What’s and where’s the evidence?

Andy Haines. Credit WHO

Third day of the symposium, and health experts are getting down to the nittie-gritties.  Thursday morning saw the lens turned on evidence.

As Andy Haines, from WHO’s task force on guidance for health systems strengthening, observed at the morning plenary, increasing investments in health systems is driving a demand for guidance from national policy makers. The drive for better evidence in guidance is in turn exposing the need for greater investment in health systems.

Haines highlighted the challenges in generating and using evidence for guidance on health systems, unlike the case of the well-defined clinical guidelines.

These include the complexity of the subject, the lack of capacity in health systems, and the strong political and ideological drivers of health policies in countries.

Besides, as Lucy Gilson from the University of Cape Town observes, health systems complexity is rooted in the people who access and receive services and provide health care, and the relationships among the people that “are at the heart of any health systems research”.

So how does one glean evidence from such complex systems?  Systemic reviews (SRs) are one option. Or individual case studies that provide rich data.

But before hunting for evidence, one must be clear about evidence for what.   Christopher Murray, Institute of Health Metrics and Evaluation at the University of Washington, says it is hard to have standardized definitions about health systems.

Christopher Murray. Credit WHO

Using a health system framework approach could be a way out, except that that there are too many competing frameworks that add to the confusion.

One could use ‘typologies’ or grouping health systems round the world, based on a specific parameter, for example, the dominant mode of health financing.  But, while there are fewer competing typologies, they do not always provide the right answers.

Or there is the ‘metrics’ or measurement systems.  But, says Murray, “comparable metrics have been slow to improve over the last 20 years,” and one “could keep doing it all our lives.”

T V Padma, South Asia Regional Coordinator, SciDev.Net

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