Accelerating Health Policy and Systems Research (HPSR) by investing in collaborative research

In the WHO Western Pacific Region, growing a collaborative research community and investing in research may be the answer to accelerating Health Policy and Systems Research (HPSR).

By Lia Palileo-Villanueva, Benjamin Palafox, Katherine Ann Reyes, Martin McKee and Dina Balabanova

There is ever more demand for timely and properly contextualized research on health policies and systems worldwide, but training in health policy and systems research (HPSR) is lagging far behind. As a result, many institutions and individuals from regions and countries facing notable capacity gaps have struggled to develop necessary research or to disseminate their findings. In response, Health Systems Global, the international membership society for the HPSR community, has implemented targeted efforts to provide support, convening or creating working groups and networks, and mentoring. Governments and donors are also increasing their investments in training programmes and creating repositories of HPSR training material.

In the WHO Western Pacific Region, where many countries are working towards strengthening health systems and achieving universal coverage, there is an urgent need for high quality HPSR to inform policy and monitor progress. Although the HPSR capacity gap is recognized and there have been efforts to close it, structural problems hinder progress. Developing HPSR capacity within existing institutions is resource intensive, and the need to integrate perspectives of multiple academic disciplines may challenge deeply embedded work cultures. Because HPSR capacity must bring together many different types of stakeholders with different roles, priorities, and expertise, training programmes must be flexible.

In the RESPOND project (Responsive and Equitable Health Systems—Partnership on Non-Communicable Diseases, NCD), we have examined promising models for accelerating capacity development, particularly for responding to NCDs.We now share some insights from our experience in the Philippines.

HPSR training responding to needs and constituencies

HPSR training is most effective when targeted to the specific needs of trainees and when it is able to integrate contemporary issues and policy-relevant questions. This was evident in the two-day HPSR short course that was developed and delivered jointly by RESPOND team members from the London School of Hygiene & Tropical Medicine (LSHTM) and faculty members from the University of the Philippines Manila (UP Manila) in June 2019. Participants included 26 researchers representing the Department of Health (central and regional offices), the academe, non-government organizations, and the private sector.

Teaching curricula and materials developed by the Collaboration on Health Policy and Systems Analysis in Africa (CHEPSAA) and LSHTM, were adapted to the needs of the participating researchers. The training focused on:

● establishing the definition and boundaries of HPSR as a field of study;

● understanding the principles of formulating an HPSR question;

● describing an overview of methods; and

● identifying communication pathways for research dissemination and impact.

The training was contextualized for the Philippines, using case studies with collective problem solving. For example, given that the country is a global leader in social media use, training considered the use of social media as a tool to facilitate a more versatile understanding of current concerns, particularly by users, and to influence policy through informing debates inside and outside the health systems.

The course will be used as a pilot for developing a permanent curriculum offering on HPSR at UP Manila, which will demonstrate the value and specific contributions of HPSR to policy-relevant research, and connect individuals interested in HPSR. This is part of a wider effort of the University to raise the profile of HPSR and strengthen the opportunities for research within and outside UP Manila.

Empowering learners

The approach used for the short course enabled participants to apply HPSR concepts in order to develop their ideas into a project. Trainees were given the opportunity to co-create the curriculum by using their judgement to identify priorities, designing studies to generate robust findings, and developing effective plans to communicate findings to different target audiences. The group also discussed possible ways to strengthen the fragmented HPSR community in the country. Similar principles have been applied to the research in the RESPOND project, where local team members have been empowered to develop their own ideas for analysis, while drawing on the knowledge and research experience of the broader team and the international communities of practice.

Growing a collaborative research community

A key objective of the RESPOND project is to create and strengthen collaborative HPSR communities by linking local researchers working across disciplines with each other, and with national and global communities of practice. Developing study groups for publications has been particularly important, raising the profile of individual researchers and their institutions, and highlighting the key role of multi-disciplinary research in strengthening health systems.

Growing this collaborative research community must also involve building networks and partnerships with key institutions and opinion leaders, implementers, and civil society groups at district and national levels. These alliances are essential to achieve synergies and advocate for policies that benefit the poor and marginalised. Expanding regional- and national-level networks also helps to create a critical mass of researchers with complementary interests, and opens possibilities for creating joint training programmes and teaching resources applicable to the region.

Addressing the structural barriers to producing quality HPSR and achieving impact

Our work in the Philippines and in the Western Pacific Region more generally highlights the need to go beyond building the capacity of institutions and individuals and creating agile training courses. Achieving change requires addressing the structural factors that have led to the gaps in HPSR training and uptake of research findings, such as insufficient investment in research and embedding evidence into policy development cycles.

As countries in the Western Pacific Region progress towards UHC, they will need access to timely and relevant knowledge to support decisions that could impact lives. A vibrant HPSR community is an important means to make this happen. However, doing more of the same—developing HPSR curricula, delivering one-off courses without institutionalizing them and ensuring that they link to career pathways—is only an interim solution. Accelerating HPSR capacity development demands a nation-wide or even a region-wide strategic approach, with endorsement of key health system actors.