Using research evidence to strengthen health policy and systems

Health systems are complex and dynamic. They are influenced by local and international political, social and economic factors. Given this complexity, how can we understand which policies are most effective and appropriate for achieving health and health systems’ goals in a given setting?

The field of Health Policy and Systems Research (HPSR) aims to generate evidence about the policies (and policy content) most appropriate and effective for achieving locally valued goals. But is there value in committing to and investing in the field of HPSR? To answer this question we need to understand how it can be of benefit in different settings.

Community education is implemented at a durbar (village meeting) | Aaron Asibi Abuos

WHO’s Alliance for Health Policy and Systems Research (AHPSR) commissioned the Nossal Institute for Global Health to provide nuanced insight of how HPSR evidence has been generated and used to improve health system function across a range of settings. We investigated the varied development trajectory of the HPSR field in Mexico, Cambodia and Ghana to understand how, why and to what extent HPSR has influenced health policy. Mexico, Cambodia, and Ghana were selected as case studies because they have each been, in various ways, early adopters of HPSR and provide diverse examples of the foundations of HPSR and its application.

In Mexico, the growth of HPSR capacity and the use of evidence produced in policy generation began with health leadership development from the early 20th Century and accelerated considerably when successive governments engaged with that leadership from the 1980s. In Cambodia, burgeoning HPSR capacity came from local demand for evidence and the role of donor partners since the 1990s. In Ghana, HPSR capacity development was catalysed during a period of political stability, policy reform and research institution establishment in the 1980s and 90s.

The contrasting pathways of Mexico, Cambodia and Ghana, determined by their varied country contexts, are instructive when seeking an understanding of HPSR pre-requisites, growth and impact. They demonstrate that each country must determine its own path while making best use of international experience and lessons learned. Supporting research structures with social development legislation, establishing relationships based on trust between researchers and policy makers, and building a strong domestic capacity for health systems research all contribute to the strengthening of health systems and demonstrate the value of HPSR.

We have developed a policy brief for WHO highlighting the value of investment in HPSR capacity when seeking to develop resilient and responsive health systems and ultimately healthier populations. We made recommendations regarding the steps that can be taken to build capacity while considering each setting’s unique characteristics. Our manuscript will published in the journal of Health Policy and Planning.

Dr Daniel Strachan is a Senior Technical Advisor with the Nossal Institute. He is a social scientist whose research aims to support more equitable and effective health system development (and ultimately healthier communities) through engagement with community perspectives and approaches to health.

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Dr Daniel Strachan