What must be done to ehance capacity for health systems research?


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This presentation was written by Sara Bennett, Ligia Paina, Christine Kim, Irene Agyepong, Somsak Chunharas, Di McIntyre and Stefan Nachuk for the Global Symposium on Health Systems Research, November, 2010.

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  • 49 articles HICs, 24 articles LMICs
  • Problems: no baseline data, no comparison groups……
  • What must be done to ehance capacity for health systems research?

    1. 1. Sara Bennett, Ligia Paina, Christine Kim, Irene Agyepong, Somsak Chunharas, Di McIntyre, Stefan Nachuk
    2. 2. Aims Map different facets of HSR capacity at individual, organizational and environmental/network levels Identify strategies to promote capacity development for HSR and those that appear effective
    3. 3. Methods Defining HSR: health services, health systems research, operational or intervention research Mapping – review of existing international databases Systematic review of capacity development initiatives for HSR, including papers Reported implementation of a project or initiative HIC or LMIC Whether or not evaluated Capturing information on: nature of interventions, context, implementation issues, evaluation design, evaluation findings Reflection on authors’ experiences
    4. 4. The Gap The situation in LMICs The situation in US Population – 5.5 billion 250-300 health systems research organizations in LMICs 6-7,500 health systems researchers Population – 310 million 709 research organizations that housed PIs for HSR projects 13,000 health services researchers Source: Pittman & Holve 2009
    5. 5. Region # orgs offering HS or policy MScs # orgs offering HS or policy PhDs or DrPHs Types of course offerings Africa 10 2 Health services planning and management, health economics, health systems and policy Americas 20 7 Politics and planning, public policy and health, politics of health Asia 9 5 Health economics, Health policy and systems, Health financing
    6. 6. Overview of review findings 73 papers – 67% from HICs (especially US, UK, Canada) Most initiatives had multiple components Initiatives targeted most at individual level, then organizational then environmental/network Largely targeted university based researchers (43% HICs, 54% LMICs) But service providers, especially GPs and nurses also a key audience in HICs.
    7. 7. Interventions identified in systematic review HICs Mentoring 31% Research seminars 27% Fellowships 24% Research grants 24% Partnerships 20% Short courses 10% Networking 18% Post grad training 10% Research infrastructure 10% LMICs Short courses 58% Networking 38% Research grants 29% Post grad training 29% Partnerships 25% Basic training 17% Mentoring 17% Research infrastructure 8% Strategic planning 4% Research seminar 4%
    8. 8. Implementation factors (# studies) Facilitators Constraints Enthusiasm and motivation of participants (5) Institutional support from parent organization (4) Flexibility in program design (4) Strong leadership (3) Builds on existing partnerships (2) Participatory approach (2) Being part of broader program (2) Lack of time – participants, staff and mentors (13) Insufficient funding (sustainability) (8) High coordination costs (7) Timelines too short (6) Lack of support from host organization (4) Lack of confidence of participants (4) Lack of institutional and managerial support (3) Language barriers (3)
    9. 9. Key Findings Interventions successful at the individual level had limited overall effects due to organizational or environmental level constraints Few interventions targeted constraints at multiple levels Maintaining flexibility in capacity development programs is key Mentoring is an effective strategy Short course training alone is necessary but not sufficient for developing research capacity Very few interventions evaluated – weak evaluation designs, most by internal evaluators, no cost data
    10. 10. Evaluation of interventions HICs LMICs Total # articles 49 24 % articles with evaluation 47% 37.5% No. articles with independent evaluation 2 2 # articles with costs 10 7
    11. 11. Over-arching Capacity development interventions should be: Multi-faceted, responding to capacity needs at different levels Tailored to the context where they are being implemented As we scale up investment in capacity development, we must evaluate the effects of CD initiatives
    12. 12. Environment/network level External funders should funnel a larger share of their funding to local stakeholders Strengthen networks between different types of HSR actors within countries Support capacity development among health workers and health service organizations
    13. 13. Organizational level Engage with organisational leaders to advocate for HSR Intensify efforts to secure predictable and sustainable core funding, including endowments Ensure better funding for research networks and cross-country partnerships
    14. 14. Individual Level Develop open access training modules in HSR that support training needs of different types of researchers coming to the field Provide incentives and innovative schemes for senior researchers to stay in-country