1. Workshop on health systems research in low and middle income countries: the role of global health funders in the UK The Wellcome Trust, Gibbs Building, 13-14 December 2011 Professor Sir Andy Haines, Chair of the MRC Global Health Group Professor Sir Andy Haines, 13 Dec 2011

2. Workshop and report convened by UK global health-related research funders: 1. Background to the workshop Professor Sir Andy Haines, 13 Dec 2011

3. 1. Background to the workshop Background paper Health systems workshop Future funding strategies Professor Sir Andy Haines, 13 Dec 2011

4. 1. Background to the workshop Current definitions of health systems research Breadth of the field Key issues and priorities in the field Relevant funding programmes Background paper aims: Professor Sir Andy Haines, 13 Dec 2011

5. Analysing the burden of a health problem to identify research needs Cannot be averted with existing interventions Averted with current mix of interventions and population coverage Avertable with existing but not cost-effective interventions 100% z 0% x y 100% Combined efficacy of intervention mix Effective coverage in population Research to identify new effective interventions Research to reduce the cost of existing interventions Research on health systems and policies x – population coverage with current mix of interventions y – maximum achievable coverage with a mix of available cost-effective interventions z – combined efficacy of a mix of all available interventions Source: Adapted from Ad Hoc Committee on Health Research, Investing in health research and development (WHO, 1996) Avertable with improved health system performance Professor Sir Andy Haines, 13 Dec 2011

6. 2. Setting the scene Examples of common barriers/challenges to improving service delivery identified in reviews of major initiatives on Maternal health, Child health, TB, Malaria, HIV/AIDS, (and NCDs) (Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder A, Pielemeier N, Mills A, Evans T. Lancet 2004) Multiple providers, public & private Human resources Weak service management –poor quality services Financial constraints (up to 70% out of pocket payments), inequitable resource allocation Lack of co-ordination between programmes Weak monitoring systems, poor use of information Professor Sir Andy Haines, 13 Dec 2011

7. Why has health-policy and systems research been neglected? The topics are not visible or emotive Seen as too applied and lacking rigour Long time frame of answers Questions about generalisability Lack of capacity and funding Professor Sir Andy Haines, 13 Dec 2011

8. An increase in funding for Health Systems Strengthening An upsurge in interest in Health Systems Research Essential to provide a strong body of evidence for informed decision making 2. Setting the scene Why is there increased interest in HSR now?: Professor Sir Andy Haines, 13 Dec 2011

9. Health interventions have system-wide effects Don de Savigny and Taghreed Adam. Systems thinking for health systems strengthening. Alliance for Health Policy and Systems Research, WHO, 2009 Professor Sir Andy Haines, 13 Dec 2011

10. Several terms are used to describe the field: 3. Health Policy and Systems Research Health systems research Health policy and systems research Health services research Health systems and services research Implementation research Operational research Health policy research Professor Sir Andy Haines, 13 Dec 2011

11. Definitions 3. Health Policy and Systems Research A recent definition: the purposeful generation of knowledge that enables societies to organize themselves to improve health outcomes and health services Taken from the First Global Symposium on Health Systems Research One proposed way to progress would be to agree on what we are hoping to achieve rather than on standardised definitions? Professor Sir Andy Haines, 13 Dec 2011

12. A multidisciplinary and interdisciplinary field: 3. Health Policy and Systems Research Health economics Epidemiology Sociology Statistics Management sciences Political sciences Anthropology Geography History Psychology Professor Sir Andy Haines, 13 Dec 2011

13. Question-driven Health system as a whole (rather than a disease or service) Policies, organisations, programmes Public, populations, communities 3. Health Policy and Systems Research Focus: Professor Sir Andy Haines, 13 Dec 2011

14. Knowledge leads to improvement of health systems Enables the scale up of interventions Directly informs policy and decision making Context specific 3. Health Policy and Systems Research Essential research: Essential to provide a strong body of evidence Professor Sir Andy Haines, 13 Dec 2011

15. Routes to a research agenda: Analyses of health systems constraints to achieving the MDGs Regional consultations Inputs from WHO staff and other expert contributors Article in Lancet and use of e-mail discussion lists Task Force identified 12 broad topic areas which address the health system barriers to the attainment of the MDGs but also have wider relevance. Financial and human resources Organisation and delivery of health services Governance, stewardship and knowledge management Global influences Professor Sir Andy Haines, 13 Dec 2011

16. Field is at a tipping point… 4. Key issues and priorities in Health Policy and Systems Research Disciplinary challenges: Nature and scope of field: need for clarity and consensus Context specific Perceived lack of rigour of methodologies Disciplinary capture: mutual understanding between disciplines Professor Sir Andy Haines, 13 Dec 2011

17. Field is at a tipping point… 4. Key issues and priorities in Health Policy and Systems Research Disciplinary constraints in LMICs: Lack of funding: limited capacity to conduct research Inadequate infrastructure and facilities Shortage of skilled researchers Lack of Demand? Need to build HPSR (supply and demand) capacity in LMIC Professor Sir Andy Haines, 13 Dec 2011

18. 4. Key opportunities in Health Policy and Systems Research Opportunities By the end of 2010, GAVI had committed US$ 568 million to health system strengthening support (HSS) for 53 countries. Round 8 of GFATM funding committed $593 m to 66 countries for HSS The Health Systems Funding Platform (the Platform) was established in 2009 on the recommendation of the High Level Task Force on Innovative International Financing for Health Systems. It is intended as a mechanism to accelerate progress towards the MDGs, and specifically to: “…coordinate, mobilize, streamline and channel the flow of existing and new international resources to support national health strategies.” The Platform is being developed initially by the GAVI Alliance, the Global Fund and the World Bank, and facilitated by WHO),High Level Task Force on Innovative International Financing for Health SystemsMDGGAVI AllianceGlobal FundWorld Bank Professor Sir Andy Haines, 13 Dec 2011

19. According to the World Bank, LICUS are home to almost 500 million people, half of whom earn less than a dollar a day. They have infant mortality rates a third higher than other low-income countries, a life expectancy that is 12 years lower, and a maternal mortality rate that is 20 per cent higher. 5. Challenges include - poor governance Professor Sir Andy Haines, 13 Dec 2011

20. 5. Challenges include -

21. Source: WHO Global Report: Preventing Chronic Diseases: a vital investment, 2005 5. Challenges include –Rise of NCDs Professor Sir Andy Haines, 13 Dec 2011

22. 2010 – a harbinger of things to come? Pakistan floods ~ 20 m affected Chinese floods ~ 12m displaced Russian drought and fires –wheat harvest down ~ 30% 56,000 extra deaths in Moscow and Western Russia (Munich Re estimate) Record temperatures in 17 countries. Future challenges include-Climate Change Professor Sir Andy Haines, 13 Dec 2011

23. 6. Workshop purpose How can we improve our contribution to producing research that can be used effectively to strengthen and improve health systems in low and middle income countries? Professor Sir Andy Haines, 13 Dec 2011

24. 6. Workshop purpose Aim: To discuss the needs and opportunities in health systems research Objectives: 1.Consider how the UK might best focus its resources to make a difference to the global health systems research field 2.To inform possible future interdisciplinary funding strategies through discussion of best practice in health systems research Professor Sir Andy Haines, 13 Dec 2011

25. 6. Workshop agenda Day 1 Session 1: Lessons learnt from examples of health systems research Some examples of health system research to stimulate debate and case examples for discussion on other sessions Session 2: Global priorities in health systems research: where might the UK best focus its resources? Down to business – what should funders consider when developing their thinking around HSPR – where might the UK be best placed to focus Drinks and Dinner: Informal networking opportunity Professor Sir Andy Haines, 13 Dec 2011

26. 6. Workshop Day 2 Session 3: Methodologies in health systems research Discussions on different disciplinary research methodologies and how to integrate these where appropriate Session 4: What factors enable relevant research evidence to influence policy and practice? What can the research community do to enable research to make a difference? Session 5: Summary of recommendations Pulling together the discussions – what are the key messages Professor Sir Andy Haines, 13 Dec 2011

27. 7. Next steps A workshop discussion paper will be written, summarising the main recommendations The funders will take this into consideration as they think about their funding strategies for this area Following the workshop discussions: Professor Sir Andy Haines, 13 Dec 2011