Health Systems - Research Needs

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The BasicsThe World Health Organization (WHO) defi nes health systems as, “all the activities whose primary purpose is to promote,

restore, or maintain health.” Health systems strengthening aims to improve health by responding to people’s needs and

providing services in a fair and equitable manner.1

The WHO defi ned six building blocks of health systems that encompass

the activities needed to provide universal access to needed services and

universal coverage of health care through comprehensive strategies.

The scope of activities ranges from high-level governance issues to

community level point-of-care and service delivery approaches.

Why Research on Health Systems?Weak or missing elements of the building blocks create bottlenecks to

effi cient and effective delivery of health care. Health systems research identifi es where bottlenecks exist and provides

innovative solutions to improve the delivery of care. For example, health workers need information, tools, skills and

medicines to effectively deliver health care services; patients need money, subsidies or insurance to utilize them.

Practitioners and program implementers face numerous challenges in providing care and delivering interventions at all

levels of health systems, but particularly at the community level. Both the need and the capacity for fi nding solutions are

greater than ever before. Researchers, working in partnership with governments and the private sector, play an important

role in developing and sustaining health systems and providing feasible solutions to systemic bottlenecks.

Confronting these challenges in settings where health infrastructures are crumbling and weaknesses exist on multiple

fronts requires targeted research on health systems and health policy.2 Coordination and collaboration on research projects

are needed to avoid duplication, maximize opportunities for data collection and comparison, and to build local capacity

for health systems research in developing countries, where obstacles to care are especially problematic.

Research Priorities for the Building Blocks2

Governance, Leadership and Management w . Identify factors that contribute to the success and failure of programs or

fi nancing mechanisms.

On a national level, develop health priorities to guide investment and research.§

Promote the development of supportive policies; encourage consideration of ethical matters.§ 3

At the hospital and clinic levels, examine successful interventions for management and leadership.§

Financing Health Care and Health Systems. w Monitor long-term results of innovative fi nancing mechanisms for

health, such as the effectiveness of national health accounts, national health insurance policies or community-based

fi nancing schemes to cover those who cannot pay out of pocket.4, 5 Identify the costs associated with building a health

system; determine what an investment in health systems strengthening will buy; examine the returns on investment

for different disease-specifi c initiatives in the context of stronger health systems. 6, 7

Estimate the minimum system requirements, changes needed to make programs work, options for scaling up §

coverage, options to fi nance the scaling up coverage, and costs of implementing those changes.

Determine the transparency, availability and accessibility of health systems fi nancing data.§

WHO’s Six Building Blocks of

Health Systems

Leadership and Governance

Financing

Health Information Systems

Health Workforce

Medical Products and Technologies

Service Delivery

Health Information Systems. w Test ways to provide accurate, reliable health information in a sustainable manner.

Useful health information systems and technology investments will facilitate the management of information in all

aspects of the health system and will improve the capacity for surveillance and emergency response activities.

Health Workforce. w Research the distribution and tasks of doctors, nurses and community health workers; and research

methods of evaluation, supervision, and the impact of workforce issues on quality of care.

Research system constraints faced by various health personnel and programs.§

Understand what motivates providers in different communities and resource-strained settings and what incentives §

might encourage better quality of care, such as pay-for-performance schemes.

Medical Products and Technologies. w Research to develop effective forecasting and distribution systems for drugs and

other commodities to avoid shortages of essential medicines; research the causes of health workers being ill-equipped

with drugs and supplies to deliver necessary care and explore and test the effectiveness of solutions.

Service Delivery. w Research to identify and disseminate fi ndings about affordable, safe and effective interventions that

are widely available and to make access to health care more equitable; compare the effectiveness of delivering

services through disease-specifi c programs to delivery through primary care or integrated mechanisms.

Research is needed on how to deliver prevention, care and treatments in rural communities where there is limited §

infrastructure, particularly to tackles diseases of the poor.

Engage communities in the design of delivery mechanisms in order to identify culturally appropriate, convenient §

and sustainable approaches and measure results.6

Operations research focuses on defi ning and measuring important process and outcome indicators that assess

health systems, including service delivery successes and failures, and intervention and policy effectiveness. Include

research that links health systems inputs to outcomes, including long- and short-term cost-savings and other outcome

indicators. All research should address interrelated systems, including fi nancing and workforce needs.

A Call to ActionThe Global Health Council supports comprehensive prevention, care and treatment policies that are evidence-based and

locally appropriate. The Council supports strategic investments in health systems that include research that identifi es clear

and measurable outcomes, effective interventions and the impact of disease-specifi c initiatives and achievement of the

MDGs. The Council also calls for the United States, developing country governments and other public and private donors

to continue their leadership role in strengthening health systems.

1 World Health Organization. 2000. The world health report 2000: health systems: improving performance. Geneva: World Health Organization. Available

from: http://www.who.int/whr/2000/en/index.html2 Advancing evidence-based policy: bridging the boundaries between global health researchers and policy-makers. Global Health Conference, June 1, 2005,

Washington, DC. Available from: http://www.globalhealth.org/3 Global Health Council. Using research to meet the needs of health systems and communities. Research Symposium at the 35th annual international health

conference. May 28, 2008. Omni Shoreham Hotel. 4 Global Health Council. Follow-up interview with Dr. Ahbay Bang. July 18, 2008. (accessed October 6, 2008), Available from:

http://groups.google.com/group/ghc-research-symposium?hl=en&lnk=srg5 Ooms G, et al. 2006. Do we need a world health insurance to realise the right to health? PLoS Med 3(12):2171-6.6 Akogun O, et al. 2001. Community-directed treatment of onchocerciasis with ivermectin in Takum, Nigeria. Trop Med & Intl Health 6(3):232-43.7 Holveck JC. 2007. Prevention, control, and elimination of neglected diseases in the Americas. BMC Public Health 7(6).8 World Bank. 2007. What is a health system? The World Bank Strategy for HNP Results. Available from: http://www.worldbank.org/

Updated September 2008

From Health Systems Research to Policy Action2

Further investigation is required to examine the impact of health systems on maternal and child mortality, access

to reproductive health services and the incidence of infectious disease for Millennium Development Goals 4, 5,

and 6. In addition, research is needed to establish the link and determine the impact of health systems

strengthening on poverty reduction, gender equality, agricultural output and access to education, microfi nance and

clean water and sanitation.8

The dissemination of research results, both positive and negative, is critical to expanding the health system in an

effective and effi cient manner. Improvements in the fl ow of information to donors, policymakers and practitioners

are needed to ensure that policy is evidence-based and to minimize the time it takes to transfer research to policy

action.