What Is Health Systems Reseach and Why Do We Need It?
In an upcoming issue of Tropical Medicine and International Health, Jaffar et al write an editorial on the need for more research into "how to implement and scale-up interventions of proven efficacy and how to deliver health services more effectively within the current infrastructure, i.e. to optimize existing health service delivery."
This article aligns with other recent calls for a great focus on health research, including by the World Health Organization (see their resolution passed at the World Health Assembly in May), and calls in the Lancet for a clear health research agenda.
In this recent article, Jaffar and co-authors advocate for "health services research" (what we call health systems research or implementation science) in a number of areas:
- Strategies for training, managing and supporting health care workers
- Decentralization of care from hospitals out to more rural facilities, and from clinical to non-clinical staff
- Strategies for enabling better integration of services, such as for HIV and TB but also for other chronic conditions such as hypertension and diabetes
- Scaling-up of testing and diagnostics, as well as treatment program
They also emphasize the need to keep research simple enough to be conducted in routine practice settings without placing undue burden on staff. However, the article also notes that funding for health systems research is scarce, and even when it is available, heavy demands for service delivery and weak infrastructure can be barriers for managers to undertake research projects.
In many of our program countries, the ministries of health have begun to prioritize health systems research as a way to understand how services are being delivered, what may be preventing patients from receiving care, and what policy or protocol changes may be necessary.
We started conducting annual "operations research" trainings in Mozambique several years ago, and have since also provided trainings for Ministry of Health managers in Peru and Cote d'Ivoire. We are planning a training for 2011 in Timor-Leste as well. Participants in the training learn about study design methodologies and begin planning research projects to address identified needs.
Some of the research projects we have been a part of have included looking at how well non-physician health workers provide HIV/AIDS care as compared to doctors, and bottlenecks to patients staying on antiretroviral treatment, specifically related to numbers and types of health workers available.
These kinds of projects tell health system managers what changes should have the greatest impact in improving health care and patients' outcomes. We're happy to see that our These kinds of projects tell health system managers what changes should have the greatest impact in improving health care and patients' outcomes. We're happy to see that our Ministry of Health partners are building their internal capacity to conduct this kind of practical -- and essential -- research.
Leave a Reply