Sustaining capacity in health policy and systems research in Thailand

Abstract

Introduction Strengthening research capacity in developing countries is aimed at generating and translating knowledge into policy decisions to improve health systems and increase equitable access to health services in the population. (1) The International Health Policy Program (IHPP) in Thailand has strengthened health policy and systems research capacity in the Ministry of Public Health since 1998 and has sustained its capacity for a decade. This paper analyses and illustrates the experience of building and sustaining capacity in health policy and systems research in Thailand to provide lessons for developing countries. We found that international and national collaboration were important in strengthening research capacity but that migration of well-trained health professionals impeded sustainable capacity development. (2) While individual training was an entry point in capacity building, challenges remain on how to enhance the research environment to sustain the individual's capacity and interest so as to maximize their contribution. (3) Building capacity IHPP was established in 2001 through a memorandum of understanding between the Health Systems Research Institute and the Ministry of Public Health. It emerged from the Thailand Research Fund's Senior Researcher Scholar (SRS) programme in health economics and financing. Two rounds of 3-year institutional grants to SRS and other funding sources have been meaningful in building capacity in health policy and systems research. Since 1998, SRS has recruited young professionals with a strong public health background for research apprenticeships to conduct policy-relevant research under the mentorship of senior researchers before their placement for doctoral training. Long-term fellowships have been sought from WHO and other competitive sources. The WHO Country Office and IHPP have jointly managed the fellowship programme since 2000. International collaboration with the Health Economics and Financing Programme at the London School of Hygiene and Tropical Medicine since 1993 and other networks in Europe and North America has been an important platform for long-term capacity building, especially in granting Doctors of Philosophy (PhDs). Of the 36 WHO long-term fellowship grants approved in the 10-year period since 1998, 17 were masters degrees, 5 certificates and 14 doctoral degrees. There was a zero attrition rate and no international loss. All fellows returned upon graduation to serve mostly in the Ministry of Public Health and a few universities. This successful return rate was an asset for sustaining capacity development. IHPP researchers and post-doctoral contributions have been significant. Publication performance has increased especially in international journals, from two papers in 2001 to 13 papers in 2006. Policy impact was just as important as publication rates. Recent major reforms for universal coverage relied on strong human capacity in health policy and systems research as well as synergistic political and civic society movements. (4,5) The main contributions of IHPP were cost studies, the estimation of budget requirements for the universal coverage scheme in its implementation phase and a manual for analysis of hospital financial status and performance. In addition, several IHPP partners, such as the European Union-supported Health Care Reform Office, the Center for Health Equity Monitoring, Naresuan University and the Health Systems Research Institute, contributed to the policy decisions. Based on parameters applied by Gonzalez Block, (6) Table 1 summarizes the evolution of Thailand's health policy and systems research capacity and its outcome. Sustaining capacity The critical factor in sustaining research capacity was the selection of young professionals for research apprenticeships and long-term fellowship placements. It was vital that they had a good track record of commitment, especially towards rural health services. …