Life, death and health systems research

Until recently, the field of health systems research has been relatively neglected, but there are signs that its importance it now being recognised. Its contribution to reducing the terribly high levels of maternal and child mortality, and thus achieving MDGs 4 and 5, may yet be significant.

On 29 March I attended a conference at the London School of Hygiene and Tropical Medicine. Entitled Delivering Effective Health Care For All, this was an opportunity for several Research Programme Consortia (RPCs) to present their research findings. Funded by the UK development arm DFID, 3 acronym-rich RPCs – COMDIS, CREHS and TARGETS – presented the results of their research on health systems.

It’s sometimes easy to be put off by the technical jargon. Health systems, RPC, even research, can seem like obscure terms quite removed from more fundamental public health priorities. In fact health systems‘ research can play a very useful role in making health care more available to those who need it most, generating new knowledge on how to strengthen health policies and practice in ways that benefit poor and marginalised groups.

There are several ways in which this can be achieved. One is to introduce an experimental project and to expand it if it proves successful. For example, CREHS presented research from Coast Province, Kenya, where the removal of user fees, or payments at the point of use at a health centre was compensated by direct payments to health facilities to cover essential costs. Health fees invariably mean that poor people cannot afford essential health care, but they may produce some revenue for the health service, and so need to be subsidised in some way. This innovative approach was perceived to have improved health worker motivation, the use of services and the quality of care and, as a result, will be rolled out nationally in Kenya in 2010.

Another research method is to model the potential effect of a new health policy initiative. A serious shortage of health workers in rural areas means that many people in low-income countries are unable to access health care. Researchers therefore looked at different combinations of initiatives – salary increases, training possibilities, improved housing – and their relative effectiveness in attracting nurses to rural areas in South Africa, Kenya and Thailand. The study found that financial incentives alone were not sufficient, and that nurses’ preferences varied significantly between countries – hence the importance of policy solutions that are specific to the context.

The London conference showed that health systems research, when made relevant to the needs of policy makers rather than carried out primarily as an academic pursuit, can provide very useful guidance for decision makers struggling with how best to ensure that health care is made accessible to those who need it most.

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