29 June 2026

Launching the Special Supplement: Changing Health Systems: Advancing Justice and Sustainability through Research, Policy and Practice

News type: HSG News

Nanuka Jalaghonia, Partnerships and Engagement Manager, Health Systems Global | Stephanie M Topp, Director, JCU Centre for Rural Remote and Tropical Health Systems | Kabir Sheikh, Director, UCL Centre for Global Health Systems and Policy

Health Systems Global (HSG) and Health Policy and Planning (HPP), with the support of the International Development Research Centre (IDRC), are pleased to announce the publication of a Special Supplement - Changing Health Systems: Advancing Justice and Sustainability through Research, Policy and Practice.

This supplement distills and spotlights some of the rich debates and discussions from the Eighth Global Symposium on Health Systems Research (HSR2024). Convened by HSG from 18-22 November 2024, the Symposium was co-sponsored by the Alliance for Health Policy and Systems Research and the World Health Organization, and hosted by a consortium of organizations from the Western Pacific region led by Nagasaki University in collaboration with Japan International Cooperation Agency.

HSR2024 came at a potentially defining moment as health systems worldwide continue to face pressures from conflict and fragility, climate change, widening inequities, demographic change and fiscal constraints. These challenges have reinforced the need for shared learning and collective action across countries, disciplines and sectors. The Symposium's focus on Building Just and Sustainable Health Systems: Centering People and Protecting the Planet reflected many of the questions facing the global health community today: how health systems can adapt and evolve while remaining equitable, responsive and sustainable. The discussions captured in this supplement, Changing Health Systems: Advancing Justice and Sustainability through Research, Policy and Practice, contribute to these ongoing conversations and highlight the role of research, policy, and practice in supporting meaningful health system change.

This supplement consists of:

Seven original research papers, accompanied by one commentary and one editorial
Contributions aligned with the Symposium's key theme, Building Just and Sustainable Health Systems: Centering People and Protecting the Planet
Studies spanning global, cross-country, national and local levels
A range of research approaches, including systematic and scoping reviews, policy analysis and qualitative interviews

Edited by Stephanie M. Topp, Chair of the HSR2024 Symposium and Kabir Sheikh, Health Systems Research Editor of Health Policy and Planning, with the support of relevant section editors, this collection of papers demonstrates the diversity of topics, disciplinary perspectives and research approaches that define the field of Health Policy and Systems Research.

The corresponding authors of these papers represent institutions in India, Australia, Ireland, Nigeria, the United Kingdom, Bangladesh, Iran, Norway, the United States, and Georgia, reflecting both LMIC and cross-country collaboration across multiple regions.

The papers brought together in this supplement examine how health systems are responding to change in contexts shaped by political transition, environmental vulnerability, economic disruption, rapid urbanisation, and evolving population health needs. Together, they explore how governance, workforce policies, service delivery, innovation and research influence health system responses to emerging pressures and priorities. Rather than treating justice and sustainability as fixed end goals, the collection highlights how progress towards these aims is shaped through everyday policy decisions and the actions of communities, practitioners, researchers and policymakers.

Several papers focus on how health systems navigate uncertainty and disruption. Research from informal settlements in Dhaka, Bangladesh, examines how residents, community leaders, non-governmental organisations, and public authorities collectively negotiate access to health services in the absence of strong formal governance structures. The study highlights both the resilience and the limitations of these arrangements, showing how they can expand access while also reinforcing existing inequalities. In Nepal, an analysis of community health workforce governance explores how the country's transition to federalism has reshaped decision-making, accountability, and local participation, while also revealing the challenges of decentralisation when authority, resources, and responsibilities remain unevenly distributed.

Questions of resilience and adaptation are further explored through an examination of health system reform in Iran under prolonged economic sanctions. The study demonstrates how external shocks expose weaknesses in policy design, coordination, and institutional learning, while also offering lessons for strengthening resilience in constrained environments. Complementing this perspective, a commentary drawing on discussions from HSR2024 considers the role of innovation in disaster-prone settings, reflecting on how digital technologies, artificial intelligence, and community-driven approaches can contribute to more responsive and resilient health systems when accompanied by strong governance and accountability mechanisms.

Other papers examine how deliberate efforts to shape health system change unfold in practice. A prospective analysis of workforce reforms in Meghalaya, India, considers how health systems can respond to growing burdens of non-communicable diseases while addressing longstanding inequities in access to care. Another contribution from Assam explores how nutrition interventions are sustained through informal relationships, community networks, and the often-unrecognised labour of frontline workers and their families, highlighting dimensions of health systems that frequently remain invisible within formal policy frameworks.

The collection also reflects on the role of research in advancing health system transformation. One paper examines how realist evaluation can be used to generate more context-sensitive and inclusive forms of evidence by elevating the perspectives of actors whose experiences are often overlooked. Another reviews the growing use of political economy analysis in health systems research, demonstrating how attention to power, institutions, interests, and ideas can strengthen understanding of why reforms succeed, stall, or produce unintended consequences.

These discussions will continue at the Ninth Global Symposium on Health Systems Research (HSR2026) in Cairo, Egypt, 7-9 December 2026, where the supplement will be formally launched in a dedicated session featuring its guest editors and contributing authors. We invite readers to join us for a timely and engaging conversation on the challenges and opportunities facing health systems around the world.

ARTICLES IN THE SUPPLEMENT

Note: The views expressed in the Special Supplement do not necessarily reflect the views of the IDRC.

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