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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,......

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……

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  • 1. Sara Bennett, Ligia Paina, Christine Kim, Irene Agyepong, Somsak Chunharas, Di McIntyre, Stefan Nachuk
  • 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. 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. 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
    • Source: Bennett et al 2010
    • Population – 310 million
    • 709 research organizations that housed PIs for HSR projects
    • 13,000 health services researchers
    • Source: Pittman & Holve 2009
  • 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. 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. 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. 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. 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. 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.  
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. 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