Health systems research in the time of health system reform in India: a review

Health Research Policy and Systems, Aug 2014

Background Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. Methods We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Results Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). Conclusions The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in states and institutions that have a scarcity of researchers, as well as states that have been the focus of little research. While more funding for health systems research is required, this funding needs to be targeted at deficient health systems domains, geographical areas, and institutions.

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Health systems research in the time of health system reform in India: a review

Health Research Policy and Systems Health systems research in the time of health system reform in India: a review Krishna D Rao 0 1 Radhika Arora 0 Abdul Ghaffar 2 0 Public Health Foundation of India, ISID Campus, Vasant Kunj Institutional Area, Vasant Kunj , New Delhi 110070 , India 1 Health Systems Program, Department of International Health, Johns Hopkins University , 615 N. Wolfe Street, Baltimore, Maryland 21205 , USA 2 Alliance for Health Policy and Systems Research, World Health Organization , Avenue Appia 20, 1211 Geneva 27 , Switzerland Background: Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. Methods: We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Results: Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). Conclusions: The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in states and institutions that have a scarcity of researchers, as well as states that have been the focus of little research. While more funding for health systems research is required, this funding needs to be targeted at deficient health systems domains, geographical areas, and institutions. - Background Research on health systems is an important contributor to improving health system performance [1]. Such research has informed on the state of country health systems, generated evidence for improving health services, particularly for the poor, and guided health policy [2-4]. In particular, research on program implementation and policy also has the important function of creating a culture of public accountability. In several countries that have committed to reforms for universal health care, research on health systems has played an important role in guiding reforms and monitoring progress [1,5]. In this, the health systems research community plays a critical role as observers of health system reform efforts. In the last 10 years there have been two major developments in Indias health system. The first was the launch of the National Rural Health Mission (NRHM) (20052013) to strengthen the public sector health system, particularly for primary care [6]. Through the NRHM large investments have been made in strengthening public sector health systems, establishing a national conditional cash transfer program for institutional deliveries, as well as a community health worker program. The second has been the introduction, since 2008, of government-sponsored insurance schemes covering hospital care for the poor [7]. Both state and central insurance schemes are present and it is estimated that, by 2015, 50% of Indias population will be covered by government insurance schemes [7]. These reforms have the potential of significantly altering health systems in India, as well as to move the country closer to Universal Health Care. Importantly, these reforms have been accompanied by a growing interest in health systems research. For one, the National Health Systems Resource Centers, and its affiliate State Health Resource Centers, were established under NRHM to provide research and technical assistance to the Ministry of Health and Family Welfare, and NRHM. In 2007, two years after the start of the NRHM, the Department of Health Research was established with a mandate to imp (...truncated)


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Krishna D Rao, Radhika Arora, Abdul Ghaffar. Health systems research in the time of health system reform in India: a review, Health Research Policy and Systems, 2014, pp. 37, 12, DOI: 10.1186/1478-4505-12-37