News and events

Third Global Symposium on Health Systems Research

30 September-3 October, Cape Town, South Africa

Recap and highlights from Day 2 (30 September)

The Case for Implementation Research and Delivery Science

With more than 60 participants in attendance, in a packed session, the final meeting in the mini-conference series on implementation research and delivery science opened with a brief overview of the process leading up the development of a consensus statement by Dr. Nhan Tran. This was followed by reflections by the senior leadership of the World Bank, USAID, and the Alliance for Health Policy & Systems Research. Dr. Ariel Pablo-Mendez, Dr. Tim Evans and Dr. Abdul Ghaffar led the group in thinking about how to advance the IRDS agenda globally and all three indicated their support to help take this forward. The group was then engaged in a participatory process that resulted in the inclusion of research ethics, engagement with the private sector, and a discussion of multi- and trans-disciplinary research in the final version of the consensus which will be circulated for signature by the broader HSR community. The session concluded with a strategic discussion of next steps and action points, including the development of case studies from different areas of work that illustrate embedded implementation research.

Policy-relevant systematic reviews to strengthen people-centred health systems

The Alliance supported a satellite session led by Sandy Oliver, Professor of Public Policy, EPPI-Centre, Institute of Education, University of London, UK, presenting global studies of policy-relevant reviews, a policy-maker perspective and a review-team perspective, which set the scene for small-group discussions of on-going systematic reviews to explore the methodological and organizational challenges of producing policy-relevant reviews for strengthening health systems. This session was a chance for researchers, policy-makers, practitioners, donors, and civil society organizations to discuss good practices in shaping systematic reviews in ways that maximise their research rigour and their utility for decision-making. One of the key messages of the discussion was the importance of mutual understanding of research and policy worlds in order to promote evidence-literate policymakers and policy-sensitive systematic reviewers.

Implementation Research Initiative on Results Based Financing

The Alliance participated to the Satellite session on Results Based Financing organised by the World Bank and the Community of Practice on Performance Based Financing. The day started with presentation of World Bank funded impact assessments as well as several operational and implementation research initiatives. The Alliance's presentation by Maryam Bigdeli focused on our new Implementation Research Initiative on Results Based Financing. This multi-country study aims at asking a new set of questions around implementation of RBF initiatives related to scaling up from scheme to system. Scaling-up RBF initiatives pose a number of distinct challenges that the programme seeks to investigate in 11 countries, with support from the Institute of Tropical Medicine.

Thematic Working Group on Medicines in Health Systems

The Alliance actively supports the Thematic Working Group on medicines in health systems. a small but dedicated group convened during this first business meeting of this TWG. Maryam Bigdeli presented the rationale for the creation of this TWG, and Dennis-Ross Degnan from Harvard Medical School chaired the discussions around the future agenda of the group. More discussions will take place tomorrow during the second business meeting over the lunch break.

Reminder: TWG Medicines in health system's business meeting are open meetings and the group welcomes a large participation to brainstorm on how the medicines agenda can be strengthened in health system strengthening debate.

Thematic Working Group on Learning and Teaching Health Policy and Systems Research

The satellite session of this Thematic Working Group featured the presentation of the results of the survey aimed at mapping training and teaching for HPSR in LMICs. This survey, funded by the Alliance, feeds the strategy and the agenda of the TWG. As for all other TWGs, the dicussions will continue during the lunchtime business meeting on 2 October, open to members only.

Recap and highlights from Day 1 (29 September)

Meeting of the Cochrane/GESI and Alliance HPSR supported Systematic Review Centers

The systematic review centres (SRCs), supported by the Alliance and Cochrane/Global Evidence Synthesis Initiative (GESI), had a chance to meet and discuss common challenges in conducting systematic reviews in low- and middle-income countries (LMICs). The meeting aimed to: 1) reflect the lessons learned in conducting HPSR systematic reviews in LMICs, and 2) exchange good practices regarding engaging policy- and decision-makers in the review process.

The meeting was an opportunity to discuss the engagement of all stakeholders in the selection of review themes, systematic assessment of evidence, translation of results, and uptake of evidence syntheses into policy- and decision-making processes. The session was also the occasion to address the important challenges of sustainability and capacities of review teams, as well as continuous engagement of policymakers in the review process.

Meeting of the Advisory Group on Health Systems Research (HSR) Synthesis

The Alliance convened a meeting of its Advisory Group on Health Systems Research (HSR) Synthesis on the evening of 29 September. The Advisory Group brings together different collaborations and institutions interested in health systems research synthesis and its use in decision-making processes, with a focus on LMIC needs and capacity building. Participating organisations include the Cochrane and Campbell Collaborations, numerous academic institutions, and governmental and non-governmental organizations (e.g. the Norwegian Institute of Public Health and the International Initiative for Impact Evaluation (3ie)).

The meeting was an occasion to discuss the establishment of the new Global Evidence Synthesis Initiative (GESI), as well exchange on the findings of a study entitled Policy-relevant systematic reviews for health systems: a multi-stakeholder study, led by Prof Sandy Oliver from the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Center), Institute of Education, University of London.

Implementation Research and delivery science challenges for HIV/AIDS

Despite the fact that the current challenges in the global response to HIV centre on implementation, the response from the HIV community has not sufficiently interacted with researchers, policy-makers and systems engineers from outsides its own content area. Through a diverse panel including funders, NGOs, and international organisations, this session was aimed at maximizing the lessons learned from other disease areas and importantly, to create a link to the broader health systems research community. The discussions highlighted the generalizability of many of the implementation challenges facing the HIV community and the need for a common framework to address these challenges. Dr. Nhan Tran described the Alliance’s approach to implementation research and talked about how an embedded approach is being applied in many of the projects supported by the Alliance, including some that are focused on HIV/AIDS. Through a diverse panel including representatives of NGOs, foundations, and international organisations, discussions also explore the application of approaches used in business and emphasized the need to strengthen feedback mechanisms within programmes to increase their capacity to be responsive to implementation barriers.

Improving recommendations for policies and practices to strengthen people-centred health systems: is the state of evidence sufficient?

This interactive session was aimed at reviewing the standards of evidence for implementation and explored the methods available for synthesising evidence as well as innovative approaches to developing briefs for programme improvement with examples from family planning and reproductive health. Realist reviews were discussed as an important method for synthesizing information on the role of context and other factors that influence implementation. Dr. Nhan Tran reflected on the complexity of implementation and highlighted the need to strengthen the learning capacity of organisations, particularly as implementation is an iterative process. This was followed by a critical discussion of the evidence on the way evidence is used to change policies, programmes, and practices. The group was challenged to think about other factors—beyond research evidence, that are considered in decision-making by policy-makers and the need for researchers to have a greater appreciation of these things. There was broad consensus on the need to improve the quality and transparency of decision-making which the increased use of evidence could contribute to. The session concluded with a rich discussion on institutional mechanisms—such as the legislation mandating impact evaluations of publically funded social programmes, that could be put into place to improve the quality of decisions.

Implementation Research and Delivery Science Mini-Conference Series

The Alliance for Health Policy and Systems Research (AHPSR) within the World Health Organization (WHO), United States Agency for International Development (USAID) and World Bank organized a series of meetings to create a common platform for advancing Implementation Research and Delivery Science (IRDS) to improve health in low and middle income countries (LMICs). The meetings convened 78 participants from diverse sectors and various institutions, including Ministries of Health from LMICs, international and bilateral health and development agencies, academia, research organizations, international health services NGOs, and other civil society organizations. The first meeting was held in Washington DC, from April 7 – 8, 2014 and focused on “Barriers and Facilitators to Successful IRDS”. The second and third meetings on “Changing Incentives for IRDS” and “Improved Programming through Embedded Implementation Research” were held back to back in Accra Ghana, from July 30 to August 1, 2014.

Despite the wide diversity of interests and experience at the meetings, there was a common recognition that IRDS is focused on improving implementation of health policies, programs, and interventions in real-life settings, and that the IRDS endeavor involves applying scientifically sound methods to gain knowledge and apply it to implementation problems. There was also widespread agreement around the need to develop IRDS as a collaborative endeavor between key stakeholders, including the public and intended beneficiaries of health interventions. To advance understanding and support for IRDS with a much wider audience, the following products were proposed by participants:

  • Drafting a consensus statement (see link below) on IRDS to serve as a call for action to all stakeholders, to be circulated at a satellite session at the 3rd Global Health Systems Research Symposium (at Cape Town, South Africa) as well as through other fora in order to promote dialogue and increased engagement;
  • Developing of a glossary of terms, concepts and language around IRDS;
  • Developing a targeted set of products for key audiences (i.e., funders, policy-makers, implementers and academics) on the following topics: implementation constraints, how to incentivize for IRDS and promote engagements among various actors; theories and methods for causal inference in IRDS; and case studies that provide learning experiences in IRDS.

Other proposed next steps include consideration of how to create a clearing house or repository of IRDS materials and activities; finding ways to promote the expansion of training opportunities in IRDS; and exploring ways for incentivizing implementers in IRDS including consideration for international awards. The next meeting in this series is a satellite session at the Symposium in Cape Town, South Africa on September 30, 2014 from 8:30-12:00pm in Room 1.44.

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