National Health Research Systems Research Articles

Health research prioritization in Somalia: setting the agenda for context specific knowledge to advance universal health coverage.

Despite recognition that health research is an imperative to progress toward universal health coverage, resources for health research are limited. Yet, especially in sub-Saharan Africa, more than 85% of the resources available for health research are spent on answering less relevant research questions. This misalignment is partially due to absence of locally determined health research priorities. In this study, we identified health research priorities which, if implemented, can inform local interventions required to accelerate progress toward universal health coverage in Somalia. We adapted the child health and nutrition research initiative method for research priority setting and applied it in 4 major phases: (1) establishment of an exercise management team, (2) a web-based survey among 84 respondents to identify health research questions; (3) categorization of identified health research questions; and (4) a workshop with 42 participants to score and rank the identified health research questions. Ethical approval was received from ethics review committee of the London School of Hygiene and Tropical Medicine (Ref:26524) and the Somali Research and Development Institute (Ref: EA0143). Two hundred and thirty-one unique health research questions were identified and categorized under health systems, services and social determinants (77), communicable diseases (54), non-communicable diseases (41) and reproductive, maternal, new-born, child, adolescent health and nutrition (59). A priority score ranging from 1 to 9 was assigned to each of the questions. For each category, a list of 10 questions with the highest priority scores was developed. Across the four categories, an overall list of 10 questions with the highest priority scores was also developed. These related to bottlenecks to accessing essential health services, use of evidence in decision making, antimicrobial resistance, distribution and risk factors for non-communicable diseases, post-traumatic stress disorder and factors associated with low antenatal care attendance among others. The developed priority research questions can be used to focus health research and to inform appropriation of health research resources to questions that contribute to generation of local health system knowledge which is required to accelerate progress toward universal health coverage in Somalia. The Somalia national institute of health should set up a consortium for provision of technical and financial support for research addressing the identified priority research questions, establish a mechanism to continuously monitor the extent to which new health interventions in Somalia are informed by knowledge generated through conducting prioritized health research and prioritize interventions aimed at strengthening the broader national health research system for Somalia.

An assessment of the performance of the national health research system in Mauritius

BackgroundThe goal of universal health coverage (UHC) is that every individual has access to high-quality health services without running the consequences of financial hardship. The World health report 2013 "Research for universal health coverage" states a performant National Health Research Systems (NHRS) can contribute by providing solutions to challenges encountered in advancing towards UHC by 2030. Pang et al. define a NHRS as the people, institutions, and activities whose primary aim is to generate and promote utilization of high-quality knowledge that can be used to promote, restore, and/or maintain the health status of populations. The WHO Regional Committee for Africa (RC) adopted a resolution in 2015 urging member states to strengthen their NHRS to facilitate production and utilization of evidence in policy development, planning, product development, innovation, and decision-making. This study aimed to calculate NHRS barometer scores for Mauritius in 2020, identify the gaps in NHRS performance, and recommend interventions for boosting the Mauritius NHRS in the pursuit of UHC.MethodsThe study used a cross-sectional survey design. A semi-structured NHRS questionnaire was administered and complemented with a review of documents archived in pertinent Mauritius Government Ministries, universities, research-oriented departments, and non-governmental organizations websites. The African NHRS barometer developed in 2016 for countries to monitor the RC resolution implementation was applied. The barometer consists of four NHRS functions (leadership and governance, developing and sustaining resources, producing and utilizing research, financing research for health [R4H]), and 17 sub-functions, e.g., existence of a national policy on research for health (R4H), presence of a Mauritius Research and Innovation Council (MRIC), existence of knowledge translation platform.ResultsIn 2020, Mauritius had an overall average NHRS barometer score of 60.84%. The four NHRS functions average indices were 50.0% for leadership and governance, 77.0% for developing and sustaining resources, 52.0% for producing and utilizing R4H, and 58.2% for financing R4H.ConclusionThe performance of NHRS could be improved through the development of a national R4H policy, strategic plan, prioritized agenda, and national multi-stakeholder health research management forum. Furthermore, increased funding for the NHRS may nurture the human resources for health research capacities, hence the number of pertinent publications and health innovations.

Academic Impact Evaluation in National Health Research System: Toward Public Health Promotion.

The Article Abstract is not available.

What the policy and stewardship landscape of a national health research system looks like in a developing country like Iran: a qualitative study

BackgroundThe health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points.MethodsThis study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro.ResultsAnalysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base.ConclusionsStewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework.

Think Global, Act Local

Think Global, Act Local

The Roles of Regional Organisations in Strengthening Health Research Systems in Africa: Activities, Gaps, and Future Perspectives.

Regional cooperation on health in Africa is not new. The institutional landscape of regional cooperation for health and health research, however, has seen important changes. Recent health emergencies have focussed regional bodies' attention on supporting aspects of national health preparedness and response. The state of national health research systems is a key element of capacity to plan and respond to health needs - raising questions about the roles African regional bodies can or should play in strengthening health research systems. We mapped regional organisations involved in health research across Africa and conducted 18 interviews with informants from 15 regional organisations. We investigated the roles, challenges, and opportunities of these bodies in strengthening health research. We deductively coded interview data using themes from established pillars of health research systems - governance, creating resources, research production and use, and financing. We analysed organisations' relevant activities in these areas, how they do this work, and where they perceive impact. Regional organisations with technical foci on health or higher education (versus economic or political remits) were involved in all four areas. Most organisations reported activities in governance and research use. Involvement in governance centred mainly around agenda-setting and policy harmonisation. For organisations involved in creating resources, activities focused on strengthening human resources, but few reported developing research institutions, networks, or infrastructure. Organisations reported more involvement in disseminating than producing research. Generally, few have directly contributed to financing health research. Informants reported gaps in research coordination, infrastructure, and advocacy at regional level. Finally, we found regional bodies' mandates, authority, and collaborations influence their activities in supporting national health research systems. Continued strengthening of health research on the African continent requires strategic thinking about the roles, comparative advantages, and capability of regional organisations to facilitate capacity and growth of health research systems.

Governance of health research in four eastern and southern African countries

BackgroundHealth research governance is an essential function of national health research systems. Yet many African countries have not developed strong health research governance structures and processes. This paper presents a comparative analysis of national health research governance in Botswana, Kenya, Uganda and Zambia, where health sciences research production is well established relative to some others in the region and continues to grow. The paper aims to examine progress made and challenges faced in strengthening health research governance in these countries.MethodsWe collected data through document review and key informant interviews with a total of 80 participants including decision-makers, researchers and funders across stakeholder institutions in the four countries. Data on health research governance were thematically coded for policies, legislation, regulation and institutions and analysed comparatively across the four national health research systems.ResultsAll countries were found to be moving from using a research governance framework set by national science, technology and innovation policies to one that is more anchored in health research structures and policies within the health sectors. Kenya and Zambia have adopted health research legislation and policies, while Botswana and Uganda are in the process of developing the same. National-level health research coordination and regulation is hampered by inadequate financial and human resource capacities, which present challenges for building strong health research governance institutions.ConclusionBuilding health research governance as a key pillar of national health research systems involves developing stronger governance institutions, strengthening health research legislation, increasing financing for governance processes and improving human resource capacity in health research governance and management.

Health Service Delivery as a Research Agenda

For any company or organization, its service delivery mirrors its effectiveness in attaining its goals. For a health care institution, this is health service delivery. Why should health service delivery be a priority of any health care institution or organization
 The World Health Organization (WHO) talks about improving the quality of patient-centered health service as the road to achieving universal health coverage and the Sustained Development Goals (SDGs).1 The US Agency for International Development (USAID) embarked on ASSIST, Applying Science to Strengthen and Improve Systems, a five year project designed to improve health and social services in USAID-assisted countries.2
 It is imperative that health service delivery is designed in such a way that it is based on the best scientific evidence for a particular disease, is made easily accessible, and one that follows a structure or system that will support its delivery.
 The USAID further puts an even broader concept called governance for quality health care and service delivery. These include use of policy and strategies, effective regulation, engaging non-state actors, garnering political will, pursuing reliable data, culture of continuous improvement, promoting knowledge sharing, and linking financing to quality.2
 Health service delivery as a research agenda, therefore, is not only confined to looking for treatment interventions based on the best evidence. It should also consider addressing access and availability of the health service, and the institutional architecture to support a quality health service or intervention. Defining of roles and responsibilities of personnel at various levels of care within the organization and the aligning of other resources necessary for delivery are vital parts of it also.
 In the Philippines, the National Unified Health Research Agenda (NUHRA) came about as it reflects the health needs of the Filipinos. The NUHRA creates a template for health research in these specific areas in a 5-year scope.3
 The Philippine General Hospital (PGH) has included health service delivery as one of its top research agenda. In the past 4 years that it has established such, many of the research outputs have addressed specific disease interventions, hospital processes, and personnel welfare and readiness. There are still, however, a lot of gaps and questions that remain to be addressed.
 The papers on this fourth issue of the PGH for Acta Medica Philippina are diverse in scope but are all products of the authors’ questions that needed addressing in order to improve delivery of care to the PGH patients. May the impact of the results of these research endeavors truly make a difference in the lives of the patients the National University Hospital serves.
 
 Jean Anne B. Toral, MD, MScCoordinator for ResearchPhilippine General Hospital
 
 REFERENCES
 1. World Health Statistics 2016 Monitoring Health for the SDGs. ISBN 978 92 4 156526 4.2. Laird K, Tarantino L, Mennen T, Koon A. Governance to Improve the Quality of Health Services: A Research Agenda. January 2018.3. Philippine National Health Research System, National Unified Health Research Agenda [Internet]. [cited 2021 Feb 5]. Available from: www.healthresearch.ph/index.php/nuhra1.

Monetary value of disability-adjusted life years lost from all causes in Mauritius in 2019

Background: The Republic of Mauritius had a total of 422,567 disability-adjusted life years (DALYs) from all causes in 2019. This study aimed to estimate the monetary value of DALYs lost in 2019 from all causes in Mauritius and those projected to be lost in 2030; and to estimate the monetary value of DALYs savings in 2030 if Mauritius were to attain the national targets related to five targets of the United Nations Sustainable Development Goal 3 on good health and well-being. Methods: The human capital approach was used to monetarily value DALYs lost from 157 causes in 2019. The monetary value of DALYs lost in 2019 from each cause was calculated from the product of net gross domestic product (GDP) per capita in Mauritius and the number of DALYs lost from a specific cause. The percentage reductions implied in the SDG3 targets were used to project the monetary values of DALYs expected in 2030. The potential savings equal the monetary value of DALYs lost in 2019 less the monetary value of DALYs expected in 2030. Results: The DALYs lost in 2019 had a total monetary value of Int$ 9.46 billion and a mean value of Int$ 22,389 per DALY. Of this amount, 84.2% resulted from non-communicable diseases; 8.7% from communicable, maternal, neonatal, and nutritional diseases; and 7.1% from injuries. Full attainment of national targets related to the five SDG3 targets would avert DALYs losses to the value of Int$ 2.4 billion. Conclusions: Diseases and injuries cause a significant annual DALYs loss with substantive monetary value. Fully achieving the five SDG3 targets could save Mauritius nearly 8% of its total GDP in 2019. To achieve such savings, Mauritius needs to strengthen further the national health system, other systems that tackle the social determinants of health, and the national health research system.

Health research in Madagascar: state-of-the-art, challenges and perspectives

L´évolution et les défis contemporains de la recherche pour la santé (RS) à Madagascar sont peu documentés. Notre objectif est de faire un état des lieux du Système National de Recherche pour la Santé (SNRS) dans le but de comprendre les facteurs qui influencent son développement. Nous avons mené une étude de cas qualitative, qui consistait en une revue documentaire et des entretiens semi-structurés avec 38 informateurs clés. Nous avons effectué une analyse thématique et nous sommes inspirés des composantes du Baromètre des SNRS de l´OMS/AFRO pour structurer la présentation des résultats. À Madagascar, les institutions de RS opèrent sans un cadre législatif spécifique. Il existe toutefois un document de politique présentant les orientations nationales de la RS. Les ressources humaines sont insuffisantes, du fait de défis dans l´accès à la formation et la rétention des chercheurs. La collaboration internationale représente quasiment l´unique source de financement de la RS. Elle contribue également au renforcement des capacités humaines, institutionnelles mais ne favorise pas toujours l´adéquation entre la recherche effectuée et les besoins prioritaires du pays. Les efforts inaboutis de régulation et la modicité de l´investissement public dans la formation et la mise en œuvre de la recherche traduisent un engagement insuffisant des gouvernants pour la RS. La négociation de partenariats internationaux équitables, la disponibilité de financements publics, et l´alignement de la RS aux priorités nationales de santé constitueraient une base solide pour le développement du SNRS à Madagascar.

Towards universal health coverage: can national health research systems deliver contextualised evidence to guide progress in Africa?

### Summary box As the global movement towards universal health coverage (UHC) gains momentum, countries in the WHO African Region will need to overcome several design and technical challenges within their health systems to achieve set targets. UHC is defined as ensuring that all people have access to needed health services of sufficient quality to be effective, while ensuring that the use of these services does not expose the user to financial hardship.1 The definition embodies several dimensions including ensuring that good quality services are available and accessible, the whole population is reached with the services they need, and no one faces financial hardships in seeking care. Health systems must be strong to ensure attainment of the aspirations in the different dimensions. Health systems strengthening, and reforms are very challenging—both in terms of designing policies and programmes and effectively implementing them to achieve the desired impact. There is often a knowledge gap between ‘how to’ implement health systems changes and the technical assistance provided. Research evidence can provide …

Strengthening national health research systems in the WHO African Region \u2013 progress towards universal health coverage

BackgroundHealth challenges and health systems set-ups differ, warranting contextualised healthcare interventions to move towards universal health coverage. As such, there is emphasis on generation of contextualized evidence to solve local challenges. However, weak research capacity and inadequate resources remain an impendiment to quality research in the African region. WHO African Region (WHO AFR) facilitated the adoption of a regional strategy for strengthening national health research systems (NHRS) in 2015. We assessed the progress in strengthening NHRS among the 47 member states of the WHO AFR.MethodsWe employed a cross sectional survey design using a semi structured questionnaire. All the 47member states of WHO AFR were surveyed. We assessed performance against indicators of the regional research strategy, explored facilitating factors and barriers to strengthening NHRS. Using the research barometer, which is a metric developed for the WHO AFR we assessed the strength of NHRS of member states. Data were analysed in Excel Software to calculate barometer scores for NHRS function and sub-function. Thematic content was employed in analysing the qualitative data. Data for 2014 were compared to 2018 to assess progress.ResultsWHO AFR member states have made significant progress in strengthening their NHRS. Some of the indicators have either attained or exceeded the 2025 targets. The average regional barometer score improved from 43% in 2014 to 61% in 2018. Significant improvements were registered in the governance of research for health (R4H); developing and sustaining research resources and producing and using research. Financing R4H improved only modestly. Among the constraints are the lengthy ethical clearance processes, weak research coordination mechanisms, weak enforcement of research laws and regulation, inadequate research infrastructure, limited resource mobilisation skills and donor dependence.ConclusionThere has been significant improvement in the NHRS of member states of the WHO AFRO since the last assessment in 2014. Improvement across the different objectives of the regional research strategy is however varied which compromises overall performance. The survey highlighted the areas with slow improvement that require a concerted effort. Furthermore, the study provides an opportunity for countries to share best practice in areas of excellence.

Stakeholders in the Development of the National Unified Health Research Agenda of the Philippines

Objectives. Stakeholders and stakeholder engagement in agenda setting are not well documented despite its increased recognition. This paper aimed to describe stakeholder engagement in the agenda setting. Specifically, it aimed to (1) describe the process of stakeholder engagement in the development of the NUHRA 2017-2022; (2) describe characteristics of stakeholders involved; and (3) identify lessons learned during the engagement.
 Methods. Documents pertinent to the agenda setting process, which included profile of participants and feedback on the consultation process were reviewed and analyzed. Key informant interviews were also conducted among selected PCHRD officials and members of the Philippine National Health Research System - Research Agenda Committee. Stakeholder mapping was conducted prior to the engagement to identify potential stakeholders. Consultations were conducted in each region involving different stakeholders. Stakeholders in the consultation process were national government agencies, local government units, academe, public and private health facilities, and non-government organizations (NGOs).
 Results. The stakeholder with the highest representation was the national government (n=110), while the lowest were public and private health facilities (n=14 each). Interactive discussion of stakeholders with diverse background, is the top item that went well during the consultation and should be retained in the future, and; brainstorming session and presentation were identified item that needs improvement.
 Conclusion. A diverse and well-represented set of stakeholders is important in an agenda setting to appropriately identify priorities and to improve uptake of the agenda. Stakeholder engagement, however, should not be limited to agenda setting, collaborative work must be sustained in all aspects of the research cycle.

Operationalizing the Development of the National Unified Health Research Agenda 2017-2022

Introduction. The National Unified Health Research Agenda is a major document whose creation by the Philippine National Health Research Systems is mandated by Philippine Law. Multiple frameworks, methods, and approaches for the development of a health research agenda exists. Available literature on research priority setting have mostly focused on its methods, results, or implementation. There are limited studies on the operations management of conducting a national health research priority-setting exercise.
 Objectives. This paper aims to describe the operational components utilized to develop the NUHRA 2017-2022 and provide lessons learned for future research priority setting endeavors. Methods. This paper identified and categorized the operational components to develop the NUHRA 2017-2022 using the Enabler Criterion of the European Foundation for Quality Management’s (EFQM) Excellence Model.
 Results. Operationalizing the development of a national health research agenda requires the harmonization of multiple components. Having region-based staff involved in the production of a regional situational analysis improved its context and accuracy. The workload for each cluster team must be considered and anticipated by the management. Stakeholder engagement requires political, diplomatic, advocacy, marketing, management, and technical skills. The process requires building relationships with various institutions. In a largescale project, management processes must be in place to effectively track and monitor its progress.
 Conclusion. Operations and management are usually a neglected area in research and development projects. In a bottoms-up research priority-setting approach, iteration and flexibility is needed which requires a lot of management skills and insight. Duration of the project, planning, resources available, and quality of outputs have a strong interconnected relationship.

Applying Knowledge Management in Generating and Using Evidence in Health Research Priority Setting (HRPS)

Background. Current international recommendations in generating and using evidence in Health Research Priority Setting (HRPS) include the use of systematic reviews, and systematic or scientific situational analysis. In the Philippines, the Philippine National Health Research System’s (PNHRS) National Guidelines for Health Research Prioritization recommends the use of either a Combined Approach Matrix (CAM) or situational analysis in generating and using evidence for HRPS. At present, there is a lack of a gold standard in generating and utilizing evidence in HRPS.
 Objective. The primary objective of this paper is to document a practical yet alternative/innovative approach on how evidence was generated and utilized in the process of HRPS as observed in the development of the National Unified Health Research Agenda (NUHRA) in the Philippines. Specifically, it identifies the types of knowledge products produced and their role in the process of health research agenda setting; how evidence was used and managed in the course of NUHRA development; and, the lessons learned from the experience.
 Methods. This case study is descriptive of the experience of generating and utilizing evidence for HRPS in the Philippines. The study utilized primary and secondary data. Knowledge Management (KM) was used as a lens to describe the process of generating and managing information for the NUHRA. Document analysis was used in comparing and aligning data with the integrated KM framework.
 Results. Pre-selected data were captured and created; shared and disseminated; and subsequently acquired and applied voluntarily by stakeholders during the process of HRPS. Relevant data was presented into various information products designed with a specific stakeholder in mind. Technical papers were developed to cater to national level stakeholders and focused on broad, nationally-relevant issues. Regional situational analysis reports focused on regional and local data and were designed for regional stakeholders to use during the development of Regional Unified Health Research Agenda (RUHRA). Infographics were developed to present the findings of the technical papers creatively and concisely and the NUHRA methodology and were presented to both national and regional stakeholders. The RUHRAs and the NUHRA were the outputs of the health research prioritization activities and will be made available through local and national channels of the PNHRS.
 Recommendations. Opportunities for formalization and institutionalization of knowledge management for generating and using evidence in HRPS may be explored to address health information fragmentation across the health research system.

Strengthening the Policy Environment for Health Research in the Philippines: Insights from a Preliminary Analysis of Existing Policies

Background and Objective. Research plays an important role in generating new knowledge that could improve health outcomes when translated into action. As such, there must exist a supportive research policy environment that facilitates the provision of necessary resources and sustainably ensures an appropriate number of skilled researchers buttressed by institutions. These, in turn, are envisioned to provide facilities, information systems, financial grants, and avenues for career development and collaboration. This study aims to analyze factors in the current policy environment that makes health research possible in the Philippines.
 Methods. Qualitative exploratory design was used to characterize the Philippine health research environment. Guided by Adamchak's framework on policy environment, a content review of 39 policy documents (1991 to 2018) by the four core agencies of the Philippine National Health Research System was conducted. Seven elements of the policy environment were described.
 Results. The policies analyzed in this study mainly addressed the legal, political, cultural, economic, and ecological elements of the policy environment. Policies that support the demographic and technological elements are lacking, in that these leave out details that are essential for capacity building and use of research output. A cross-cutting effort to resolve gaps may be necessary.
 Conclusion. Several factors continuously affect the environment in which policy is developed. There is room for improvement in terms of showcasing the government’s regulatory quality and independence from political pressure. Equal attention must also be paid to human capital development, innovation partnerships, and mechanisms to improve knowledge impact, absorption, and utilization.

Approaches to Health Research Priority Setting in the Philippines across the Years

Background. As one of the research councils under the Department of Science and Technology (DOST), health research priority setting has been the mandate of the Philippine Council for Health Research and Development (PCHRD) since its establishment in 1982. The development of the National Unified Health Research Agenda (NUHRA) convenes the major stakeholders for health in the country to establish the priorities for health research. The NUHRA aims to address the most urgent health issues in the country for the generation of solutions to the health concerns of the country.
 Objectives and Method. Through document review, this paper describes the approaches and lessons learned in research priority setting since the establishment of the Philippine National Health Research System.
 Results. The Philippines has employed a bottoms-up, top-down, and a combination of both approaches to develop its health research agenda.
 Conclusion. The health research agenda-setting must consider evolving funding sources, its link to production of researches with high probability of knowledge translation to health technology innovation, and policy formulation. Measuring the impact of the NUHRA to the health systems and health situation of the country is a difficult assessment, but the gradual change in healthcare technology utilization and evidence-informed policies towards health equity can be a subjective measurement of the NUHRA’s success.

Implementation of a KPI for assessing the effectiveness of the national health research system

Implementation of a KPI for assessing the effectiveness of the national health research system

The Palestinian health research system: who orchestrates the system, how and based on what? A qualitative assessment

BackgroundIn 2011, the WHO Eastern Mediterranean Region committee launched a strategy for scaling up research in the region to address the countries’ health needs through formulating and analysing the National Health Research System (HRS). Stewardship comprises three functions, namely governance, policy and priorities, and is a central pillar of this system to ensure a well-organised and functioning HRS. This study aims to examine the perceptions of the HRS performers to understand these functions and to generate insights for system strengthening.MethodsThe study was carried out in Palestine, targetting three sectors in the health field, including relevant governmental health institutions, schools of public health, and major local and international health agencies. The data were collected through 52 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) with policy-makers, academics, directors, and experts. Participants and institutions were selected purposively based on a set of criteria and peer review.ResultsA total of 104 experts participated in the IDIs (52 participants) and FGDs (52 participants in 6 FGDs), highlighting that stewardship functions remain problematic and insufficiently performed, mainly due to a missing health research structural and regulatory framework and dispersed health research work. Despite the limited good practices, the majority of the participants described the Ethical Review and Clearance as weak due to the lack of an agreed-upon national committee and procedural quality and ethics guidelines for non-compliance. A policy or strategy dedicated to health research is lacking. The exercises of research priority-setting appear to be evolving despite the lack of consensus and the low levels of knowledge and experience in research prioritisation. Common gaps, such as weak political will and capacity support, the absence of a national unified regulating body, and the indirect effects of political conditions on strengthening the HRS as well as other sectors, also emerged.ConclusionsThe stewardship functions of the Palestinian HRS remain weak along with substantial political, structural, and resources and capacity gaps. The study emphasises the imperative need to initiate strategic efforts led by the MOH and the Palestinian National Institute of Public Health alongside with other players to strengthen a national HRS through improving the stewardship functions. To achieve this, attention and support of decision-makers, involvement, mobilisation and strategic dialogue are indispensable, in order to embark on building a well-regulated and coordinated structure, operational research policy, and prioritisation of essential research.

Evaluation of regional project to strengthen national health research systems in four countries in West Africa: lessons learned

BackgroundSince the Commission on Health Research for Development (COHRED) published its flagship report, more attention has been focused on strengthening national health research systems (NHRS). This paper evaluates the contribution of a regional project that used a participatory approach to strengthen NHRS in four post-conflict West African countries – Guinea-Bissau, Liberia, Sierra Leone and Mali.MethodsThe data from the situation analysis conducted at the start of the project was compared to data from the project’s final evaluation, using a hybrid conceptual framework built around four key areas identified through the analysis of existing frameworks. The four areas are governance and management, capacities, funding, and dissemination/use of research findings.ResultsThe project helped improve the countries’ governance and management mechanisms without strengthening the entire NHRS. In the four countries, at least one policy, plan or research agenda was developed. One country put in place a national health research ethics committee, while all four countries could adopt a research information management system. The participatory approach and support from the West African Health Organisation and COHRED were all determining factors.ConclusionThe lessons learned from this project show that the fragile context of these countries requires long-term engagement and that support from a regional institution is needed to address existing challenges and successfully strengthen the entire NHRS.