Meeting calls for society on health systems research

[MONTREUX, SWITZERLAND] Concerns about the gulf between the abilities of rich and poor countries to conduct health research have led to a proposal to create an international society on health systems research, knowledge and innovation.

The society, proposed at the First Global Symposium on Health Systems Research in Switzerland last week (16–19 November), would use science to accelerate universal health coverage.

It would support regional and national efforts to strengthen health systems research, and catalyse scientists’ contributions towards setting standards and practices in health systems research.

The symposium resolved to clarify terms and classifications, and identify ways of measuring and evaluating the impacts of health interventions. There are also plans to evaluate the strength of evidence from field studies, and to identify ways of bridging the gap between health researchers and policymakers.

Presentations at the meeting also highlighted the gulf in health systems research between high-income countries and low- and middle-income countries (LMICs), and the urgent need to strengthen research capacities in LMICs.

Bibliometric analysis of four topics — access to medicines, human resources for health services, health financing, and the roles of state and non-state actors — highlights that there has been an increase in health systems research from 2004 to 2009. But researchers from high-income countries dominate, said John-Arne Rottingen, chief executive of the Norwegian Knowledge Centre for the Health Services.

High-income countries provide almost two-thirds of publications on human resources for health, with a tenth from Latin America and the Caribbean, a tenth from the Middle East and seven per cent from South Asia.

Sara Bennett, associate professor at the Johns Hopkins School of Public Health, said capacity building for such research in LMICs is a "critical issue". The United States has 709 health systems research organisations and 13,000 health systems researchers for a population of 310 million, whereas LMICs, with 5.5 billion people, have only 250–300 health systems research organisations and 6,000–7,500 researchers.

In addition, the research that is done in LMICs is mostly funded by donors and does not reflect the local context, said Bennett.

Irene Agyepong, from the Ghana National Health Services, said that the research that is done in poor countries is mostly funded by donors, and that the "agenda of the donors appears to drive them [researchers] … the sector sees less and less their immediate relevance as they do not appear to be providing solutions to the sector’s problems".

Di McIntyre, of the health economics unit at the University of Cape Town suggested setting up health systems research institutions with some permanent funding either in universities or in national ministries of health in developing countries.

To build capacity in health systems research in poor countries, some delegates called for fellowships and individual mentoring. University curricula should be updated to include topics that are relevant to policy, others said, and there should be more collaboration between research groups.