Institutional capacity to generate and use evidence in LMICs: current state and opportunities for HPSR

BACKGROUND: Evidence-informed decision-making for health is far from the norm, particularly in many low- and middle-income countries (LMICs). Health policy and systems research (HPSR) has an important role in providing the context-sensitive and -relevant evidence that is needed. However, there remain significant challenges both on the supply side, in terms of capacity for generation of policy-relevant knowledge such as HPSR, and on the demand side in terms of the demand for and use of evidence for policy decisions. This paper brings together elements from both sides to analyse institutional capacity for the generation of HPSR and the use of evidence (including HPSR) more broadly in LMICs. METHODS: The paper uses literature review methods and two survey instruments (directed at research institutions and Ministries of Health, respectively) to explore the types of institutional support required to enhance the generation and use of evidence. RESULTS: Findings from the survey of research institutions identified the absence of core funding, the lack of definitional clarity and academic incentive structures for HPSR as significant constraints. On the other hand, the survey of Ministries of Health identified a lack of locally relevant evidence, poor presentation of research findings and low institutional prioritisation of evidence use as significant constraints to evidence uptake. In contrast, improved communication between researchers and decision-makers and increased availability of relevant evidence were identified as facilitators of evidence uptake. CONCLUSION: The findings make a case for institutional arrangements in research that provide support for career development, collaboration and cross-learning for researchers, as well as the setting up of institutional arrangements and processes to incentivise the use of evidence among Ministries of Health and other decision-making institutions. The paper ends with a series of recommendations to build institutional capacity in HPSR through engaging multiple stakeholders in identifying and maintaining incentive structures, improving research (including HPSR) training, and developing stronger tools for synthesising non-traditional forms of local, policy-relevant evidence such as grey literature. Addressing challenges on both the supply and demand side can build institutional capacity in the research and policy worlds and support the enhanced uptake of high quality evidence in policy decisions

Introduction to the Special Issue on "Analysing the Politics of Health Policy Change in Low- and Middle-Income Countries: The HPA Fellowship Programme 2017-2019".

This special issue presents a set of seven Health Policy Analysis (HPA) papers that offer new perspectives on health policy decision-making and implementation. They present primary empirical work from four countries in Asia and Africa, as well as reviews of literature about a wider range of low- and middle-income country (LMIC) experience

Evolution and lessons from an integrated service delivery network in North West Syria

From Springer Nature via Jisc Publications RouterHistory: received 2022-10-14, registration 2023-03-15, accepted 2023-03-15, epub 2023-03-24, online 2023-03-24, collection 2023-12Acknowledgements: This study is a collaboration between the World Health Organization (WHO) Field Presence in Gaziantep and Queen Margaret University, Edinburgh, with support from Rebuild for Resilience and the Alliance for Health Policy and Systems Research, WHO HQ. We would also like to acknowledge the perspectives of all informants and the work of UDER in data gathering in north west Syria.Publication status: PublishedFunder: WHO Euro/GaziantepSophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Karin Diaconu - ORCID: 0000-0002-5810-9725 https://orcid.org/0000-0002-5810-9725Ibrahim Bou-Orm - ORCID: 0000-0003-3563-4014 https://orcid.org/0000-0003-3563-4014Zeina Jamal - ORCID: 0000-0002-5078-3416 https://orcid.org/0000-0002-5078-3416Background: Northwest Syria (NWS) is a complex and extremely fragile operating environment, with more than 2.8 million people needing humanitarian assistance. To support a common standard of care delivery and enable coordination among the multiple providers in NWS, WHO developed an Essential Health Services package (EHSP) in 2016-17 and subsequently supported a facility network model to deliver the EHSP. This article provides an evaluation of the network to date, aiming to inform further development of the network and draw wider lessons for application of similar approaches in complex emergency settings. Methods: This mixed method study included document review, participatory, qualitative and quantitative data, gathered in the first half of 2021. Participatory data came from two group model building workshops with 21 funders and implementers. Semi-structured interviews with 81 funders, health professionals and community members were also conducted. Analyses of the workshops and interviews was inductive, however a deductive approach was used for synthesising insights across this and the document review. The final component was a survey of health providers (59 health care professionals) and service users (233 pregnant women and 214 persons living with NCDs) across network and other comparable facilities, analysed using routine descriptive and inferential statistics. Findings across all methods were triangulated. Results: The study finds that the network and its accompanying essential service package were relevant to the dynamic and challenging context, with high but shifting population needs and multiple uncoordinated providers. Judged in relation to its original goals of comprehensive, coordinated services, equitable access and efficient service delivery, the data indicate that gains have been made in all three areas through the network, although attribution is challenging, given the complex environment. The context remains challenging, with shifting boundaries and populations displaced by conflict, difficulties in retaining staff, the need to import medicines and supplies across borders, and governance gaps. Conclusion: This study adds to a very limited literature on coordinated network approaches used to raise care quality and improve referrals and efficiency in a complex emergency setting. Although areas of ongoing challenge, including for sustainability, are noted, the network demonstrated some resilience strategies and can provide lessons for other similar contexts.pubpu

Rethinking External Assistance for Health.

Coronavirus disease (COVID-19) and the subsequent economic crisis have raised questions about the long-term sustainability of external assistance for health and the interventions that it supports. New thinking is needed on how external assistance for health may best contribute to the sustainable coverage of essential health interventions embedded within countries’ efforts to make progress towards Universal Health Coverage (UHC). We propose a research agenda to expand the evidence base and inform this rethink of external assistance to support sustainable coverage

Moving towards universal health coverage: engaging non-state providers

Abstract This editorial provides an overview of the special issue “Moving towards UHC: engaging non-state providers”. It begins by describing the rationale underlying the Alliance’s choice of a research program addressing issues of non-state providers and briefly discusses the research process this entailed. This is followed by a summary of the findings and key messages of each of the eight articles included in the issue. The editorial concludes with a series of reflections regarding lessons learnt about the engagement of non-state providers, methodological challenges, areas for future research as well as the contribution of the research program towards efforts to build capacity and strengthen health systems towards universal health coverage

Health Policy and Systems Research Capacities in Ethiopia and Ghana: Findings From a Self-Assessment

Introduction: Health systems are complex. Policies targeted at health system development may be informed by health policy and systems research (HPSR). This study assesses HPSR capacity to generate evidence and inform policy in Ethiopia and Ghana.Methods: We used a mixed-methods approach including a self-administered survey at selected HPSR institutes and in-depth interviews of policy makers.Results: Both countries have limited capacity to generate HPSR evidence, especially in terms of mobilizing adequate funding and retaining a critical number of competent researchers who understand complex policy processes, have the skills to influence policy, and know policy makers' demands for evidence. Common challenges are limited government research funding, rigidity in executing the research budget, and reliance on donor funding that might not respond to national health priorities. There are no large research programs in either country. The annual number of HPSR projects per research institute in Ethiopia (10 projects) was higher than in Ghana (2.5 projects), Ethiopia has a significantly smaller annual budget for health research. Policy makers in the 2 countries increasingly recognize the importance of evidence-informed policy making, but various challenges remain in building effective interactions with HPSR institutes.Conclusion: We propose 3 synergistic recommendations to strengthen HPSR capacity in Ethiopia and Ghana. First, strengthen researchers' capacity and enhance their opportunities to know policy actors; engage with the policy community; and identify and work with policy entrepreneurs, who have attributes, skills, and strategies to achieve a successful policy. Second, deliver policy-relevant research findings in a timely way and embed research into key health programs to guide effective implementation. Third, mobilize local and international funding to strengthen HPSR capacities as well as address challenges with recruiting and retaining a critical number of talented researchers. These recommendations may be applied to other low- and middle-income countries to strengthen HPSR capacities