A new special edition of Public Health Research & Practice supported by the Alliance provides the most comprehensive analysis to date of the state of funding for health policy and systems research (HPSR), covering more than 50 countries, regions and territories spanning all six WHO regions. The studies suggest that less than 2% of global health funding is being spent on health systems strengthening and health policy and systems research (HPSR). The special edition is published in collaboration with the Sax Institute in Australia with support from the United States Agency for International Development (USAID).
In the editorial in this issue, Professor Vivian Lin of the University of Hong Kong and colleagues suggest that the COVID-19 pandemic has clearly demonstrated the need for stronger health systems and the context-relevant knowledge that HPSR can provide. Several factors are at play in the underfunding of HPSR, they write. One is the over-medicalisation of health research, in part due to the pharmaceutical industry’s emphasis on disease-oriented rather than prevention-oriented health care. Another is the issue of randomized controlled trials as the gold standard in health research. However, health policy and health system reforms are classic ‘wicked problems’, they argue, that deal with complex and interconnected systems.
“Now is the time, as the world comes to terms with COVID-19, for HPSR proponents to seize the opportunities provided by increased political and public attention to health policies and systems,” they write.
Indeed, in a paper from Professor David Stuckler of Bocconi University and colleagues, they suggest that, “the political window of opportunity could not open any wider” to mobilize resources and partners to strengthen health systems and address the shortcomings of the global COVID-19 response, where the emphasis on developing vaccines has overshadowed investment in the health systems that can deliver them.
Another paper in this issue highlights the near invisibility of funding for HPSR in low- and middle-income countries (LMICs). It finds that, while it is almost impossible to reliably estimate HPSR funding in most countries, health research funding in general prioritizes biomedical and clinical research over HPSR. Recommendations in this paper include creating mechanisms to ensure funds are allocated to HPSR, creating a database to track HPSR funding and advocating for the value-add of HPSR.
Articles in the special edition include:
Editorial
Perspective
Research
- Domestic funding for health policy and systems research: why is it invisible? Geetanjali Lamba, Livia Dal Zennaro, Solip Ha, Sonam Yangchen
- Health policy and systems research: an inconsistent priority in South East Asia by Manu Raj Mathur, Aayushi Gurung, Sakthivel Selvaraj, K Srinath Reddy
- Funding for health policy and systems research in the Eastern Mediterranean region: amount, source and key determinants by Maha El Rabbat, Fadi El-Jardali, Racha Fadlallah, Sameh Soror, Elham Ahmadnezhad, Elsheikh Badr, Jennifer Dabis
- Soviet legacy is still pervasive in health policy and systems research in the post-Soviet states by George Gotsadze, Akaki Zoidze
- Politics and political determinants of health policy and systems research funding in Latin America and the Caribbean by Francisco Becerra-Posada, Laura dos Santos Boeira, Bárbara García-Godoy, Elizabeth Lloyd, Héctor Xavier Martínez-Sánchez, Carolina O'Donnell, Ulysses de Barros Panisset, Donald T Simeon, Diana Salazar-Barragán, Patricia Villa-Maldonado, Mauricio Bustamante-Garcia
- Challenges and opportunities for health policy and systems research funding in the Western Pacific region by Swee Kheng Khor
- An assessment of perceived prioritisation and resource allocation for health policy and systems research in West Africa by Chigozie J Uneke, Ijeoma N Okedo-Alex, Ermel A Johnson, Ifeyinwa C Akamike, Onyedikachi E Chukwu, Irene I Eze, Bilikis I Uneke
In practice