Health Systems Research & Policy Research: beyond the global bubble

The bi-annual symposium on HPSR has been the biennial high mass of HPSR since its conception in Montreux 2010. The scope of the symposia has broadened from Universal Health Coverage (UHC) to Planetary Health, Emerging Voices has secured the participation and rise of the young and bold, and global health organizations have increasingly contributed with satellite sessions and networking events. It has become the place to meet old friends and like-minded, a warm bubble bath. For myself, the water has become somewhat lukewarm. I make a plea for more reciprocal learning, to infuse the bathwater with evidence from case studies beyond the usual suspects.
Health systems strengthening: a global need
Since the landmark WHReport 2000, comparative health system research has examined patterns of performance, with the wider domains of HPSR examining the mechanisms, drivers and effects. Global metrices, such as those for access to quality [1] or universal health coverage [2] are not perfect, but definitely informative for monitoring trends over time, place and socio-economic development. Advanced studies looking at technical efficiencies of health systems [3] show us that all health systems can do better with their current means. So health systems strengthening is, by no means, an exclusive assignment for the global south.

Yet, the HPSR research and symposia have focused largely on the global south. This focus is rooted in history, a value-system and – frankly – the dominance of global health actors. I can understand many of those. However, we miss out on opportunities for leaning, on both sides of the equation. The success of the Brazilian Health strategy has taken two decades to cross the Atlantic ocean; European countries could have learnt on integration of community health workers in their health system long before. On the other hand, pivotal research such as the importance of normative integration [4] is not taken into account in health care delivery reform in low income countries. The strong alignment of HPSR with the global health community is at the expense of HPSR being strengthened with insights from research disciplines to strengthen its scientific basis.
Build innovative bridges
There are clear ways forward. First, research partnerships with interventions across income settings positions actors at a more equal level playing field. Credits to the Global Alliance for Chronic Diseases who has explicitly funded, facilitated and disseminated such collaborative projects. The obvious win-wins for all countries can be better advocated and exploited, also by Health Systems Global. Reciprocal learning can be accelerated throughout the research circle, by the right framing, adoption pathways and bridging organizations to facilitate transnational collaboration and diffusion [5]. Second, building bridges between HPSR and other research domains can strengthen the methodological basis. The SHAPES working group provided an excellent example of linking with social sciences, and expansions to the education sector and quality research domain would be highly welcome.

HPSR is action-oriented and thus political, and so are the underlying frameworks and paradigms. Researchers in HPSR are positioned to contribute to better health systems, at all levels in all parts of the world. The next HSR symposium can facilitate this. Three recommendations. First, the regional and thematic groups in the Health Systems Global can organise sessions of reciprocal learning during the next symposium. Second, think about how to involve high income countries more in the HPSR discussions. Third, we could invite key note speakers from other domains and disciplines to shine a new light on stubborn problems. I have confidence in the leadership and agency of members to make this happen. And I am looking forward to jumping into that bath again, splashing a few bubbles.

Acknowledgements. I thank Taufique Joarder for his comments on the draft version of this blog.
References
[1] A. Haakenstad et al., “Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019,” Lancet Glob Health, vol. 10, no. 12, pp. e1715–e1743, Dec. 2022, doi: 10.1016/S2214-109X(22)00429-6.
[2] World Health Organization, World Bank, and International Bank for Reconstruction and Development, “Tracking Universal Health Coverage: 2017 Global Monitoring Report,” 2017.
[3] P. Eze, C. J. Idemili, and L. O. Lawani, “Evaluating health systems’ efficiency towards universal health coverage: A data envelopment analysis,” INQUIRY: The Journal of Health Care Organization, Provision, and Financing, vol. 61, Jan. 2024, doi: 10.1177/00469580241235759.
[4] P. P. Valentijn, S. M. Schepman, W. Opheij, and M. A. Bruijnzeels, “Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.,” Int J Integr Care, vol. 13, 2013, doi: 10.1192/bjp.bp.105.016006.
[5] J. Dearing, C. Masquillier, J. Van Olmen, S. G. Zieff, A. Liu, and A. Rollins, “Reciprocal coproduction as a basis for the diffusion of global health innovations,” Oct. 04, 2023, BMJ Publishing Group. doi: 10.1136/bmjgh-2023-013134.