Local ownership of health policy and systems research in low-income and middle-income countries: a missing element in the uptake debate

Abstract

Health policy and systems researchers (HPSRs) in low-income and middle-income countries (LMICs) aim to influence health systems planning, costing, policy and implementation. Yet, there is still much that we do not know about the types of health systems evidence that are most compelling and impactful to policymakers and community groups, the factors that facilitate the research to decision-making process and the real-world challenges faced when translating research findings into practice in different contexts. Drawing on an analysis of HPSR from LMICs presented at the Fifth Global Symposium on Health Systems Research (HSR 2018), we argue that while there is a recognition in policy studies more broadly about the role of co-production, collective ownership and the value of localised HPSR in the evidence-to-policy discussion, ‘ownership’ of research at country level is a research uptake catalyst that needs to be further emphasised, particularly in the HPSR context. We consider embedded research, participatory or community-initiated research and emergent/responsive research processes, all of which are ‘owned’ by policymakers, healthcare practitioners/managers or community members. We embrace the view that ownership of HPSR by people directly affected by health problems connects research and decision-making in a tangible way, creating pathways to impact.

How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries

“…Because of these limitations in community health in many countries, even where evidence exists, it is perceived as irrelevant and decision-makers are not encouraged to use it. The third limitation is capacity for evidence selection, understanding and use in community health decision-makers; this is a finding from consistent with wider studies in LMIC health systems ( Stansfield et al , 2006 ; Wickremasinghe et al , 2016 ; McCollum et al , 2018b , c ; Vanyoro et al , 2019 ). Comprehensive planning for community health programmes would involve decision-makers assessing an extensive set of routine data from health information systems that include: census, vital events, monitoring, public health surveillance, resource tracking, facility-based service statistics and household surveys ( Stansfield et al , 2006 ).…”

Guiding principles for quality, ethical standards and ongoing learning in implementation research: multicountry learnings from participatory action research to strengthen health systems

“…They can disseminate information to policy makers in terms that researchers may not. Having joint ownership of research process and outputs with HSAs supports the integration of scientific findings in policy implementation and HSS ( Vanyoro et al , 2019 ).…”

A Methodology for Mapping the Patient Journey for Noncommunicable Diseases in Low- and Middle-Income Countries

“… 46 Policymakers and health system managers can utilize the data to review and address deficiencies in health policy; and inform resource allocation, healthcare workforce, capability development and integration of NCD care, and improve efficiencies. 47 Patients stand to gain from these improvements with paths to greater health literacy and processes that enable greater participation in managing their health. 48 The gaps in the mapped evidence can be transformed into beyond-the-pill solutions by bringing together traditional and non-traditional stakeholders for NCD management.…”

“…50 Resilient and responsive health systems require decision makers and health actors to identify, collect, and interpret local evidence while responding to new or emerging healthcare challenges, and monitor periodically. 47 By focusing on local, patient-centric data, the goal of the MAPS initiative is to address and prioritize research and knowledge gaps, then provide support and recommendations to improve patient care and decision-making to effectively tackle NCDs in LMICs.…”