Health systems research in the time of health system reform in India: a review.

Krishna D Rao,Radhika Arora,Abdul Ghaffar

doi:10.1186/1478-4505-12-37

Abstract

BackgroundResearch on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period.MethodsWe reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks.ResultsOur findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland).ConclusionsThe growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in states and institutions that have a scarcity of researchers, as well as states that have been the focus of little research. While more funding for health systems research is required, this funding needs to be targeted at deficient health systems domains, geographical areas, and institutions.

Highlights

Research on health systems is an important contributor to improving health system performance [1]
The first was the launch of the National Rural Health Mission (NRHM) (2005–2013) to strengthen the public sector health system, for primary care [6]
We reviewed published articles on health systems research during the period 2005–2013 and examined temporal trends in publications, the health system areas covered in this research, the characteristics of the researchers, and the geographical areas covered in published health systems research

Summary

Introduction

Research on health systems is an important contributor to improving health system performance. Significant health system reforms have been implemented in India These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. The second has been the introduction, since 2008, of government-sponsored insurance schemes covering hospital care for the poor [7] Both state and central insurance schemes are present and it is estimated that, by 2015, 50% of India’s population will be covered by government insurance schemes [7]. These reforms have the potential of significantly altering health systems in India, as well as to move the country closer to Universal Health Care. The Aarogyasri Health Care Trust, which implements the Rajiv Aarogyasri health insurance scheme in Andhra Pradesh, has created an embedded research unit

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Discussion

Conclusion