HEALTH SYSTEM
RESEARCH
A HEALTH MANAGEMENT TOOL
FOR HEALTH DOVELOPMENT
Promoting health system
research as management tool
an over view
Dr m v sagar
Goal of any national health development process
• Is to enable its people to reach level of health that at least enables
them to participates actively in the social and economic life of the
community
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To attain this objective existing health system must be
redirected to achieve
equitable allocation resources to health
- total coverage , increased accessibility to primary health care
services and effective referral to secondary and tertiary care
Goal of any national health development process
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Such redirection of health system require
Changes in
Health care planning ,and government policy
In the organization and administration of health
Financing and budgeting of health
And in the selection and application of appropriate
technology
Goal of any national health development process
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To affect necessary changes
Countries must decide best approaches to adopt
This requires
Detailed and accurate information on needs
possibilities And consequences of recommended
action
• Such information is often lacking ,inadequate or
unreliable
Goal of any national health development process
• As result discission based on assumptions and un
justified conclusions
• And often result in
• Inappropriate policy choices and disciverec only after
implementation
Research in health past
• Contributions to health
• by providing knowledge on he causes of disease and ill health
• And by developing the technology to cure and prevent the
disease
How ever despite the considerable amount of
knowledge and technology to cure and prevent
the disease available today
MANY PEOPLE AND COUNTRIES REMAIN
UNABLE TO ACHIEVE TARGETS OF HEALTH FOR ALL
WHY IS THIS SO É
Health
needs
Health
resources
Interventions
Evaluating health interventions
Health needs
Perceived by
Health resources
health
Available from
professionals
health services
and
other sectors
population Interventi
ons
Covering all
Effective
Affordable
Efficient
and population
What is research
research is a systematic search for information and new knowledge
What is research
• Research is the systematic collection of data analysis
interpretation to answer certain questions and solve a
problem
•It answers two questions
• First basic research basic or fundamental research
• is necessary to generate new knowledge and
technologies to deal with major
What is research
research is a systematic search for information and new knowledge
What is research
• Second Applied research
• is necessary to identify priority problems and to
design and evaluating policies and programmes that
will be of greatest benefit , using existing knowledge
and available resources ,both financial and human
• These two purposes together ,in what has now been
defined as ESSENTIAL NATIONAL RESEARCH
•Catalyse the generation of new knowledge and
the application of existing knowledge ,an
essential link to equity ad dovelopment
What is research
research is a systematic search for information and new knowledge
What is research
• Second Applied research
• is necessary to identify priority problems and to
design and evaluating policies and programmes that
will be of greatest benefit , using existing knowledge
and available resources ,both financial and human
What is research
research is a systematic search for information and new knowledge
What is research
• These two purposes together ,in what has now been
defined as
•ESSENTIAL NATIONAL RESEARCH
•Catalyse the generation of new knowledge and
the application of existing knowledge ,an
essential link to equity ad dovelopment
The focus of health system research
• H S R IS ULTIMATELY CONCERNED WITH IMPROOVING HEALTH
OF THE COMMUNITY BY ENHANCING THE EFFICIENCY AND
EFFECTIVENESS OF THE HEALTH SYSTEM AS AN INTEGRAL PART
OF THE OVERALL PROCESS OF SOCIOECONOMIC
DOVELOPMENT
What is meant by health system ?
• A health system may be defined as
• A set of Cultural belefs about health and illness that forms the
basis for health seeking and health promoting behaviour
• The institutional arrangements within which that behaviour
occurs
• And socio economic ,political ,and phyla context for those
belifs and institutions
What is meant by health system ?
• In short
• It consist of
• What people believe and know about health and illness and
what they do to remain healthy and cure diseases
• For example
• If in a society
• People perceive evil ancestor spirits as a cause illness there will
be specialists and rituals to appease these spirits
• If they see germs as the cause ,they will look for modern
(modern health care)
What is meant by health system ?
• If biomedical health care introduced
• people may Accept the services
• but the beliefs and knowledge to support this behaviour may
not have been fully developed
• Health worker must be aware of the indigenous explanations for
illness
Institutional arrangements within which health behaviour
occurs encompasses more than delivery Of medical care
through government health services
They include
all indivisuals ,
groups
And institutions
that directly or indirectly contribute to health
These may differ from society to society ,
but usually cover four components
the individual
,family ,
and community :
health care services ;
health related sectors
Health
care services
health system Health care services by
government
Health workers ,out
reach services
Health personnel
health financing
health infrastructure
Health centres district
hospitals
multispecialty
hospitals
The number ,type ,distribution
,and quality of services
provided by these services
influence health and well being
Health system health care services( private sector)
the relative importence of these components
varies in different socities
Traditional medicine (folk medicine)TBAHERBAL
,DIVINERS WHO MAY IDENTIFY NATURAL OR
SUPER NATURAL CAUSES OF DISEASE AND TREAT
THEM ACCORDINGÈY
Private modern medical practice legal or illegal
health system
Health related sectors
• these include for example
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Agriculture and food distribution
Education ( formal and non formal)
Water and sanitation
Transport and communication
• ALL THESE SECTORS CONTRIBUTE TO HEALTH EITHER DIRECTLY
OR INDIRECTLY
• INTERNATIONAL SECTOR INCLUDES BILATARAL AND MULTI
LATARAL AGENCY (UNICEF ,WHO ETC ) THAT MAY SUPPORT
HEALTH AS WLL AS DOVELOPMENT ACTIVITIES
INDIVISUAL FORMS MAJOR INTEGRATING
FORCE OF THE HEALTH SYSTEM
• HE OR HIS RELATIVES CHOOSE AND COMBINE THE ACTIVITIES
WHICH THEY BELIEVE WILL PROMOTE THEIR WELL BEING
• THEY MAY DECIDE TO USE CERTAIN INSTITUTIONS AND
REJECT OTHERS
• HEALTH SERVICES MAY NOT BE THEIR FIRST CHOICE
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How well the different components of the
health system functions depend to a large
extent on
Socio economic factors
political factors
Cultural facyors
physical factors
epidemiological factors
And other contextual factors
For example economic crisis or zoom and nutritional status
as well as national budget available for health services
Fig health system
Selectivity versus comprehensiveness in H S R
• Because H S R IS problem oriented it should be selective and
concentrate on those factors that will help to solve the
problem being examined
Even man power field H S R Focusses on specific topic depending
on who experience the problem and at what level
Even in man power field H S R Focusses on specific
topic depending on who experience the problem
and at what level
• HEALTH POLICY MAKER
• How can special programmes
drain away resources
• Ready ORS PACKETS GIVEN IN
DIORRHOEA or people should be
taught about how to prepare
sugar salt solution
• Managers at district level
• Why neonatal mortality is
higher in cerain districts
Even in man power field H S R Focusses on specific
topic depending on who experience the problem
and at what level
• Hospital doctors
• Why do so many pregnant
women come with severe
anemia
• Are the first line services
available and sufficiently and
adequate
• Are patients coming for
treatment late for T B IF SO WHY
• Managers at district level
• Why neonatal mortality is
higher in cerain districts
Even in man power field H S R Focusses on specific
topic depending on who experience the problem
and at what level
• VILLAGE LEVEL WORKER
• Why are our village health
workrs post underutilized
• How we can assist ileterate
women so that they can
effectively prevent and treat
diorrhoea
• Community leaders
• Effects cost recovery programme
on drug costs and availability of
drugs
• How much community labour
required to manage new water
system
The aim of H S R IS to provide health managers
at all levels as well as community leaders ,with
the relevant information they need to make
decisions on problems they are facing
We must be aware that problems at one level of
the health system are usually connected to
problem at other level if seen at one level
results partly explain the problem in sufficient
to solve it (areas of major concern policy
,administration and management ,direct
services ,indivisuals and families ,the
community ,the environment.)
Who should be involved in H S R
• H S R IS MULTIDISCIPLINARY
Many of the issues in one area of concern are interrelated
and interact with issues in other areas (bio medical science
,epidemiology ,behavioural science environment
,economics ,operation research
H S R IS NOT However the concern of scientists alone
Participatory nture of H S R
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Participatory nature of H S R is one of the major characteristic
1 policy makers
2 decision makers
3 health staff
4 community
5 professional researchers
GUIDELINES FOR H S R
NEW Concepts and research approaches to
support health dovelopment
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Evolved rapidly
Described by specific terms such as
Operational research
Health services research
Health man power research
Policy and economic analysis
Applied research
Decision linked research
All these has made
crucial contributions
to the dovelopment
of health system
research (H S R )
H S R ULTIMATELY CONCERNED WITH
IMPROOVING HEALTH OF THE
COMMUNITY
DEFINED BY
Enhancing the efficiency and
effectiveness of the health system as an
integral part of the overall process of
socio economic dovelopment
Aim of H. S. R.
• TO PROVIDE health managers at al level with relevant
information
• That they need to solve the problems they are facing
• Participatory nature is on of the major characteristic
Aim of H. S. R.
• i. e . Involvement of all parties – the community ,health care
managers , decision makers ,and researchers in the definition
of the problem
• Helps to focus the investigation and to enrich the quality of
data
• participation at all level is essential to acceptability of
solutions to implementation and sustainability
• H S R ADDRESSES HEALTH PROBLEMS IN THE BROAD
CONTEXT OF SOCIAL, ECONOMIC ,AND COMMUNITY
DOVELOPMENT
Aim of H. S. R.
• RESEARCH INPUTS FROM MANY DISCIPLINES REQUIRED
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THESE INCLUDE
• demography ,epidemiology ,health economics ,policy and
management sciences ,social and behavioural sciences
,statistics and some apects of the clinical sciences
• Researchers from these disciplines needs to acquire skills to
work together in multi disciplinary teams
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The main charecterstics of H S R
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Its focus on priority problems in health
Its participatory nature
Its Acton orientation
Its integrated ,multidisciplinary approach
The main charecterstics of H S R
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Its multisectoral in nature
Its emphasis on cost effectiveness
Its focus on practical timely solutions
its iterative nature that allows for
evaluation of the impact of planned change
and consequent revision of action plans
and health policy
r
The main charecterstics of H S R
• The methodology can be applied to similar problem in
different countries
the findings and solutions to these problems are unlikely to be
the same
Because of differences in cultural ,social economic and political
realities
So each country must have its own agenda of H S R
Capacity building in H S R
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Training programmes organised by
IDRC
PAHO
WHO
USAID
UNICEF
UNICEF APPROACH OF CAPACITY BUILDING For
child survival and development
• “To strengthen the awareness skills and knowledge For
operations research using health system approach
• to promote inquisitiveness and self reliant approaches
• to identify pressing problems at community level and practical
solutions to them “
Capacity building in H S R
• “ to improve the relevance of medical education by enhancing
the ability of medical graduates to help identify and solve the
problems of community in which they serve using partnerships
among universities ,governments ,and communities the focus
of which is
• a programme Of
• national health research “
Major challenges for the future development of
HSR
• How to enhance the demand for H S R
• how to strengthen national capacities in H S R
• And
• How to institunalise the efforts into a sustainable process
Promoting the use of health systems research as
a management tool
• Decision making process
policy decisions
operational decisions
• Decision linked approach to H S R is one in which decission makers
and researchers work together to identify
• what key decisions to be made regarding health service issue
• what type of information needed to improove
• what part of information available in routinely collected data
What measures need to be taken to design and implement research
Decision making process
1 recognising
issues
7 assessing
consequences
2Formulating
problems
Intervening
3 identifying
needs
4 setting goals
5 considering
options
Phases in institutionalisation of H S R
1consensus
building
2 Capacity
building
3
consolidation
STRATEGIES FOR PROMOTING HEALTH SYSTEM
RESEARCH AMONG SENIOR MANAGERS
• understanding and support of senior managers is essential to use h sr as
a problem solving tool to be adopted through out the health system
• HAVE little knowledge decision linked health system research
• Research results can provide information leading to better management
decisions
• Role is important in institutionalising H S R research
Summaries of major strategies
inter country workshop
Summaries of major strategies
2 task force on health research
Summaries of major strategies
3 national consultative meetings on HSR
Summaries of major strategies
4 H S R PROJECTS with intensive involvement of
stake holders
Summaries of major strategies
5 sessions on HSR IN MORE BROADLY FOCUSSED
WORKSHOPS AND CONFERENCES (piggy back
workshops)
Summaries of major strategies
6 H S R CONSULTANTS
Summaries of major strategies
7 orientation session for decision makers
preceding H S R PROPOSAL –developmental
workshop
Summaries of major strategies
8 case study work sgops on H S R
Summaries of major strategies
9 Manager/funding agency representative
working sessions
Summaries of major strategies
10 HSR FOCAL POINTS HEALTH RESEARCH UNITS
AND ADVISORY COMMITTEES
Summaries of major strategies
11 national and international network for H SR
Summaries of major strategies
3 national consultative meetings on HSR
Case study workshop
1 rationale for work shop
2 Priority problems
SENIOR HEALTH MANAGERS
ACADEMIC PROFESSIONALS
SENIOR RESEARCHERS
3 H S R CASE STUDY1,2,3
INCREASE IN DECISSION MAKERS
SKILLS KNOWLEDGE AND
SUPPORT FOR HSR
4 ORGANISING AND MANAGING
HSR DOVELOPING A NATIONAL
H S R POGRAMME PLAN
IMPLEMENTATION OF NATIONAL
H S R PROGRAMME PLAN
CASE STUDY WORKSHOP
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PARTCIPANTS
Decision makers and health managers from ministry of health
Senior researchers from health research and training institute
organizers
Consultants in case study methods
WHO
DONOR ORGANIZATION
Ministry of health
Facilitators health professionals or researchers in H S R
Duration 5 DAYS
CASE STUDY WORKSHOP
OBJECTIVES OF WORKSHOP
1. IDENTIFY THOSE ASPECTS OF CURRENT PROBLEMS
2. FORMULATE QUESTIONS
3. Recognise the importance of previous studies national statistical
information
4. Determine the cost (time money and resources )
5. Design a research study and prepare plan of action
6. Evaluate research report convince other managers of the importance of H
SR
7. RECOGNISE THE MULTI DISCIPLINARY AND INTER SECTORAL APPROACH
IN SOLVNG HEALTH AND HEALTH SYSTEM PROBLEMS
CASE STUDY WORKSHOP
PROCESS
CASE STUDY WORKSHOP
PRODUCT
CASE STUDY WORKSHOP
FOLLOW UP
CASE STUDY WORKSHOP
POTENTIAL IMPACT
CASE STUDY WORKSHOP
LIMITATIONS
Case study workshop
1 rationale for work shop
2 Priority problems
SENIOR HEALTH MANAGERS
ACADEMIC PROFESSIONALS
SENIOR RESEARCHERS
3 H S R CASE STUDY1,2,3
INCREASE IN DECISSION MAKERS
SKILLS KNOWLEDGE AND
SUPPORT FOR HSR
4 ORGANISING AND MANAGING
HSR DOVELOPING A NATIONAL
H S R POGRAMME PLAN
IMPLEMENTATION OF NATIONAL
H S R PROGRAMME PLAN
In 1986 national council on international health in u s a
conducted a conference
ON
: application of bio medical and health research in
developing world ;
A decision linked research to promote to use health
system research in the managerial process among the
wide range of health managers and health professionals
P 72 SESIONS ON HEALTH SYSTEMS RESEARCH IN MORE
BROADLY FOCUSSED WORKSHOPS AND CONFERENCES
• Modules on H S R
• CAN BE USED IN WORK SHOPS AND CONFERENCES FOR
SENIOR HEALTH MANAGEMENT PROFESSIONALS
• ; PIGGY BACK WORK SHOPS
• ; CAN BE USED TO TO PRESENT THE CONCEPT OF DECISSION
LINKED RESEARCH TO A MUCH WIDER AUDIENCE AT LESS
COST
P 72 SESIONS ON HEALTH SYSTEMS RESEARCH IN
MORE BROADLY FOCUSSED WORKSHOPS AND
CONFERENCES
R
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P 72 SESIONS ON HEALTH SYSTEMS RESEARCH IN
MORE BROADLY FOCUSSED WORKSHOPS AND
CONFERENCES
Participants
Organizers
facilitators
duration
objectives
process
Follow up z
potential impact
Limitations
ISSUES RELATED TO H S R AT THE NATIONAL LEVEL
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1 )REVIEW OF HEALTH RESEARCH
2)REVIEW H S R DOVELOPMENT
a) strengthening the national capabilities for H S Rr
B ) strengthening the H S R process
3)training for H S R
4) INSTITUTIONAL STRENGTHENING
5) )PROMOTION INFORMATION , COORDINATION ,AND UTILIZATION
6) INFORMATION COORDINATION AND UTILIZATION
STRATEGIES FOR PROMOTING HEALTH SYSTEM
RESEARCH AMONG SENIOR MANAGERS
• understanding and support of senior managers is essential to use h sr as
a problem solving tool to be adopted through out the health system
• HAVE little knowledge decision linked health system research
• Research results can provide information leading to better management
decisions
• Role is important in institutionalising H S R research
STRATEGIES FOR PROMOTING HEALTH SYSTEM
RESEARCH AMONG SENIOR MANAGERS
• Who are the senior managers
STRATEGIES FOR
PROMOTING HEALTH SYSTEM
RESEARCH AMONG SENIOR
MANAGERS
What should senior
manager have been able to
do once the orientation
completed
STRATEGIES FOR
PROMOTING HEALTH
SYSTEM RESEARCH
AMONG SENIOR
MANAGERS
What should senior
manager have been
able to do once the
orientation completed
• Research required for decision
making
• Utilize research results in
management decision
• Prioritize research needs
• Dovelop research policy
• Evaluate research proposal in relation
to priorities and available resources
• Institutionalising research structure
that can effectively respond to on
going informational needs at all levels
of health system
STRATEGIES FOR
PROMOTING HEALTH
SYSTEM RESEARCH
AMONG SENIOR
MANAGERS
What should senior
manager have been
able to do once the
orientation completed
• Dovelop mechanism for on going
training of healh personnel and junior
researchers
• Assign separate budget
• Ensure research results reach in a
forat in time frame useful for decision
making
STRATEGIES FOR PROMOTING HEALTH SYSTEM RESEARCH AMONG
SENIOR MANAGERS
Major Promotional strategies
1.
2.
3.
4.
5.
Inter country work shops on H S R
TASK FORCES ON HEALTH RESEARCH
National consultative meetings on H S R
H S R projects with intensive involvement of decision makers
Sessions on HSR in more broadly focussed workshops or
conferences
(piggyback workshops
6 H S R CONSULTANTS
STRATEGIES FOR PROMOTING HEALTH SYSTEM RESEARCH AMONG
SENIOR MANAGERS
Major promotional strategies continued
7 orientation session for decision makers preceeding HSR proposal
workshops
8 CASE STUDY WORKSHOPS ON H S R
9 joint health manager / funding agencies working sessions
10 H S R FOCAL POINTS VHEALTH RESEARCH UNITS AND ADVISORY
COMMITTEES
11 National and international workshops for HSR
Results
with a probability of
application and
HSR PROJCT
impact improvement
WITH
in health delivery
DECISSION
and health of
MAKER
population
INVOLVEMENT
development of
decision linjed HS R
programme
during planning
phase ,while the
research being
conducted ,when
results are
available T