Reducing low-value care in African health systems: a narrative review of clinical and resource outcomes

Abstract

Background and objective Reducing low-value care may improve clinical practice and preserve scarce resources, but lower use alone does not demonstrate better allocation. We examined how selected African studies define inappropriate care, assess whether patients receive needed care, and report resource consequences and subsequent use. Methods We narratively reviewed English- and non-English-language clinical, implementation, economic, and health-system evidence. Database searches covered publications from 2000 through October 1, 2026, using PubMed/MEDLINE, Scopus, Web of Science Core Collection, and African Journals Online (AJOL). We also searched citations backward and forward. We selected sources purposively to illustrate different clinical criteria, study designs, and resource outcomes, and linked reports from the same program. We compared 27 program evaluations; audits and financing studies provided context. The selection was illustrative rather than exhaustive. Results Evidence concentrated on malaria management, antimicrobial stewardship, and laboratory testing. Some interventions reduced care judged inappropriate against explicit criteria; others reduced total prescribing under clinical algorithms. Diagnostic trials also reported null or mixed effects, and prescribing improvements sometimes coexisted with missed indicated care. Economic findings included estimated drug costs, avoided laboratory charges, recorded expenditure, and modeled outcomes. Diagnostic and implementation costs could offset reductions in other inputs. None of the 27 evaluations, including linked reports, established that reducing inappropriate care made net resources available, led to intentional reinvestment, and improved outcomes in a receiving service. This finding is limited to the selected reports. Conclusion Selected African interventions improved prescribing or reduced inappropriate care, but the evidence did not establish subsequent benefit from deliberate resource reallocation. By linking clinical and economic reports, this review distinguishes clinical improvement, additional indicated care within a service, and benefit from reinvestment. Evaluations should measure the outcomes needed to support the benefit claimed. Clinical improvement remains valuable even when it does not release funds.

The authors' abstract, as published at the source. F1000Research, 2026 · DOI ↗