Alliance at the Universal Health Coverage Forum 2017

21 December 2017

Left to Right at Embedding health systems research within health systems to achieve universal health coverage panel: Dr Kumanan Rasanathan, Mr Ikuo Takizawa, Dr Aku Kwamie, Mr Dana Hovig, Dr Jeanette Vega
Health Systems Global, 2017

Two Alliance- and Health Systems Global (HSG) – organized-panel discussions at the Universal Health Coverage Forum 2017, in Tokyo, from 12 to 15 December 2017 gave prominence to the Alliance’s roles of advocate for HPSR and pioneer of new approaches to generate and use evidence for health systems strengthening. The Forum, which was co-organized by the Government of Japan, the World Bank, WHO, UNICEF, JICA, and UHC 2030 brought together Heads of State, the Secretary-General of the United Nations, Ministers of Health, Ministers of Finance, Global Health Funders, as well as global health leaders from policy and academia.

The first panel discussion Domestic Financing for HPSR: Key to UHC brought together as speakers Jeanette Vega, Director, National Chilean Public Health Insurance Agency (FONASA); Abdul Ghaffar, Executive Director of the Alliance HPSR; Bocar Kouyate, Senior Policy Advisor, Ministry of Health, Burkina Faso; Christoph Kurowski, Global Lead, Health Financing, World Bank; and Aku Kwamie, Ghana Health Service.

The session began with the reflection that while funding for the field of HPSR and the number of HPSR publications had increased over the past decade, there was still overall a dearth of research, particularly carried out by authors based in low-income countries. The funding base for HPSR continued to be narrow, with 93% of HPSR funding coming from just 10 funders (all of which are based in high-income countries), largely in the form of projects that restricted the ability of countries to set their own research priorities. But changes in the health and development space through UHC, the SDGs, prioritizing domestic financing, as well as national ownership, represent an opportunity to transform this situation. Several measures need to be taken. One is reframing HPSR funding as an investment rather than an expenditure, which requires advocacy with national Ministries of Finance. Adopting innovative mechanisms such as matching funds are needed through which funders can catalyze domestic spending on HPSR, something that multilateral institutions have begun exploring. Panelists emphasized however, that increasing domestic financing for HPSR was not just about money but also equally about developing institutional arrangements to incentivize policy relevant research among academics. In Chile, for example, health research was almost solely funded domestically but this has not always led to the research being relevant for policy-making.

The panel concluded that there was a need to increase engagement and trust between researchers and policy-makers, including through the approach of embedding research, thus making research and the funding of research an integral part of the health program.

The second panel focused more specifically on Embedding Health Systems Research within Health Systems to Achieve UHC, building on seeing embedded research as integral to increasing domestic funding for HPSR. The panel included as speakers Jeanette Vega, Director, National Chilean Public Health Insurance Agency (FONASA); Kumanan Rasanathan, Senior Health Specialist, UNICEF; Ikuo Takizawa, Deputy Director-General, Human Development Department, Japan International Cooperation Agency (JICA); Aku Kwamie, health systems researcher from Ghana; and Dana Hovig, Director of Integrated Delivery, Bill and Melinda Gates Foundation, and brought together a diverse range of perspectives on this issue. Working closely with policy-makers was identified as fundamental to building an understanding of embedded research and actually carrying it out, which required moving away from a paradigm of research for its own sake. This often made it challenging to work with established universities. As a result, in both Chile and Japan, research that had informed policy was largely done within bureaucracies or with consultants. Experience from Ghana showed that the role of policy champions within Ministries of Health (MoH) for embedding research was crucial and had led to the establishment of a Health Research Unit linked to three field sites where questions of direct relevance to the MoH were addressed. Research was a routine part of everyday decision-making and was seen as solving the day-to-day problems of individual frontline managers as opposed to being exclusively a public good. Several policy-makers reported informally undertaking precisely this kind of problem-solving research.

The session concluded with a discussion on the need to move beyond binaries of doers vs thinkers and towards a paradigm of the co-production of knowledge, something that required the development of long-term relationships based on trust.

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