Research Article: Defining Research to Improve Health Systems

Date Published: November 16, 2010

Publisher: Public Library of Science

Author(s): Jan H. F. Remme, Taghreed Adam, Francisco Becerra-Posada, Catherine D’Arcangues, Michael Devlin, Charles Gardner, Abdul Ghaffar, Joachim Hombach, Jane F. K. Kengeya, Anthony Mbewu, Michael T. Mbizvo, Zafar Mirza, Tikki Pang, Robert G. Ridley, Fabio Zicker, Robert F. Terry

Abstract: Robert Terry and colleagues present working
definitions of operational research, implementation research, and health
systems research within the context of research to strengthen health

Partial Text: A major obstacle to achieving the health-related Millennium Development Goals (MDGs) is the weakness of the health systems in many low- and middle-income countries, and their struggle to effectively provide health care to populations in need [1],[2]. Several global health initiatives have been created over the last decade to support the delivery of available interventions for priority health problems, and in recent years there have been some major new initiatives to support health system strengthening [1],[3],[4]. These developments have been accompanied by a growing recognition of the role of research in improving health systems and health care delivery. The ministerial summit on health research that was held in Mexico in 2004 concluded that research has a crucial part to play in strengthening health systems and in improving the equitable distribution of quality health services for populations in need, and the summit called for greater support for such research [5]. Since then, the number of research initiatives on health systems in low- and middle-income countries has increased substantially [6],[7]. This is a positive development that we would like to see expanded and accelerated to build up evidence-based knowledge to improve the effectiveness of health systems. Unfortunately, these initiatives have also led to growing confusion about what type of research is involved and at whom that research is targeted. The fact that the various research initiatives originate from different research backgrounds (biomedicine, social sciences, organization of services, health economics, etc.) has led to an inconsistent use of terminology to describe the research. Multiple definitions of operational research, implementation research, and health systems research have been proposed in recent years [2],[6]–[18], and many of these define the scope of their research very broadly, resulting in considerable overlap between definitions. Operational research and implementation research are sometimes used interchangeably in the literature, or are classified as health systems research [10]–[12],[17].

Building on the numerous definitions that exist in the literature under the overall umbrella of research to improve health systems, three domains of research can be defined using their primary characteristics: the focus of the research, the users of the research outputs, and the utility of the research outputs (see Figure 1 and Table 1).

There are a number of related research areas that may overlap with the above research domains but are out of the scope of this paper. Some of them are briefly described here. First, monitoring and evaluation aims to track the progress of a health intervention and to determine whether it is having its intended impact. As a routine operational activity, it is usually not regarded as research by itself, although its findings are instrumental for identifying priority problems for research. However, the term evaluation can sometimes refer to the more formal evaluation designs such as process, economic, or impact evaluations, or can be used separately to answer questions related to the three research domains described in this paper [34].

Definitions are meant to clarify. But if too many different definitions for the same terms abound, so much confusion results that they become an obstacle to progress. Our aim here is not to establish which of these definitions are correct or to launch an intense debate about definitions that would distract from the need to support the research itself and the use of research results to improve health. Instead, we seek to provide a simple framework that is easily understood by both experts in the field and the managers, policy makers, and donors working to improve health systems and deliver better health care. We have tried to map the three main research domains, the research targets, and the users, and to highlight the importance of context and study design in the subsequent utility of the research findings.



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