Wednesday, March 21, 2012

[EQ] Conceptual Issues Related to Health Systems Research to Inform a WHO Global Strategy on Health Systems Research

Background Paper on:

Conceptual Issues Related to Health Systems Research to Inform a WHO Global Strategy on
Health Systems Research

Steven J. Hoffman1-4-| John-Arne R√łttingen5-6 - Sara Bennett7 - John N. Lavis1-2,8-9 - Jennifer S. Edge10 - Julio Frenk5,11

1 Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada

2 McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada

3 Munk School of Global Affairs, University of Toronto, Ontario, Canada

4 Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, USA

5 Harvard Kennedy School, Harvard University, Cambridge, MA, USA

6 Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway

7 Department of International Health, John Hopkins School of Public Health, Baltimore, MD, USA

8 Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, Ontario, Canada

9 Department of Political Science, McMaster University, Hamilton, Ontario, Canada

10 Department of International Development, University of Oxford, Oxfordshire, UK

11 Harvard School of Public Health, Harvard University, Boston, MA, USA

A Working Paper in Progress - Last Revised 29 February 2012

Available online PDF [72p.] at:

“…..This paper was commissioned to provide a conceptual underpinning for the WHO Global Strategy on Health Systems Research that is currently under development. It reviews existing definitions, terms, conceptual models, taxonomies, standards, methods and research designs which describe the scope of health systems research as well as the barriers and opportunities that flow from them. It addresses each of the five main goals of the WHO Strategy on Research for Health, including organization, priorities, capacity, standards and translation…”



Health systems research is widely recognized as essential for strengthening health systems, getting cost-effective treatments to those who need them, and achieving better health status around the world.
However, there is significant ambiguity and confusion in this field’s characteristics, boundaries, definition and methods. Adding to this ambiguity are major conceptual barriers to the production, reproduction, translation and implementation of health systems research relating to both the complexity of health systems and research involving them. These include challenges with generalizability, comparativity, applicability, transferability, standards, priority-setting and community diversity.


Three promising opportunities exist to mitigate these barriers and strengthen the important contributions of health systems research

·         First, health systems research can be supported as a field of scientific endeavour, with a shared language, rigorous interdisciplinary approaches, cross-jurisdictional learning and an international society.

·         Second, national capacity for health systems research can be strengthened at the individual, organizational and system levels.

·         Third, health systems research can be embedded as a core function of every health system.

Addressing these conceptual barriers and supporting the field of health systems research promises to both strengthen health systems around the world and improve global health outcomes….”

Table of Contents



1. Conceptualizing Health Systems

2. The Promise of Health Systems Research

3. Conceptualizing Health Systems Research

3.1 Characteristics of Health Systems Research

3.2 Boundaries of Health Systems Research

3.3 Defining Health Systems Research

3.4 Study Designs and Methods Used in Health Systems Research

4. Conceptual Barriers for Health Systems Research to Improve Health Outcomes

4.1 Generalizability Challenge

4.2 Comparativity Challenge

4.3 Applicability and Transferability Challenge

4.4 Standards Challenge

4.5 Priority-Setting Challenge

4.6 Community Diversity Challenge

5. Strengthening the Contributions of Health Systems Research
5.1 Supporting Health Systems Research as a Field of Scientific Endeavour

5.1.1 Need for a Common Language

5.1.2 Need for Cross-Disciplinary and Cross-Jurisdictional Learning

5.1.3 Need for an International Society for Health Systems Research

5.2 Building National Capacity for Health Systems Research

5.2.1 Individual-Level Capacities

5.2.2 Organization-Level Capacities

5.2.3 System-Level Capacities

5.3 Embedding Health Systems Research as a Core Function of Health Systems

6. Conclusion


Appendix 1: Tabular Comparison of 41 Health System Frameworks

Appendix 2: Brief Summaries of 41 Health System Frameworks

Appendix 3: Institutional Partners of the Alliance for Health Policy & Systems Research

Appendix 4: Do You Know Your Health Systems Definitions?

Appendix 5: Taxonomy of the Health Systems Evidence Database



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