Decade of Health Systems Research, A

Executive summary

Since 1987, the Joint WHO/DGIS HSR Project has been working with Eastern and Southern African countries on the establishment and/or strengthening of national health systems research (HSR).Following a decade of implementation, it has contributed to the demystification of research so that HSR has become an acceptable tool for generating evidence-based information for policy and programme decisions. It promoted the development of research culture and the training of a cadre of health workers; facilitated the establishment of HSR structures and mechanisms within the health sector; provided a forum for networking; the exchange of experience and technical cooperation (TCDC) in HSR among these countries.

It institutionalised a methodology for HSR training and the training of trainers utilising a HSR training series developed for this purpose. It promoted the conduct of HSR studies as well as the application of research evidence at different levels. Evaluation of the HSR project showed that most studies have focused on operational issues and have had less impact on health policies than expected; there is limited networking among researchers in countries and limited application of skills among those who had been trained in HSR.

Lessons learnt include the need to strengthen networking and participatory and team planning of HSR priorities, HSR agenda and policy-oriented research. Partnership among policy makers, programme managers and researchers in planning and implementing HSR has not been the norm while financial support in countries to the HSR process needed to be improved and sustained. At the start of its second decade of implementation, a new approach in HSR capacity strengthening took stock of these lessons. The HSR project objectives remain valid, but the strategies called forrecasting taking into consideration the readiness of participating countries.

This approach focuses on strengthening internal and inter-country networking and partnership among researchers and policy-makers/programme managers in prioritising HSR issues on key programme areas of regional importance, in formulating HSR frameworks on the top HSR priorities and promoting the use of evidence for policy and programme decisions. It entails bringing together teams from selected countries that are in the forefront in the key health problem area under consideration. This has been applied in two inter-country consultations organised by the WHO/AFRO/HSR: the first on health sector reform, the second on responsiveness of the health systems to HIV/AIDS.

Lessons learnt from the first consultation were considered in organising the second consultation. The newly-launched WHO conceptual framework on health systems performance provided a basis for identifying gaps in HIV/AIDS interventions and organising the potential areas for HSR according to the four functions of the health system. The 13 countries that participated are among those with the highest rate of HIV/AIDS globally. They have expressed a desire to participate in the multicountry studies involving five HSR frameworks developed at the consultation.

The external partners expressed interest in participating in the follow-up with possibility of funding. The WHO/AFRO/HSR has put together a pro-active regional package and has initiated concrete steps to provide follow-up support to the national teams in implementing the outcomes. It is notable that in a third of the countries that participated in the HIV/AIDS consultation, concrete steps had been taken to start the implementation of their POAs with feed-back provided to the WHO/AFRO/HSR Programme.

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Source: KIT website