Innovations for equity

Catalysing political will to build health systems research capacity

In Global Symposium on Health Systems Research on November 19, 2010 at 10:55 am


Sara in plenarySara Bennett, from Johns Hopkins School of Public Health, gave a rousing plenary speech on the final day of the Global Symposium. She argued that all stakeholders – policy makers, service providers, the leaders of research organisations, funders and health development partners – need to come together to support capacity development for health systems research. Health systems research capacity development can be seen as worthy but dull and it may not be compelling to donors. Yet there are a lot of exciting innovations in research capacity development occurring in low and middle income countries.


1. There is a limited evidence base. Donors are unlikely to invest unless there is evidence that interventions will be effective and show impact. But there are very few published articles with rigorous, independent, solid evaluation in this area. Few papers include evidence about cost.

2. The delivery of financing creates bottlenecks and distortions. As Irene Agyepong puts it, “Our health research units in the Ghana Health Service seem to be increasing developing a life of their own…it is a result of the fact that they are dependent on a large part of their financing and therefore survival on external donors. The agenda of these donors therefore drives them…It creates an unfortunate cycle where the sector sees less and less their immediate relevance as they do not appear to be providing solutions to the sectors problems.”

3. Lack of investment. Despite commitments to invest in research it is unclear that financing is flowing to this area. This creates tensions within countries and a lack of coordination and cooperation as people compete for scarce resources. Furthermore competitive calls mean that lower capacity organisations are disadvantaged in the fight for financing.

What we must do

1. Employ different methods of teaching and learning. Traditional to capacity development methods are academic and didactic and employ a one size fits all approach. Sara explained that we need to enable learning across networks and actors and use different approaches for different audiences. This might include formal training mixed with practice opportunities or extending distance learning. There is a recognition that we work in complex adaptive systems and so there is a need for continuous learning to understand unexpected consequences of reforms. We need to prepare for and invest in research communications, through learning platforms and other institutions, so that policy makers understand and can apply knowledge.

2. Support country leadership. The findings of research are dependent on context. This points to the need to develop capacity in all settings. We need to build national organisations and perhaps employ a system of pooled financing and compacts with national Governments – with decisions about where financing goes being made by local stakeholders.

3. Support junior researchers and incentivise people to stay in their institutions. Because this is an emerging field many researchers are younger. Their supervisors and institutional leaders may not understand this area or the social science research methods that are being employed. Capacity development initiatives need to include mentoring, salary top-ups and incentives schemes to retain senior health systems researchers in country.

A rising tide of political will

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