Health Research Systems Analysis (HRSA) concepts and indicators
A draft conceptual framework as the basis for this initiative is forthcoming as a peer-reviewed publication. It is intended that this framework serves as the basis for operational description and analysis of national health research from a system's perspective, rather than from the perspective of selected sectors driven by markets, interest groups, technocrats, etc. The framework has been developed during a series of extensive consultations with experts and other interested organizations, a wide range of researchers and representatives from countries, and individuals and institutions working on strengthening health research systems, and also benefits from an extensive literature review. In March 2001, WHO organized an international workshop on National Health Research Systems, in Cha-am, Thailand, with financial and logistic support from the Global Forum for Health Research, the Council for Health Research and Development and the Rockefeller Foundation. Key concepts covering goals and terminology, mapping of the system and approaches to strengthen health research systems were discussed in detail and summarized. Since then, continued discussions at various forums have contributed to refining the framework and obtaining a wider consensus. For example, during the Roundtable on Supporting Cooperation in Health Research for Development sponsored by the Rockefeller Foundation, held in Arusha, Tanzania, in November 2002, a detailed discussion on the "enabling environment" for health research was held, including a discussion on key domains, analytical approaches and use of data for policy options in this area.
A brief version of the conceptual framework is presented, through a series of key questions:
- What is the definition of a health research system?
The framework sets out to delineate a boundary of the health research system based on the following definition: "The people, institutions, and activities whose primary purpose is to generate high quality knowledge that can be used to promote, restore, and or maintain the health status of populations. It can include the mechanisms adopted to encourage the utilization of research." Health research systems overlap to some extent with health systems and other research systems. It is important to note that although boundaries may not be clear, it is important to discuss what national health research systems include at a particular point in time. Such concrete definitions are required to describe and analyse what is considered as health research, (i.e., the topics covered), who is doing health research (i.e., institutions and individuals), who are the research users (i.e., policy makers, communities, donors) and how much does health research cost (i.e., funding flows and allocation). Being specific at this stage will also aid in the more difficult task of understanding how the system evolves over time, and how to attribute improvements in health or health equity, to health research system activities in a particular country
- What are the overall goals?
The main goals of health research are the advancement of scientific knowledge and utilization of knowledge to improve health and health equity. There are many intermediary benefits, such as knowledge benefits, benefits to future researchers, political and administrative benefits, benefits to the health sector, and broader social and economic benefits. Nevertheless, the intrinsic goals of health research, as opposed to other research or activities, should ultimately contribute to improvements in health and health equity.
- What are the functions of health research systems?
The following functions are proposed as putative attributes of a well-functioning health research system:
- Stewardship Function
- Define and articulate a vision for a national health research system
- Identify appropriate health research priorities and coordinate adherence to them
- Set and monitor ethical standards for health research and research partnerships
- Monitor and evaluate the health research system
- Financing Function
- Secure research funds and allocate them accountably
- Creating & Sustaining Resources
- Build, strengthen and sustain the human and physical capacity to conduct and absorb health research
- Producing & Using Research
- Produce scientifically validated research outputs
- Translate and communicate research to inform health policy, health practice, and public opinion
- Promote the use of research to develop drugs, vaccines, devices and other applications to improve health
Indicators of each function's key components will be selected and methods to estimate these indicators, will be developed and tested with countries participating in the in-depth description and analysis study. The overall typology or structure of health research systems will be derived from the data, analysis and evidence collected through the overall HRSA initiative, which draws on different but complementary epistemological assumptions, in depth country and cross-country case studies and a benchmarking exercise.
- Proposed areas for core indicators and descriptive variables to benchmark National Health Research Systems