Table 2 Themes common to multiple system levels including example strategies

Legislation and policy

Values and clarity [70, 72, 73, 77, 82,83,84,85]

Consistent definition of equity across the system

Proportionate universalism [15, 39, 86]

Universal policies applied proportionally to need

Accountability [81, 87,88,89]

Legislated community accountability requirements such as community engagement in planning

System commitment [68, 74, 80, 83, 90, 91]

Embed framing to balance efficiency against equity needs.

Expenditure and budget

Guaranteed and sustained funds [72, 91,92,93,94,95,96,97]

Sufficient and continued financing for equity

Financial incentives and supports [8, 39, 68, 71, 76, 88, 97, 98]

Financial incentives for partners to partake in the equity promoting programs

Management and coordination

Leadership commitment and vision [72, 77, 79, 82, 90, 92, 94, 97, 99,100,101]

Leadership responsibility, buy in and commitment to equity

Collaboration and coordinated approach through communication and clear role delineation [8, 12, 74, 76, 77, 90, 98, 101,102,103,104,105]

Intentionality across project structure to ensure effective equity operations

Adaptability [78, 88, 89, 99, 102, 106, 107]

Adaptation of model to ensure feasibility and sustainability at the local level to meet local needs

Multilevel accountability [76, 79, 87, 94, 101, 108]

Multi-level governance to address fragmentation, recognising the opportunities for devolved governance to address equity

Longer timelines [73, 80, 82, 98, 101]

Timeline adjustments for vulnerable populations to build momentum and address barriers

Social norms

Shared power and decision-making [68, 72, 76, 86, 90, 91, 96, 97]

Community and user engagement through formalised governance and at organisation level, with equitable representation in roles

Shared understanding and sensitivity to community context [72, 82, 84, 91, 99]

Creation of two-way channels through which implementers and leadership can communicate in a timely manner and build trustful relationships

Inclusive, respectful, equitable, and trust-filled partnerships [73, 78, 80, 95, 98, 101,102,103, 109,110,111]

Build trust based on recognition and respect for cultural values

Resources

Digital systems [39, 68, 93,94,95, 110, 112, 113]

Interoperable electronic health records across services to consistently capture equity domains

Monitoring, evaluation and feedback strategies, processes, and resources [8, 74, 83, 106]

Equity specific monitoring and evaluation (e.g., outcomes, training impact, unmet need)

Quality data [39, 76, 77, 89, 97, 98, 103, 106, 109, 114, 115]

Disaggregated data to reduce invisibility and enable greater tailoring of services

Training and awareness [39, 73, 74, 84, 94, 110]

Tailored educational messaging and information specific to communities

Multi-profession representation [84, 91, 108, 116]

Multi-professional teams

Diverse roles and responsibilities [72, 84, 93, 98, 99, 107].

Specific equality and diversity staff, local health equity champions and lay advocates

Utilisation and Environment

Community and patient-centred [39, 68, 70, 77,78,79, 86, 97, 98, 101, 104, 108, 114, 116,117,118,119]

Interventions embedded in social settings to promote accessible services

Culturally safe, agile, and flexible services and implementation [39, 74, 81, 97, 99, 104, 105, 108, 117, 120, 121)

Flexible implementation in response to contextual needs

Accessible services that are safe [68, [74, [77, [101, [109, [122]

Focus on reducing geographical barriers