Looking back to move forward: Reflections from the Health Policy and Systems Research Conference - 20 Years On

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Amanda Edwards, Anne Mills and Lucy Gilson at the conference in Stockholm, Sweden

It was my enormous privilege to attend the 20th anniversary of the formation of the Alliance for Health Policy and Systems Research (AHPSR). Hosted by the Swedish International Development Cooperation Agency, the conference was attended by a broad range of health policy and systems research (HPSR) stakeholders, including a number of multinational funding agencies and researchers from around the globe.

The event was held in Stockholm, Sweden, where the Alliance was established in 1997. The conference served as an important milestone for the Alliance, allowing the opportunity to reflect on the successes and challenges of the last 20 years, and to develop plans and strategies for meeting the ambitious goals of Agenda 2030 in a global health climate that is increasingly complex and unpredictable.

I was invited to attend the conference as the representative of the writing team awarded first prize in the first AHPSR essay competition on the “Future of Health Policy and Systems Research.” The paper, written in collaboration with fellow students* in the Masters in Public Health at the University of Cape Town, sought to describe the challenges faced by global health policy and systems researchers, and explore the potential and possibilities for the Alliance and the field of HPSR from a Southern perspective. The theme of the essay allowed us to explore issues we felt passionate about, and explicate these issues from our own perspective. Little did we realise that these ideas would resonate so deeply with members of the Alliance. I was invited to present the essay in the opening plenary of the conference, alongside HPSR pioneer, Dame Anne Mills.

In this blog, I offer some personal reflections on the experience, and draw out key issues arising from these two days of intensive, reflexive and engaging debate.

World Report on Health Policy and Systems Research
The conference saw the launch of the first World Report on Health Policy and Systems Research. The report was met with wide applause and served to guide group discussions on strategies for leveraging increased domestic funding for HPSR, building increased institutional capacity to demand and conduct HPSR related work in local contexts, and the development of global public goods within the field.

Bridging the gap between policymakers and researchers
Further panel discussions focused on ways to improve policy actor engagements to promote the generation and use of HPSR evidence in decision-making for health system strengthening. It was particularly exciting to witness the strong South African contingent leading the debate on policy actor engagement through the presence of three local health system stakeholders: Beth Engelbrecht and Keith Cloete from the Western Cape Department of Health, and Gail Andrews from the National Department of Health.

The discussions underscored the enduring challenges in bridging the gap between policymakers and researchers. In a context where health systems are increasingly required to do more with less, there is an urgent need to move current and future research into policy and practice. However, this requires careful, deliberate strategies built on nuanced understandings of the dualities experienced by policymakers in environments that place them under enormous pressure to make decisions quickly and effectively.

Policy networks and mutual learning platforms should be harnessed for their potential to strengthen communication pathways and build trusting relationships that foster the translation of knowledge in real-time and align competing priorities. Although difficult, ensuring that the research we conduct is implementer-led and locally relevant may necessitate that researchers take their cue from policy-makers in directing research agendas and timelines.

Building institutional capacity is critical to both the field and broader health system strengthening
Much of the discussion centred on the need to build institutional capacity for good HPSR. Actions to build institutional capacity should move beyond merely equipping individuals to produce knowledge. In vulnerable contexts, there is a need to stimulate both the demand, provision and use of HPSR work by a broad range of stakeholders including policy institutions, non-government organisations and academic departments. In achieving this, we should not attempt to reinvent the wheel, but look to other fields such as business and management sciences that have made important gains in these areas.

Additionally, facilitating knowledge sharing within and across national boundaries will be crucial to developing learning networks that strengthen local institutions to conduct useful HPSR. While it is important to recognise that capacity building strategies must always be context-specific, common lessons can be distilled from the experiences of others. The potential for south-south and south-north learning to drive capacity-building was highlighted, as was the importance of recognising that all health systems play an important role in the global health architecture.

Strategic advocacy and new alliances are crucial to raising the visibility, and demonstrating the value, of HPSR
Evidence-based knowledge is a highly valued form of social currency in the post-truth era of fictitious facts and hearsay judgments. However, our ability to shape public opinion by demonstrating impact has so far been underutilized. This risks diminishing the perceived value and utility of HPSR for stakeholders and the wider public.

Research projects and institutions should be firmly embedded not only in health systems, but also in broader society. There is a need to form new alliances and build on current networks that will elevate HPSR in the public discourse. Working alongside policymakers and civil society groups can help frame important issues that promote the funding and implementation of research and increase perceptions of public value.

In overcoming these and other challenges there is an ongoing role for the Alliance in providing leadership and guidance on the way forward. Fortunately, from what I witnessed at this conference, the members and leadership of the Alliance stand ready to face these challenges, and provide considered leadership in building evidence-based responses to complex challenges. The field of HPSR is rooted firmly on the successes of the past and is well-positioned to act strategically, collaboratively and with sensitivity in the future.

*with grateful thanks and acknowledgement to fellow authors Eleanor Whyle, Annabel Grieve, Chelsea Lee and Chirag Rajpuria

Read the full report of the Stockholm meeting

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