Framework for systems of pediatric well-care visits: a scoping review.

BACKGROUND

Despite decades of global efforts to reduce under five mortality, 5 million children die before their fifth birthday. Numerous landmark reports have called for integrated approaches to further accelerate reductions, yet interventions are often delivered in silos and, to our knowledge, no global synthesis of the evidence for integrated preventive systems exists. We conducted a scoping review to map the existing literature on systems of well-care visits for children under five years from 2000 to 2023 globally.

METHOD: A systematic search of relevant databases (MEDLINE, the Cochrane Library, Web of Science, and OVID Global Health) was conducted. In total, 8,945 unique documents were identified and after screening titles and abstracts, a total of 1587 articles were assessed for eligibility through full-text review. The information was extracted based on the WHO's established health system framework, and from these pillars, a conceptual framework was derived on the components and the potential impact on child health care.

RESULTS

We found 322 eligible articles (217 primary articles, 105 reviews). Among the primary articles, close to 50% focused on high-income countries, while less than a fifth focused on low-income countries. Across regions, systems of preventive well-care visits are organized differently; from health days to home-visits, programs, and clinics. Depending on the context, the content differs (e.g., vaccinations, screenings, parent education) and the contextual challenges and solutions for implementation (e.g., mHealth, scale up existing structures).

CONCLUSIONS

This review identifies core components of well-care visit systems, including interventions, workforce composition, and governance structures, alongside key implementation strategies such as the scaling up of existing service delivery models. We introduce a framework for systems of well-care visits. These systems may offer child health care improvements, including enhanced attendance rates, increased service utilization, and decreased health care expenditure, thereby contributing to improved child health care for all.