Evaluation of regional project to strengthen national health research systems in four countries in West Africa: lessons learned

BackgroundIn 2011, the WHO Eastern Mediterranean Region committee launched a strategy for scaling up research in the region to address the countries’ health needs through formulating and analysing the National Health Research System (HRS). Stewardship comprises three functions, namely governance, policy and priorities, and is a central pillar of this system to ensure a well-organised and functioning HRS. This study aims to examine the perceptions of the HRS performers to understand these functions and to generate insights for system strengthening.MethodsThe study was carried out in Palestine, targetting three sectors in the health field, including relevant governmental health institutions, schools of public health, and major local and international health agencies. The data were collected through 52 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) with policy-makers, academics, directors, and experts. Participants and institutions were selected purposively based on a set of criteria and peer review.ResultsA total of 104 experts participated in the IDIs (52 participants) and FGDs (52 participants in 6 FGDs), highlighting that stewardship functions remain problematic and insufficiently performed, mainly due to a missing health research structural and regulatory framework and dispersed health research work. Despite the limited good practices, the majority of the participants described the Ethical Review and Clearance as weak due to the lack of an agreed-upon national committee and procedural quality and ethics guidelines for non-compliance. A policy or strategy dedicated to health research is lacking. The exercises of research priority-setting appear to be evolving despite the lack of consensus and the low levels of knowledge and experience in research prioritisation. Common gaps, such as weak political will and capacity support, the absence of a national unified regulating body, and the indirect effects of political conditions on strengthening the HRS as well as other sectors, also emerged.ConclusionsThe stewardship functions of the Palestinian HRS remain weak along with substantial political, structural, and resources and capacity gaps. The study emphasises the imperative need to initiate strategic efforts led by the MOH and the Palestinian National Institute of Public Health alongside with other players to strengthen a national HRS through improving the stewardship functions. To achieve this, attention and support of decision-makers, involvement, mobilisation and strategic dialogue are indispensable, in order to embark on building a well-regulated and coordinated structure, operational research policy, and prioritisation of essential research.Electronic supplementary materialThe online version of this article (10.1186/s12961-018-0347-4) contains supplementary material, which is available to authorized users.

Section: Discussionmentioning

confidence: 99%

The Palestinian health research system: who orchestrates the system, how and based on what? A qualitative assessment

AlKhaldi

Alkaiyat

Abed

et al. 2018

“…The importance of considering national health research systems is highlighted by an article in the new supplement published in July 2017, ‘People and research: improved health systems for West Africans, by West Africans’ [ 50 ]. The article by Sombié et al [ 104 ] drew on the WHO framework for health research systems set out at the start of this editorial, plus earlier work from the Commission (later Council) on Health Research for Development (COHRED) [ 105 ], to evaluate a regional project that used a participatory approach to strengthen national health research systems in four post-conflict West African countries – Guinea-Bissau, Liberia, Sierra Leone and Mali.…”

Section: Editorialmentioning

confidence: 99%

‘Knowledge for better health’ revisited – the increasing significance of health research systems: a review by departing Editors-in-Chief

Hanney

González-Block

2017

How can nations organise research investments to obtain the best bundle of knowledge and the maximum level of improved health, spread as equitably as possible? This question was the central focus of a major initiative from WHO led by Prof Tikki Pang, which resulted in a range of developments, including the publication of a conceptual framework for national health research systems – Knowledge for better health – in 2003, and in the founding of the journal Health Research Policy and Systems (HARPS). As Editors-in-Chief of the journal since 2006, we mark our retirement by tracking both the progress of the journal and the development of national health research systems. HARPS has maintained its focus on a range of central themes that are key components of a national health research system in any country. These include building capacity to conduct and use health research, identifying appropriate priorities, securing funds and allocating them accountably, producing scientifically valid research outputs, promoting the use of research in polices and practice in order to improve health, and monitoring and evaluating the health research system. Some of the themes covered in HARPS are now receiving increased attention and, for example, with the assessment of research impact and development of knowledge translation platforms, the journal has covered their progress throughout that expansion of interest. In addition, there is increasing recognition of new imperatives, including the importance of promoting gender equality in health research if benefits are to be maximised. In this Editorial, we outline some of the diverse and developing perspectives considered within each theme, as well as considering how they are held together by the growing desire to build effective health research systems in all countries.From 2003 until mid-June 2017, HARPS published 590 articles on the above and related themes, with authors being located in 76 countries. We present quantitative data tracing the journal’s growth and the increasing external recognition of its role. We thank the many colleagues who have kindly contributed to the journal’s success, and finish on an exciting note by welcoming the new Editors-in-Chief who will take HARPS forward.

“…The second systems-level approach involves partnerships and multicountry initiatives, especially with international organisations. Two initiatives from the West African Health Organization (WAHO) are particularly important examples [5,37]. Here, the ministries of health of the 15 West African member countries worked together in a joint initiative covering all the countries and with funding and expertise from a range of partners, including the Council on Health Research for Development (COHRED), the Canadian International Research Centre, the Special Programme for Research and Training in Tropical Diseases, and the Wellcome Trust.…”

Section: Introductionmentioning

confidence: 99%

“…Donors can play an important part in building capacity but, recognising the need to avoid donor domination, often do so through partnerships. These can take diverse forms ranging from multi-country initiatives, such as that by WAHO, which included an initiative focusing on the challenges of postconflict countries but was unable to meet all the needs [37], to accounts that focus on the partnership to address a broad range of capacity issues in a single country such as Malawi [7], to partnerships between individual institutions. Examples of the latter can feature particular challengesthe James Cook University in Australia worked with the Atoifi Adventist Hospital in Malaita, the most populous province of the Solomon Islands, to start establishing health research system capacity on the island using an inclusive, participatory approach [45].…”

Section: Introductionmentioning

confidence: 99%

“…The surveys also illustrate how the multi-country approach makes a useful contribution to strengthening NHRSs by helping to target action. Furthermore, the WAHO interventions made some progress but, while the evaluations identified the importance of political will and leadership provided by WAHO's parent organisation of West African states, they also emphasised that building capacity for a whole NHRS is a significant task requiring commitment over the long-term [17,37].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

How to strengthen a health research system: WHO’s review, whose literature and who is providing leadership?

Hanney

Kanya

Pokhrel

et al. 2020

Background: Health research is important for the achievement of the Sustainable Development Goals. However, there are many challenges facing health research, including securing sufficient funds, building capacity, producing research findings and using both local and global evidence, and avoiding waste. A WHO initiative addressed these challenges by developing a conceptual framework with four functions to guide the development of national health research systems. Despite some progress, more is needed before health research systems can meet their full potential of improving health systems. The WHO Regional Office for Europe commissioned an evidence synthesis of the systems-level literature. This Opinion piece considers its findings before reflecting on the vast additional literature available on the range of specific health research system functions related to the various challenges. Finally, it considers who should lead research system strengthening. Main text: The evidence synthesis identifies two main approaches for strengthening national health research systems, namely implementing comprehensive and coherent strategies and participation in partnerships. The literature describing these approaches at the systems level also provides data on ways to strengthen each of the four functions of governance, securing financing, capacity-building, and production and use of research. Countries effectively implementing strategies include England, Ireland and Rwanda, whereas West Africa experienced effective partnerships. Recommended policy approaches for system strengthening are context specific. The vast literature on each function and the ever-growing evidence-base are illustrated by considering papers in just one key journal, Health Research Policy and Systems, and analysing the contribution of two national studies. A review of the functions of the Iranian system identifies over 200 relevant and mostly national records; an analysis of the creation of the English National Institute for Health Research describes the key leadership role played by the health department. Furthermore, WHO is playing leadership roles in helping coordinate partnerships within and across health research systems that have been attempting to tackle the COVID-19 crisis. Conclusions: The evidence synthesis provides a firm basis for decision-making by policy-makers and research leaders looking to strengthen national health research systems within their own national context. It identifies five crucial policy approachesconducting situation analysis, sustaining a comprehensive strategy, engaging stakeholders, evaluating impacts on health systems, and partnership participation. The vast and ever-growing additional literature could provide further perspectives, including on crucial leadership roles for health ministries.