A major obstacle to achieving the health-related Millennium Development Goals is the weakness of the health systems in many low and middle income countries, and their struggle to effectively provide health care to populations in need. Research into health systems aims to improve health care delivery; however, multiple definitions of this type of research exist and this lack of clarity is negatively affecting the credibility, and hence progress, of this research. In a paper published in PLoS Medicine this week to coincide with the first Global Symposium on Health Systems Research, Robert Terry and colleagues from the World Health Organization and allied organizations lay out working definitions of the three key research domains within the context of research to strengthen health systems; operational research, implementation research and health systems research
The three research domains defined are Operational, Implementation, and Health Systems research. Although these research domains overlap frequently, they can be usefully separated out.
Operational research is on specific health programmes, is local in impact, and is targeted at health care providers and programme managers. An example cited of such research is whether a Sleeping Sickness programme in Equator Nord province, DRC, should change its first-line drug.
Implementation research may be of local or broad influence, as it affects implementation strategies for specific products or services. It is of relevance to programme managers, and research and development managers. An example of such research is how to improve access to vaccination among children that are currently not reached by immunisation services.
Health systems research is broad in impact, in that it affects some or all of the building blocks of a health system, and hence is of relevant to health system managers, and policy makers. An example of this research would be to what extent do health services reach the poor and how can this reach be improved.
Having clear definitions of these research domains is important so that those who the research affects can understand and build on it, and thus ensure that the research has the maximum possible impact. As the authors conclude "To improve health care delivery to poor populations, all of these research domains are very much needed."
Funding: No direct funding was received for this study. JHFR was employed under contract from TDR (Special Programme for Research and Training in Tropical Diseases) to write the initial draft. The salary for RFT was provided under a grant from the Bill & Melinda Gates Foundation (number 49275.01). Contributions from all other authors were salaried by their institutions during the period of writing.
Competing Interests: The authors have declared that no competing interests exist. The views expressed here are those of the authors and not of the organization they represent.
Citation: Remme JHF, Adam T, Becerra-Posada F, D'Arcangues C, Devlin M, et al. (2010) Defining Research to Improve Health Systems. PLoS Med 7(11): e1001000. doi:10.1371/journal.pmed.1001000
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