Diversity and power – where, and for whom, is health systems research going?
Kumanan Rasanathan, HSG Board Candidate 2016
A couple of things have really struck me in the discussions leading up to the HSG Board Election. First, the need for Health Systems Global (HSG) to work even harder on diversity. Second, the desire to examine the power dynamics and hierarchies within global health, including HSG itself, identifying whose voices are more easily heard. These are important discussions. One of the best reasons for being part of HSG is that it’s a global health community conscious of these issues, open to critique where it falls short, and motivated to do better.
Health systems research isn’t a new field, tracing its roots back to the studies that informed Alma Ata and beyond. But the last two decades have seen a codifying and maturing of its mission and methods, with increasing visibility and a more coherent community, to which HSG has built upon and contributed. The above questions on diversity and power in HSG reflect this maturity and the need to consider how health systems research should be undertaken, and whom it should involve.
These issues are key for HSG’s mission for health systems research, along with other fundamental questions. Do we want to chase the established paradigm for health research – of emphasizing papers, trials, and academic research institutes? Or is ours an essentially applied field, making it even more important to support communities and health systems workers to drive research? Do we prioritize expensive, generalizable, trial methodologies or focus more on specific contexts, strengthening the understanding of the value of qualitative approaches? Should we make a concerted effort to transcend publication (and impact factors and h-indices) as an end in itself and create new measures of the value of research based on the impact and change for those whose problems we investigate? Do we chase often shrinking pots of orthodox health research funding – or do we aim to embed health systems research in routine programmes and budgets?
Of course, the answers to these questions are not binary. But, in summary, they do ask where, and for whom, health system research is going. My own bias is that we need to take more seriously the need to support communities, programme managers, civil society and policymakers to lead health systems research, positioning it as part of the normal work of health systems, and closely examine the ways we appraise its value. For example, we have trialled a model in recent years (pdf) whereby we provide funding for implementers in low- and middle-income countries to lead implementation research with the support of researchers – with the funding going to the implementers.
As the global community for health systems research, HSG should be at the forefront of posing and helping to answer all of these questions. But to do so, we need to realize Karen’s vision in her blog in this series of HSG as ‘a diversity of equals [who] come together and listen to each other.’ That’s something that all HSG members have a role in, but more importantly requires reaching out to those currently not heard within HSG, and understanding how we can engage those not part of our community.
