Strategies to enhance the use of health systems research for health sector reform

Abstract

SummaryIn spite of frequent claims to the contrary, there is very little evidence that health systems research actually influences policy-making. Based on a case study from Thailand and a literature review, we develop a stakeholder-oriented model of policy-making. We argue that only if stakeholders' needs are taken into consideration during design and implementation of scientific projects and dissemination of the results, research will have a chance to influence the policy process. From this model, we derive a five-step approach to enhance the use of research by various stakeholders. We then propose institutional arrangements and conditions to make the use of research for policy-making more sustainable.keywords Health policy, health care reform, policy-making, decision-making, health system research, evidence-based medicine, research use correspondence Prof. Rainer Sauerborn,

Assessing country-level efforts to link research to action

“…If countries select and implement one or more options from the framework among particular groups and evaluate them rigorously then 5-10 years from now we should be in a much better posip p tion to refine the framework and ensure that its elements are solidly supported by research. Had such evaluations been undertaken for the frameworks that have already been developed for policyp makers, [9][10][11][12][13] we would have a more rigorp p ous research base from which to draw now. The main purpose of the examples offered here is to highlight how the framework is grounded in promising innovations that are being implemented for one or more user groups.…”

Use of research results in policy decision-making, formulation, and implementation: a review of the literature

“…Other studies propose a variant on stakeholder analysis, featuring researchers as a group with the ability to intervene in the decision-making process 46 and in the policy formulation process directly or through other key stakeholders over whom they have influence. This interpretation sees the decision-making process as susceptible to influence not only from the knowledge generated by research, but also from the research process itself.…”

A pesquisa em saúde e os objetivos do milênio: desafios e oportunidades globais, soluções e políticas nacionais

“…Sauerborn afirma que somente quando as necessidades de todos os atores são levadas em consideração, desde a fase inicial de planejamento até a implementação dos projetos e disseminação dos resultados, é que a pesquisa tem alguma chance de influenciar as políticas de saúde (Sauerborn et al, 1999). A replanificação orçamentária e operacional das ações de saúde em dois distritos sanitários na Tanzânia é um exemplo desta abordagem: com a participação das autoridades sanitárias, pesquisadores e populações envolvidas, fez-se um levantamento cuidadoso da carga das doenças nas áreas estudadas e os dados obtidos foram utilizados como base para uma ampla redistribuição do orçamento disponível, alocando os recursos proporcionalmente à gravidade das situações encontradas.…”

“…Como já referido acima (Sauerborn et al, 1999), isto requer o envolvimento precoce de todos os atores e setores participantes, nos mais diversos níveis. Esta via tem sido explorada quer internacionalmente, pelo estabelecimento do Global Forum for Health Research (www.globalforumhealth.org), quer nacionalmente, como no caso da Tanzânia, que estabeleceu um Fórum Nacional de Saúde (Kitua et al, 2000).…”