Dr.Rituja KaushalDepartment of Community

MedicinePCMS & RC , Bhanpur

Contents :I. OverviewII. Definition of Health Systems Research (HSR)III. PurposeIV. FocusV. Features of Health systems researchVI. Steps in conducting HSRVII. HSR in IndiaVIII.Institutes conducting HSRIX. Structure of HSRX. Priorty areas of functioning with problems &

solutionsXI. Utilisation & promotion of HSRXII. Future of HSR in India

In this presentation an attempt is made to describe what HSR is & its importance & utility in managerial & policy decision making for improving the health care through appropriate reforms in the Health systems. Brief description of the steps involved in undertaking HSR , the efforts to promote & strengthen HSR has been highlighted followed by some directions for making them more effective & relevant.

Overview

The culture of research has provided a rational knowledge based framework within which the Health processes takes place .

In view of the growing dissatisfaction with the prevailing health care delivery among the people & the concern & interest in finding out ways for improving health care , research on sources,organisation & accomplishments of health care has been considered important & urgent.

Towards facilitating governments to obtain relevant information on the health services performance , the concept of health services research was developed during 1981-1982 & was used by WHO in its sixth general prog. of work.

Then , a need is felt for integration of various health related issues into a certain type of research having a comprehensive approach towards the health system development. Thus the focus got shifted from the health services research & the WHO in the seventh general prog. Of work for years 1984-1989 employed the nomenclature of Health Systems Research.

Definition Health system research is defined as the

systematic study of the means by which biomedical , sociomedical & other relevant knowledge is brought to bear on the health of communities under a given set of conditions.

Health system research goes beyond the boundaries of health services research which mostly has been limited to narrow concern with government programmes & it covers the private sector , indigenous health care providers & practices ,efforts initiated by health care by the community itself as well as the intersectoral influence on health.

Purpose

I. To solve health problems .II. To improve the health of people through

improvement of the various interrelated components of the health system .

III. To enhance efficiency & effectiveness of health system as an integral part of the overall socio economic development.

IV. Analysis of problem from technical & human angle & translation of research results into implementable solutions .

Focus

Focus is primarily on the primary health care including integration of treatment & preventive measures for control of diseases , nutrition , family planning & environmental safety , problems of referral etc. It involves learning how to work with other sectors in a wide range of development activities that may prove important for health.

As a tool :

HSR can be considered a great help & effective tool for health system managers at all levels .It can assist health managers in more rational health planning& resource allocation & should result in better design of health systems & encourage greater personal , family & community self reliance in the solution of health problems.

Important features of HSR :

Should focus on priorty problems . Should be action oriented . Multi disciplinary & multi sectoral approach . Participatory nature . Timeliness . Simple & short term research designs . Cost effectiveness . Increased accessibility to HSR ressults for decision

makers . Ability to influence decision making. Scope of HSR is very wide .

Constituent in a continuum of research series . Emphasis in HSR should be to improve the

existing health care services incrementally . HSR is also a means to promote development of

simplest , least expensive ,acceptable ,most widely usable & affordable technology .

Through initiating improvement in specific management issues by using available facilities & personnel , HSR can remove the blocks to effective & efficient services.

Steps in conducting HSR Development of HSR proposal on a relevant problem

which cannot be solved without/which can be solved more effectively , with more information collected through research .

Implementation/actual operationalisation of the proposal in the targeted field area & collect relevant data .

Analysis & interpretation of data & preparation of report highlighting study results & their implications for action including recommendations for implementation of the research findings/results .

Dissemination of study results .

HSR in India

ICMR acts as a nodal agency for research in India to promote medical research in the initial stage ,& later on to promote field based operational research to develop programme strategies for delivery of health services .

Task force on operational research (OR) cons tituted in 1974 by GoI.

Under various National prog. , there are research & training instt. established with the purpose of contributing towards strenghtening the prog . strategies through basic & applied research as well as to provide in service training to the concerned staff . Eg. Malaria ,Filariasis ,TB ,Leprosy ,Nutrition etc.

Accord . to the recommendation of International Commission of Health research for development formulated in 1987 , every country should make more effective use of research to guide their policies & actions.

Evolution of the concept of Essential National Health Research (ENHR) took place with a base in each developing country to understand it’s own problem , improve health policy & man- agement , enhance the effectiveness of limited resources , foster innovations & experimentation & provide the foundation for a stronger developing country voice in setting international priorties.

Complexities of health problems at country level demands skills/training in generating more relevant & area specific information for identifying solutions to the health problems.

Concerned officials & staff need to be sensitized & equipped with skills in conducting & utilising HSR which is an important tool to diagnose the problems as well as to develop suitable alternate strategies for solving the problem through experimentation , so that rational decision to solve health problems can be promoted.

Instt .(Medical/Non Medical) involved in conducting HSR in India. 1. NIHFW , New Delhi.2. Indian instt. Of Health Management Research

(IIHMR), Jaipur.3. Foundation for research in Community Health

(FRCH),Mumbai.4. Centre for Multidisciplinary Development research

,Dharwad.5. National Instt. for Public finance & policy ,New

Delhi .6. Operation Research group , Baroda.7. National instt. for Rural

Developmment ,Hyderabaad.

Structure :The WHO supported HSR project/programme in India is

being co-ordinated by the NIHFW at national level.Organising training courses in capacity building in HSR has been an ongoing activity .

For promoting HSR in India in a well co-ordinated manner , the National Conference on HSR recommended constitution of a three tier body with NIHFW as the co-ordinating agency at the National level & a core group to act as an advisory body to the agencies involved in HSR as well as a broad based group of organisations to actively undertake HSR activities at the functional level.

Priority areas for HSR in India

1. Adolescents Health .2. Gerontology concerning problems .3. Women’s health & empowerment .4. Primary health care .5. Decentralisation in context of the Panchayati Raj

system .6. Improvement of the referral system .7. Vertical & horizontal integration at different levels

in the administrative hierarchy .

Problem & Solutions related to HSR :Problem :Inadequate

utilisation of results of HSR studies by health managers in taking decisions for changes/improvement of health care .

Lack of dissemination of research findings.

Poor access for managers to relevant research findings.

Solutions : Preparation of reference

document consolidating the relevant findings of research studies ,indicating their implication & utility for bringing desired results.

Eg : With financial support from WHO , NIHFW has prepared a Bibliographic Database on HSR studies conducted by different institutions in India.

Utilisation of HSR :I. It fills gap between the researchers , policy makers ,&

other administrators responsible for implementation of health programmes .

II. By proper co-ordination of research efforts it avoids unnecessary duplication of studies .

III. Fill gaps in information for specific topics & geographic area.

IV. Acts as a tool for improved managerial & policy decision making.

V. HSR provides not only a means to analyse & interpret the routinely available data but also helps in generating additional information required , through scientific methods.

Thus ,in order that HSR is fully utilised , the decision makers have to identify the areas/issues on which decisions are to be taken , the type of information required for supporting these decisions , take stock of the available/existing information & their sources , & specific questions to be answered through new information as well as measures to be taken to design & implement research for obtaining these information .

Eg. Where use of HSR results in decision making in India.

1. Decision to impliment Community Health Workers Scheme in delivery of primary health care.

2. Decision regarding use of Bio-larvicides as part of Malaria Control Prog.

3. Decision on Prog. Strategies as well as steep increases in federal government financial allocations for NPCB.

4. Issues related to financing of health care in India based on findings of research on health expenditure by Central & State Governments etc.

4. Policy decisions on blood banking in India , related to legislative & control mechanisms to encourage voluntary blood donations , compulsory screening of all blood samples etc.

5. Implementation of Multi drug therapy in National Leprosy Eradication Programme .

6. Issues related to financing of health care in India based on findings of research on health expenditure by Central & State Governments etc.

Promotion of HSR : 3 phases of the process

Future of HSR in India :I. More action oriented research are needed in actually

solving the problems thereby validating the recommendations.

II. In addition to current individual localised research approach , multi centric studies may be promoted.

III. Efforts to standardise research procedures for common issues may be prepared for comparability of research results.

IV. HSR efforts in the field of human resource development need more attention .

V. Studies in the field of health economics related to alternate health care financing mechanism ,cost containment ,economic evaluation of prog. Should be encouraged.

VI. Holistic studies covering all elements of the health system should be regularly conducted.

VII . There is need to develop rapid assessment techniques using epidemiological,statistical & anthropological methods through experimentation & proper validation to enable rational decision making without losing time.

VIII . Mechanism for sharing research results through proper reporting to all interested parties ,conferences ,publication etc. need to be developed & sustained.

IX .There is need for focussing HSR in districts .