Professor Ruairí Brugha, Head of the Department of Epidemiology and Public Health Medicine at the Royal College of Surgeons in Ireland, and Board member of the IFGH, has written a special guest editorial focusing on the recently-published World Report on Health Policy and Systems Research. Prof. Brugha notes some of the stand-out sections of the report, and highlights its value to both established researchers, as well as those newly starting their careers in the field. Please read on below for Prof. Brugha’s editorial in full, and click here to download the report from the WHO’s Alliance for Health Policy and Systems Research webpage.
WHO World Report on HPSR: Guest Editorial by Professor Brugha
The recently published World Report on Health Policy and Systems Research is the defining report on the history, status and future direction of the field of health policy and systems research (HPSR). At less than 50 pages, this is a must-read for policy makers, practitioners and researchers.
If you have no more than an hour free, chapter 1: Evolution is a tour-de-force, where Sara Bennett, Julio Frenk and Anne Mills trace the key events and publications that have informed the development of this field. For those of us who have straddled practice and research in low and middle income countries (LMICs), and in high income country health systems (Ireland), the authors bring conciseness and clarity to distinguishing between health services and health systems research. The former, focusing primarily on micro and meso level health services questions, has been the dominant paradigm in Ireland. Whereas a systems approach, addressing macro-level questions around how to organise, finance and orient national health systems, is in an emergent phase. Indeed, much of the health systems research in Ireland has been undertaken by researchers and practitioners who have done, or are doing, similar research in LMICs, especially in Africa.
For decades, the concept of ‘bringing it all back home’ has been familiar to Irish global health and development practitioners – was that term first coined by Bob Dylan or by Comhlámh?! Likewise, when one looks at the global health and health systems researchers who have risen to senior levels in Irish higher education institutions over the last ten years – coming from public health, economics, management, nursing and psychology disciplines – one can see how the field of HPSR is shifting the focus of health services research in Ireland towards these ‘big questions’. The WHO report covers some well-trodden issues, such as the historical imbalance between clinical / biomedical research and HPSR. Where it breaks new ground, at least from the perspective of the general reader, is in clarifying the different dimensions of policy that together comprise the ‘P’ in HPSR. These include research on or into policy processes, as a new sub-field of research, and the now widely-recognised field of research for policy – or getting research into policy.
It is well-accepted in the field of education that one is most open to learning and retaining what one already knows or believes – we take what makes sense, what fits, and we add it to our stock of knowledge. Hence, this report will be as welcomed by those of us who are nerds, or perhaps jaded practitioners, in the field HPSR, as it should also be a defining or framing report for students. For example, the first chapter charts how “. . . the HPSR community has tended towards inclusivity . . . different knowledge paradigms, and contributions . . . from different disciplinary perspectives”. The increasing recognition of multidisciplinary research is not unique to the field of HPSR or LMICs; and is a development that can help to break down the polarisation between HPSR and clinical research. Multidisciplinarity – not only mixed (quantitative and qualitative) methods, but also the bringing together of different fields of knowledge (clinical, sociological, health systems and policy) in research studies – is, in my experience (and practice), more honoured than observed. HPSR’s methods and approach make it well placed to answer the really important and interesting questions in the field of health, which are complex ones. Thereby, it can lead the way in generating new knowledge to benefit populations and change the world for the better (a goal that we should aspire to).
These are some of the thoughts that are stimulated by just the ten-page first chapter: Evolution. Chapter 2: Benchmarks offers the student of HPSR a rich source of data covering trends in HPSR knowledge generation, and the growth of research partnerships and collaborations, illustrated as a complex global web in Figures 4 to 6. For decision makers (donors and development agency staff), it provides trends in HPSR funding. For all those interested or working in different ways in the field of global health, it provides analyses of the dimensions of capacity, and the enablers and obstacles to the use of research. Chapter 3: Capacity further unpacks what is, or should be, a perennial concern for governments, development partners and research institutions: “the need to build and sustain institutional capacity to support HPSR in LMICs and especially LICs”. Here, the authors focus on three dimensions: “organization(s), networks (particularly policy networks) and an enabling environment”.
Chapter 4: Future, which ends the report, places HPSR in the context of the Sustainable Development Goals (SDGs). It explores “some of the future challenges for HPSR and how HPSR will need to adapt in the following overlapping areas:– Tackling the challenges of interdependence and integration in the SDG era;– Balancing the health interests of individuals, communities and populations;– Supporting the agenda for universal health coverage;– Unleashing technological and social innovation to benefit the common good and the most marginalized;and– Synthesizing and adapting HPSR knowledge across a wide range of contexts.
The report also does not disappoint in its delivery of useful references and signposts to other readings. Those who are new to the field of global health, who wish (or need) to understand the aspirations, achievements, and set-backs of the last 40 years, can use this report as a source and guide to the key documents, developments and current trends in health policy and systems research. For all who are involved in learning, practicing and applying the fruits of HPSR, the 2017 World Report on Health Policy and Systems Research is an indispensable, ground-breaking resource.
Professor Ruairí Brugha,
18th May 2017