Editor—Over the past two decades experienced health policymakers and practitioners have noted a widening gap between scientific knowledge and policies on the one hand and their implementation on the other.1 For example, despite the availability of powerful drugs and the existence of comprehensive programme policies many developing countries are still struggling to maintain acceptable cure rates for tuberculosis.2 This implementation gap has been aggravated by health sector reform and fiscal stringency, which have placed greater demands for performance on local health systems and practitioners.
Health systems research often focuses on operational aspects of health systems development. It commonly uses a combination of quantitative and qualitative methods and sometimes entails practitioners participating in reflective action research. Health systems research therefore has powerful potential to bridge the implementation gap through testing and evaluating activities and systems while simultaneously enhancing the capacity of health staff to evaluate and improve their performance. In other words, instead of focusing on the traditional “what, why, where, and who?” it focuses on “how?”
Well conducted health systems research has improved the quality and provision of health programmes even where resources are constrained.2,3 For example, paediatric ward sisters in hospitals in the impoverished former homeland areas of the Eastern Cape in South Africa used record reviews, interviews, and structured observations to identify several deficiencies in their management of severe malnutrition. Their changes led to case fatality rates almost halving.4
The relevance and importance of health systems research is unfortunately not reflected in resource allocation by funding bodies or in the curriculum of many public health courses. We have found that the flexible use of methods and an emphasis on timely and appropriate information rather than increased precision give health practitioners and researchers the confidence to use research to address health problems in a meaningful way.5
References
- 1.Berg A. Sliding toward nutrition malpractice: time to reconsider and redeploy. Am J Clin Nutr. 1993;57:3–7. doi: 10.1093/ajcn/57.1.3. [DOI] [PubMed] [Google Scholar]
- 2.Raviglione RC, Dye C, Schmidt S, Kochi A. Assessment of worldwide tuberculosis control. WHO Global Surveillance and Monitoring Project. Lancet. 1997;350:624–629. doi: 10.1016/s0140-6736(97)04146-9. [DOI] [PubMed] [Google Scholar]
- 3.Taylor CE. The uses of health systems research. Public Health Papers. 1984;78:1–50. [PubMed] [Google Scholar]
- 4.Christensson K, Bhat GJ, Eriksson B, Shilalukey-Ngoma MP, Sterky G. The effect of routine hospital care on the health of hypothermic newborn infants in Zambia. J Trop Pediatr 1995 Aug;41:210-4. [DOI] [PubMed]
- 5.Puoane T, Sanders D, Chopra M, Ashworth A, Strasser S, McCoy D, et al. Improving the clinical management of malnourished children through participatory health systems research. South Afr Med J (in press).