The first-ever, World Report on Health Policy and Systems Research, was launched recently by the Alliance for Health Policy and Systems Research. The report provides practical recommendations on how to reorient health research to more effectively address public health challenges on a national and global level. It describes the evolution of the field and provides figures on the number of publications produced, funding trends and institutional capacity in LMICs to conduct health policy and systems research. Low- and middle-income countries now have guidance for not only being users of research, but also producers. The report describes the state of the HPSR field in 1996, identifying three broad challenges to its progress that were clearly visible at that time. In the mid-1990s there were three principal challenges to the growth of the field of HPSR: (i) the fragmentation and lack of a single agreed definition of the field; (ii) the ongoing dominance of biomedical and clinical research; and (iii) a lack of demand for HPSR. Cross-cutting all these challenges was the problem of relatively limited capacity to undertake high-quality health policy and systems research. Subsequent sections then analyse how these challenges have been addressed over the intervening 20 years, resulting in greater recognition of and investment in HPSR. The report raises challenges to be addressed, including confronting the dominance of biomedical and clinical research as the primary channel for health research investments through a sustained advocacy campaign; seeking to clarify the scope and methods of the field; and finally nurturing closer collaboration with research users, in particular by capitalizing on the growth of interest in evidence-informed policy. It also collects together for the first time figures on various significant aspects of health policy and systems research: growth in the number of publications, collaboration between researchers in different parts of the world, funding trends and institutional capacities in low- and middle-income countries.
Monitoring equity and research policy
The Report focuses on bridging of the "know do" gap, the gulf between what we know and what we do in practice, between scientific potential and health realization. The bridging of this gap is central to achieving the health-related Millennium Development Goals (MDG’s) by 2015. The gap exists for each of the MDG’s and represents a fundamental and pragmatic knowledge translation challenge that must be addressed to strengthen health systems performance towards achieving the MDG’s. The Report will expound the message that we must turn scientific knowledge into actions, which improves people’s health, and that health improvement through knowledge applications is a critical factor in human development and alleviation of ill-health and poverty worldwide.
According to this report by UNESCO, in sub-Saharan Africa, social science themes have over the years evolved from topics such as structural adjustment, poverty, gender, the spread of armed conﬂ icts, and HIV and AIDS to more recent concerns such as citizenship and rights in an era of crisis, and the response to neoliberalism. The big challenge, however, is to reconstruct autonomous social science research in Africa. But as the Council for the Development of Social Science Research in Africa (CODESRIA) points out, the lack of a research infrastructure prevents social scientists from contributing as much as they could to these social endeavours. In low-income countries, the increasing role of consultancy ﬁrms and NGOs in social science research follows the relative or absolute shrinking of public funds allocated to universities, for research in general and for the social sciences in particular. In such conditions, academics rarely have the chance of working on long-term projects involving strong theoretical considerations. The report also points to the corrosive effect of the ‘brain drain’ on research in low-income countries and acknowledges many of these countries have instituted measures to help retain professionals, but the efﬁciency of these measures remains limited as long as working conditions do not improve signiﬁcantly.
The maternal mortality ratio (MMR) has risen from obscurity to become a major global health indicator, even appearing as an indicator of progress towards the global Sustainable Development Goals. This has happened despite intractable challenges relating to the measurement of maternal mortality. Even after three decades of measurement innovation, maternal mortality data are widely presumed to be of poor quality, or, as one leading measurement expert has put it, ‘guilty until proven innocent’. This paper explores how and why leading epidemiologists, demographers and statisticians have devoted the better part of the last three decades to producing ever more sophisticated and expensive surveys and mathematical models of globally comparable MMR estimates. The development of better metrics is publicly justified by the need to know which interventions save lives and at what cost. The authors show, however, that measurement experts’ work has also been driven by the need to secure political priority for safe motherhood and by donors’ need to justify and monitor the results of investment flows. They explore the many effects and consequences of this measurement work, including the eclipsing of attention to strengthening much-needed national health information systems. the authors analyse this measurement work in relation to broader political and economic changes affecting the global health field, not least the incursion of neoliberal, business-oriented funders who have introduced new forms of administrative oversight and accountability that depend on indicators.