Improving health policies and systems has long been the aim of the World Health Organisation (WHO) when identifying and promoting ways to strengthen (National) Health Research Systems (NHRSs). Added impetus has come from the desire to achieve Universal Health Coverage and meet the Sustainable Development Goals. Now, for what is thought to be the first time, a group of us have synthesized the international evidence on strengthening NHRSs for the WHO. The review’s publication coincides with a heightened awareness of the need for health research, and the benefits of conducting and coordinating it as systematically as possible, to find ways of treating and preventing COVID-19.
But why is a systems approach important and helpful?
Our synthesis starts by describing the many challenges facing health research, including securing sufficient funding, building and sustaining adequate capacity, and producing valid findings that are then utilised as appropriate to inform policies and practice. Taking a systems approach offers the potential of making coordinated advances.
We found comprehensive and coherent health research strategies play a key role at the systems level, with good examples coming from diverse countries including England, Ireland, New Zealand, the Philippines and Rwanda
In 2001 the Health Economics Research Group (HERG) at Brunel University London joined the WHO’s efforts to promote a systems approach. Tikki Pang’s WHO team recognized the contribution to the monitoring and evaluation component that could be made by HERG‘s Payback Framework for assessing the wider impacts from health research. Martin Buxton and I first developed the Payback Framework for the R&D division of the English Department of Health in the mid-1990s, but further refined it in the work conducted with WHO which examined the use of research in health policymaking.
The work of the WHO team highlighted the value of adopting a systems approach because it can be used to identify all the activities required if research is to operate effectively, and collate them into a health research system framework, such as the team published in 2003. The M&E component was one of the nine components organised into four main functions. It was part of the stewardship (or governance) function, which was followed by funding, capacity building, and production and use of knowledge.
Key policies, interventions, and tools for strengthening NHRSs. And do they work?
Our 2020 evidence synthesis focuses on literature at the systems level and includes 112 publications. We found comprehensive and coherent health research strategies play a key role at the systems level, with good examples coming from diverse countries including England, Ireland, New Zealand, the Philippines and Rwanda. Strategies help pull together and promote the diverse policies and interventions to strengthen each specific health research component. Where appropriate, as with the National Institute for Health Research (NIHR) in England, the ultimate aim is integration of the health research system into the wider health system.
Partnerships between countries and donor and international organisations are also identified as being potentially important for strengthening NHRSs. Examples include progress resulting from the activities of the West African Health Organisation, and the Pan-American Health Organisation. In the review we also used the WHO framework as an organizing structure for part of the analysis.
Our policy recommendations build on the above and include: start with a contextual analysis to inform a comprehensive strategy; develop and sustain a comprehensive and coherent strategy; engage stakeholders, including in designing the research strategy and priority-setting; adopt evaluation tools focused on system objectives, including assessing the impact on improved healthcare; and promote partnerships. Finally, the review also includes a list of useful tools for implementing the various functions.
Promoting use of the evidence synthesis to help strengthen NHRSs, especially in the COVID context
We are now also outlining and promoting the review’s key finding in a new Opinion Piece. If further analysis and research is thought to be relevant in a particular country looking to strengthen its health research system, the paper additionally indicates some of the further sources of information that are available on each of the NHRS functions. These are illustrated with reference to an excellent single-country analysis drawing on about 200 predominantly local publications to assess each component of the NHRS in Iran.
The Opinion Piece also discusses aspects of the sometimes controversial question of who should lead, or steer, attempts to strengthen NHRSs. The context of the particular nation will be crucial, but some involvement, at least, of the ministry of health is likely to be beneficial, as seen in the formation of the NIHR.
In the paper we also note how, across a spectrum of countries, the valuable coordinating role international organisations such as WHO can play is being highlighted during the COVID-19 crisis. This includes WHO’s Solidarity Trial of possible treatments, and attempts to develop a COVID-19 vaccine in record quick time. Finally, we are collaborating with WHO in creating more materials for countries wishing to strengthen their NHRS.