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Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research.

ABSTRACT: INTRODUCTION:The era of the Sustainable Development Goals calls for multidisciplinary research and intersectoral approaches to addressing health challenges. This presents a unique opportunity for multidisciplinary fields concerned with complex systems. Those working in system-oriented fields such as health policy and systems research (HPSR) and health services research must be forward-thinking in optimizing their collective ability to address these global challenges. OBJECTIVES:The objective of this commentary was to share reflections on challenges and strategies in managing the HPSR workforce in order to stimulate dialogue and cross-learning across similar fields. STRATEGIES/FINDINGS:The following strategies are discussed here: definitional clarity of expected competencies and coordination across HPS researchers, national investment in HPSR, institutional capacity for coproduction of knowledge across different types of actors, and participatory leadership. CONCLUSIONS:Creative approaches in training, financing, developing, and leading the diverse workforce required to strengthen health systems can pave the way for its full-time and part-time members to work together.

SUBMITTER: Javadi D

PROVIDER: S-EPMC6149357 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research.

Javadi Dena D Tran Nhan N Ghaffar Abdul A

Health services research 20180524

<h4>Introduction</h4>The era of the Sustainable Development Goals calls for multidisciplinary research and intersectoral approaches to addressing health challenges. This presents a unique opportunity for multidisciplinary fields concerned with complex systems. Those working in system-oriented fields such as health policy and systems research (HPSR) and health services research must be forward-thinking in optimizing their collective ability to address these global challenges.<h4>Objectives</h4>Th ...[more]

PMID: 29797708

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Project description:BACKGROUND:There is increasing interest in using systems thinking to tackle 'wicked' policy problems in preventive health, but this can be challenging for policy-makers because the literature is amorphous and often highly theoretical. Little is known about how best to support health policy-makers to gain skills in understanding and applying systems thinking for policy action. METHODS:In-depth interviews were conducted with 18 policy-makers who are participating in an Australian research collaboration that uses a systems approach. Our aim was to explore factors that support policy-makers to use systems approaches, and to identify any impacts of systems thinking on policy thinking or action, including the pathways through which these impacts occurred. RESULTS:All 18 policy-makers agreed that systems thinking has merit but some questioned its practical policy utility. A small minority were confused about what systems thinking is or which approaches were being used in the collaboration. The majority were engaged with systems thinking and this group identified concrete impacts on their work. They reported using systems-focused research, ideas, tools and resources in policy work that were contributing to the development of practical methodologies for policy design, scaling up, implementation and evaluation; and to new prevention narratives. Importantly, systems thinking was helping some policy-makers to reconceptualise health problems and contexts, goals, potential policy solutions and methods. In short, they were changing how they think about preventive health. CONCLUSION:These results show that researchers and policy-makers can put systems thinking into action as part of a research collaboration, and that this can result in discernible impacts on policy processes. In this case, action-oriented collaboration and capacity development over a 5-year period facilitated mutual learning and practical application. This indicates that policy-makers can get substantial applied value from systems thinking when they are involved in extended co-production processes that target policy impact and are supported by responsive capacity strategies.

Project description:BackgroundChoosing the appropriate definition of rural area is critical to ensuring health resources are carefully targeted to support the communities needing them most. This study aimed at reviewing various definitions and demonstrating how the application of different rural area definitions implies geographic doctor distribution to inform the development of a more fit-for-purpose rural area definition for health workforce research and policies.MethodsWe reviewed policy documents and literature to identify the rural area definitions in Indonesian health research and policies. First, we used the health policy triangle to critically summarize the contexts, contents, actors and process of developing the rural area definitions. Then, we compared each definition's strengths and weaknesses according to the norms of appropriate rural area definitions (i.e. explicit, meaningful, replicable, quantifiable and objective, derived from high-quality data and not frequently changed; had on-the-ground validity and clear boundaries). Finally, we validated the application of each definition to describe geographic distribution of doctors by estimating doctor-to-population ratios and the Theil-L decomposition indices using each definition as the unit of analysis.ResultsThree definitions were identified, all applied at different levels of geographic areas: "urban/rural" villages (Central Bureau of Statistics [CBS] definition), "remote/non-remote" health facilities (Ministry of Health [MoH] definition) and "less/more developed" districts (presidential/regulated definition). The CBS and presidential definitions are objective and derived from nationwide standardized calculations on high-quality data, whereas the MoH definition is more subjective, as it allows local government to self-nominate the facilities to be classified as remote. The CBS and presidential definition criteria considered key population determinants for doctor availability, such as population density and economic capacity, as well as geographic accessibility. Analysis of national doctor data showed that remote, less developed and rural areas (according to the respective definitions) had lower doctor-to-population ratios than their counterparts. In all definitions, the Theil-L-within ranged from 76 to 98%, indicating that inequality of doctor density between these districts was attributed mainly to within-group rather than between-group differences. Between 2011 and 2018, Theil-L-within decreased when calculated using the MoH and presidential definitions, but increased when the CBS definition was used.ConclusionComparing the content of off-the-shelf rural area definitions critically and how the distribution of health resource differs when analysed using different definitions is invaluable to inform the development of fit-for-purpose rural area definitions for future health policy.

Project description:Because health systems are conceptualized as social systems, embedded in social contexts and shaped by human agency, values are a key factor in health system change. As such, health systems software-including values, norms, ideas and relationships-is considered a foundational focus of the field of health policy and systems research (HPSR). A substantive evidence-base exploring the influence of software factors on system functioning has developed but remains fragmented, with a lack of conceptual clarity and theoretical coherence. This is especially true for work on 'social values' within health systems-for which there is currently no substantive review available. This study reports on a systematic mixed-methods evidence mapping review on social values within HPSR. The study reaffirms the centrality of social values within HPSR and highlights significant evidence gaps. Research on social values in low- and middle-income country contexts is exceedingly rare (and mostly produced by authors in high-income countries), particularly within the limited body of empirical studies on the subject. In addition, few HPS researchers are drawing on available social science methodologies that would enable more in-depth empirical work on social values. This combination (over-representation of high-income country perspectives and little empirical work) suggests that the field of HPSR is at risk of developing theoretical foundations that are not supported by empirical evidence nor broadly generalizable. Strategies for future work on social values in HPSR are suggested, including: countering pervasive ideas about research hierarchies that prize positivist paradigms and systems hardware-focused studies as more rigorous and relevant to policy-makers; utilizing available social science theories and methodologies; conceptual development to build common framings of key concepts to guide future research, founded on quality empirical research from diverse contexts; and using empirical evidence to inform the development of operationalizable frameworks that will support rigorous future research on social values in health systems.

Project description:BackgroundThere is an established body of evidence linking systems of social protection to health systems and health outcomes. The Sustainable Development Goals (SDGs) provide further emphasis on this linkage as necessary to achieving health and non-health goals. Existing literature on social protection and health has focused primarily on cash transfers. We sought to identify potential research priorities concerning social protection and health in low and middle-income countries, from multiple perspectives.MethodsPriority research questions were identified through two sources: 1) research reviews on social protection interventions and health, 2) interviews with 54 policy makers from Ministries of Health, multi-lateral or bilateral organizations, and NGOs. Data was collated and summarized using a framework analysis approach. The final refining and ranking of the questions was completed by researchers from around the globe through an online platform.ResultsThe overview of reviews identified 5 main categories of social protection interventions: cash transfers; financial incentives and other demand side financing interventions; food aid and nutritional interventions; parental leave; and livelihood/social welfare interventions. Policy-makers focused on the implementation and practice of social protection and health, how social protection programs could be integrated with other sectors, and how they should be monitored/evaluated. A collated list resulted in 31 priority research questions. Scale and sustainability of social protection programs ranked highest. The top 10 research questions focused heavily on design, implementation, and context, with a range of interventions that included cash transfers, social insurance, and labor market interventions.ConclusionsThere is potentially a rich field of enquiry into the linkages between health systems and social protection programs, but research within this field has focused on a few relatively narrowly defined areas. The SDGs provide an impetus to the expansion of research of this nature, with priority setting exercises such as this helping to align funder investment with researcher effort and policy-maker evidence needs.

Project description:Health system reforms across Africa, Asia and Latin America in recent decades demonstrate the value of health policy and systems research (HPSR) in moving towards the goals of universal health coverage in different circumstances and by various means. The role of evidence in policy making is widely accepted; less well understood is the influence of the concrete conditions under which HPSR is carried out within the national context and which often determine policy outcomes. We investigated the varied experiences of HPSR in Mexico, Cambodia and Ghana (each selected purposively as a strong example reflecting important lessons under varying conditions) to illustrate the ways in which HPSR is used to influence health policy. We reviewed the academic and grey literature and policy documents, constructed three country case studies and interviewed two leading experts from each of Mexico and Cambodia and three from Ghana (using semi-structured interviews, anonymized to ensure objectivity). For the design of the study, design of the semi-structured topic guide and the analysis of results, we used a modified version of the context-based analytical framework developed by Dobrow et al. (Evidence-based health policy: context and utilisation. Social Science & Medicine 2004;58:207-17). The results demonstrate that HPSR plays a varied but essential role in effective health policy making and that the use, implementation and outcomes of research and research-based evidence occurs inevitably within a national context that is characterized by political circumstances, the infrastructure and capacity for research and the longer-term experience with HPSR processes. This analysis of national experiences demonstrates that embedding HPSR in the policy process is both possible and productive under varying economic and political circumstances. Supporting research structures with social development legislation, establishing relationships based on trust between researchers and policy makers and building a strong domestic capacity for health systems research all demonstrate means by which the value of HPSR can be materialized in strengthening health systems.

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Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research.

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Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research.

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