Scopus, medRxiv/bioRxiv, Cochrane and online grey literature sources to identify publications that described barriers and strategies related to COVID-19 testing. Results From 1294 academic and 97 grey literature search results, 31 academic and 31 grey literature sources were included. Data were extracted from the relevant papers. The most cited barriers were cost of testing; low health literacy; low trust in the healthcare system; availability and accessibility of testing sites; and stigma and consequences of testing positive. Strategies to mitigate barriers to COVID-19 testing included: free testing; promoting awareness of importance to testing; presenting various testing options and types of testing centres (i.e., drive-thru, walk-up, home testing); providing transportation to testing centres; and offering support for self-isolation (e.g., salary support or housing). Conclusion Various barriers to COVID-19 testing and strategies for mitigating these barriers were identified. Further research to test the efficacy of these strategies is needed to better support testing for COVID-19 by addressing testing hesitancy as part of the broader COVID-19 public health response.

The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR's) Strategic Plan 2021-2026 for accelerating health system transformation is well positioned to meet the strategic priorities being outlined by many health systems in Canada and internationally (CIHR IHSPR 2021). The IHSPR Health System Impact Fellow program has been a strong influence on the embedded research and scientist program in Nova Scotia, namely, the Network of Scholars Program, which was implemented just before the pandemic. The network includes scientists and scholars from diverse academic backgrounds and skill levels including alumni of the Health System Impact Fellow program. The Network of Scholars has over 30 scholars and approximately 100 academic partners and scientists supporting embedded activities such as rapid reviews, implementation science and rapid evaluation initiatives. These embedded activities are front facing to the needs and priorities of the health system. This commentary highlights the importance of IHSPR's outlined strategic plan and direction, which are consistent with the experience and the needs for embedded supports within the Nova Scotia health system.

Many medical services lack robust evidence of effectiveness and may therefore be considered “unnecessary” care. Proactively withdrawing resources from, or de-funding, such services and redirecting the savings to services that have proven effectiveness would enhance overall health system performance. Despite this, governments have been reluctant to discontinue funding of services once funding is in place. The focus of this study is to understand how the framing of an issue or problem influences government decision-making related to de-funding of medical services. To achieve this, a framework describing how problem frames, or explanatory naratives, influence government policy decisions was developed and applied to actual cases. The two cases selected were the Ontario government’s decisions to de-fund the drug Oxycontin and blood glucose test strips used by patients with diabetes. A qualitative content analysis of public discourse (political debate and media coverage) surrounding these two resource withdrawal examples was conducted and described using the framework. In the framework, government decision-making is a partial reflection of the visibility of the policy issue and complexity of the causal story told within a problem frame. By applying this framework and considering these two key characteristics of problem frames, we can better understand, and possibly predict, the shape and timing of government policy decisions to withdraw resources from medical services.

To promote postpandemic recovery, many countries have adopted economic packages that include fiscal, monetary, and financial policy measures; however, the effects of these policies may not be known for several years or more. There is an opportunity for decision makers to learn from past policies that facilitated recovery from other disease outbreaks, crises, and natural disasters that have had a devastating effect on economies around the world. To support the development of the United Nations Research Roadmap for COVID-19 Recovery, this review examined and synthesized peer-reviewed studies and gray literature that focused on macroeconomic policy responses and multilateral coalition strategies from past pandemics and crises to provide a map of the existing evidence. We conducted a systematic search of academic and gray literature databases. After screening, we found 22 records that were eligible for this review. The evidence found demonstrates that macroeconomic and multilateral coalition strategies have various impacts on a diverse set of countries and populations. Although the studies were heterogeneous in nature, most did find positive results for macroeconomic intervention policies that addressed investments to strengthen health and social protection systems, specifically cash and unconventional/nonstandard monetary measures, in-kind transfers, social security financing, and measures geared toward certain population groups.