Implementation of the Tallinn Charter in the WHO European region: Where is the evidence? a systematic comparison of online information before and after the end of the year of signature

Background: The "Tallinn Charter: Health Systems, Health and Wealth" signed by 53 member states of the WHO European Region provides guidance for strengthening health systems. Objectives: A systematic search was conducted to compare studies and actions related to the commitments of the Tallinn Charter. Materials and methods: Target keywords were identified directly from the Charter. Structured web search was conducted on Pubmed/Google. Results for 2007-2010 were analyzed as frequencies before/after the end of the year of signature and classified by relevance and category of content. Results: Searches for 2007-2010 extracted N= 717 papers in Medline and N= 634 links in Google using combined keywords. Additional N= 165 direct links to the Charter were found by Google for 2008-2010. An increase by 18% (scientific literature) and 10% (grey literature) was observed after 2008. Discussion: The number of conceptual, methodological, analytical or system evaluation reports related to the themes of the Charter increased after 2008, while benchmarking and cross-country comparisons were less frequent. Opposite trends were observed for the grey literature. Conclusions: The implementation of the Tallinn Charter is supported by more information available on the topic. The methodology used to perform a rapid search may be usefully repeated to monitor the process.