Tracking progress on the strategic plan

After outlining a new five-year strategic plan in 2021, the Alliance has been working this year to broaden its horizons beyond traditional health systems to consider the wider determinants of health. To help track our progress on advancing knowledge, catalysing change and empowering leaders, we have developed a set of key performance indicators. 

The charts below present the five-year targets, a progress marker for the end of year two and an indication of where that indicator currently stands. The Alliance is meeting or exceeding the pace needed to reach the five-year targets on five out of ten indicators. In fact, the full five-year target has already been achieved for collaborations (there are already 32 with a target of 25) and for the number of researchers supported (202 out of 200). The five-year target has nearly been met for the number of journal articles supported (197 out of 200).

Strategic Objective 1. We advance knowledge.

The Alliance will stimulate the generation and synthesis of policy-relevant health systems knowledge, encompassing evidence, tools and methods.

Must accomplish actions

• Supporting generation and synthesis of HPSR evidence for stronger health systems

• Developing methods, frameworks and concepts to build the field of HPSR

Strategic Objective 2. We catalyse change. 

The Alliance will promote the dissemination and use of health policy and systems knowledge to improve the performance of health systems.

Must accomplish actions

• Convening stakeholders to advance HPSR

• Increasing the use of evidence

• Strengthening the Alliance Partnership

Strategic Objective 3. We empower leaders.

The Alliance will facilitate the development of capacity for the generation, dissemination and use of HPSR knowledge among researchers, policy-makers & other stakeholders

Must accomplish actions

• Strengthening capacities to generate and use HPSR

• Supporting partnerships to disseminate and use HPSR

Where we work

2023 by the numbers

I started my tenure as Executive Director of the Alliance for Health Policy and Systems Research on 1 November 2022, so I can take little credit for the impressive range of work chronicled in this annual report. I would like to acknowledge the leadership of my predecessor, Dr Abdul Ghaffar, who stewarded the Alliance for 12 years, building both the organization and the field of health policy and systems research. The strong institution that I have inherited is a testament to his dedication and hard work, and a quick read through this annual report confirms the important work that the Alliance has been doing: from advancing the field through its recent flagship report to important capacity strengthening initiatives in countries.

As I take on this role, I am keen to build upon the great foundation that has been established over the Alliance’s first twenty-five years. I see this as an important moment of transition for the organization, and for the health policy and systems research community. My first day in this role involved me flying across the Atlantic to join the team at the Seventh Global Symposium on Health Systems Research in Bogotá, Colombia. There I was able to check in with this community to get a sense of the critical issues in the field in this era of crises – and the role the Alliance can play in addressing them.

In this shifting global landscape, we are consulting widely and working with our Board and Scientific and Technical Advisory Committee members to articulate new strategic priorities for the Alliance. In the coming year, we will have more details. I am committed to strengthening the Alliance’s role as a leader in health systems research and as a trusted partner in finding solutions to pressing challenges at both national and global levels. I also recognize the importance of continuing to support the professional development and capacity strengthening of those in the health systems research community – there is no substitute for locally generated research on locally identified priorities.

I feel both great fortune and great responsibility in becoming the Alliance’s Executive Director and look forward to the continuing support of our community and all our partners. I believe that the Alliance has a unique role to play in advancing towards health equity, and I am eager to work together to ensure that our work has the greatest possible impact. 

– Kumanan Rasanathan 

Advancing knowledge in 2022

The latest flagship report from the Alliance, Systems for health: Everyone has a role, calls for a reimagining of health systems as systems for health. This new approach aims to create healthy populations and health security while also supporting universal health coverage. The report defines systems for health as systems that are ready to respond to future health threats, taking into account the social, economic, environmental and commercial factors that affect health. To establish systems for health, the report highlights four critical elements: building trust, engaging communities, working across sectors, and going beyond national boundaries. The report emphasizes the need for a comprehensive approach to health that considers all the factors that impact health, including non-medical factors like poverty, education and the environment. By focusing on these elements, the report aims to create more robust, resilient and equitable health systems that work for everyone.

The report was launched at HSR2022 in Bogotá, Colombia, and has already been cited as an illustration of the Alliance’s ability to alter the discourse and shape the field of HPSR.

Following a consultation with policy-makers in the summer of 2020, and an evidence review published in Health Policy and Planning, the Alliance is collaborating with several WHO regional offices to conduct PHC case studies in the context of the COVID-19 pandemic in close to 50 countries. These case studies build on twenty original PRIMASYS case studies on PHC.

A handful of the case studies were presented in Cairo, Egypt, during the WHO Regional Office for the Eastern Mediterranean’s celebrations of Universal Health Coverage Day. In 2023, the Alliance is planning to publish these case studies and ensure they are closely linked to supporting ongoing in-country policy processes.

Limited information, navigating access to care, and a lack of accountability from providers are all barriers being addressed through various initiatives by governments and civil society organizations (CSOs). The Alliance and the WHO Department of Health Governance and Financing supported research to understand how these initiatives have empowered citizens to exercise their health insurance entitlements in Bosnia and Herzegovina, Colombia, Ghana, India, Indonesia and Nigeria. 

Studies have shown that government-run initiatives often face low awareness, inadequate funding and staffing, conflicts of interest and unsuitable regulations. While CSO-run initiatives have raised awareness and ensured individual access to services, their location outside the public health system limits their ability to effect policy and legal changes. Findings from these studies have informed policy changes in Bosnia and Herzegovina and have been well-received by senior officials in Indonesia. The Alliance's continued support has strengthened the capacity of researchers to conduct high-quality health systems research and disseminate findings at the highest levels of government.

The Alliance supported eight special issues this year. Several are targeted at building the field, such as the special issue on Health for peace. It informs a new and growing body of work and was produced in partnership with WHO colleagues, reflecting the priority for this work by the WHO Director-General. Similarly, the special issue on Systems thinking: strengthening health systems in practice builds upon recent partnerships that the Alliance has fostered to revitalize a community of practice around systems thinking for health. Others, like the special issue on Compassionate and respectful care in Ethiopia are a result of research projects supported by the Alliance. 

Compassionate and respectful care in Ethiopia 
Ethiopian Journal of Health and Biomedical Sciences

Systems thinking: strengthening health systems in practice 
Frontiers In Public Health

Rapid reviews for health policy and systems decision-making: more important than ever before 
Systematic Reviews

Advancing learning health systems: Lessons from the African Health Initiative 
Global Health: Science and Practice

Learning health systems 
BMJ Global Health

Health for peace 
BMJ Global Health

Advancing rehabilitation through HPSR 
Bulletin of the WHO

Making health insurance responsive to citizens 
BMJ Global Health

Strong health systems are learning health systems
By Kabir Sheikh and Seye Abimbola in PLOS Global Public Health

Whole of government and whole of society approaches: call for further research to improve population health and health equity
By Flaminia Ortenzi, Robert Marten, Nicole B Valentine, Aku Kwamie and Kumanan Rasanathan in BMJ Global Health

Health policy and systems research capacity development to support maternal, new-born, child and adolescent health in West and Central Africa
By Irene Agyepong, Edwine Barasa, Kabir Sheikh, Uta Lehmann, Lucy Gilson, Yawa Dahoui, Sue Godt and Issiaka Sombie in Ghana Medical Journal

Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review
By Celestin Hategeka, Prince Adu, Allissa Desloge, Robert Marten, Ruitai Shao, Maoyi Tian,Ting Wei and Margaret E. Kruk in PLoS Medicine

Rethinking external assistance for health 
By Zubin Cyrus Shroff, Susan Sparkes, Maria Skarphedinsdottir and Kara Hanson in Health Policy and Planning

Strategies to promote evidence use for health programme improvement: learning from the experiences of embedded implementation research teams in Latin America and the Caribbean
By N. Ilona Varallyay, Caitlin Kennedy, Sara C. Bennett and David H. Peters in Health Research Policy and Systems

Catalysing change in 2022

Health Systems Global organized the Seventh Global Symposium on Health Systems Research in Bogotá, Colombia, in November with support from the Alliance. The symposium brought together around 1250 participants in person, with a further 500 joining online.

By organizing five satellite sessions, coordinating two networking sessions and participating in three organized sessions, the Alliance had a strong presence at the symposium. It also supported the participation of a number of women mentees and a handful of other grantees to attend. The symposium was an important moment to reconvene the HPSR community following the virtual-only symposium in 2020 due to the impact of COVID-19.

This initiative worked across seven countries, developing an institutional mentorship approach between the K2P Centre, at the American University of Beirut and six mentee institutions across all WHO regions, to strengthen institutional capacities for evidence-informed decision-making. This involved one in each WHO region undertaking institutional needs assessments, developing tailored coaching, strengthening policy networks through dialogues and briefs, developing curricula and initiating policy fellowship programmes within each country.

BIRD has generated many important knowledge products within each country and has also yielded important cascading effects across the six mentee institutions, including: being invited by neighbouring countries to replicate the programme (Georgia with Armenia and United Arab Emirates with Jordan); being selected to coordinate a national health research conference (Trinidad and Tobago); and informing debates in parliament, and being identified as trainers for the newly established policy analysis unit within the health ministry (Indonesia). 

A lack of appreciation for political challenges can hamper national adaptation and adoption of health taxes. This is despite these taxes being one of the most effective tools for tackling the use of harmful products like tobacco and alcohol, which contribute to the increasing burden of noncommunicable diseases in LMICs.

The Alliance has been supporting eight health policy analysis studies on health taxes in Bangladesh, Ethiopia, Ghana, Indonesia, Nepal, Pakistan, Peru and Viet Nam. The teams are now finalizing their case studies examining how political economy factors influence and frame the design, adoption and implementation of health taxes. These case studies will form part of a special issue of BMJ Global Health planned for 2023. This work is being conducted in collaboration with an Inter-Agency Working Group (IAWG) on Health Taxes and the WHO Working Group on health taxes led by the WHO Health Promotion and Health Systems Governance and Financing departments.

The Alliance established a new project to identify how health systems policy-makers and managers are responding to climate change and to share lessons on how countries can overcome existing barriers.

In collaboration with the WHO Environment and Climate Health Department, this project has begun to synthesize evidence to respond to the climate crisis and move towards climate-resilient, low-carbon and sustainable health systems. Using mixed-method approaches and working closely with national health policy-makers, the results are expected to improve health policy as well as broader resilience. The Alliance selected six country research teams to carry out this work in Bangladesh, Guyana, the Islamic Republic of Iran, Mozambique, Nepal and Peru.

Empowering leaders in 2022

To address the capacity gap of HPSR researchers in francophone Africa, the Alliance initiated a two-phase capacity initiative to support both individual and institutional capacities. In its first phase, the Laboratoire d'Etudes et de Recherche sur les Dynamiques Sociales et le Développement Local (LASDEL) in Niger, developed a six-month HPSR training programme for mid-level faculty drawn from across the region. They adapted Alliance materials in implementation research and systems thinking and used their own expertise in socio-anthropological research methods to provide training on HPSR methods, scientific writing and mentorship. In its second phase, the programme invited the 10 trained fellows to submit proposals to develop HPSR training and research programmes at their home institutions. 

It is expected that this programme will, over the next two years, strengthen teams of HPSR educators and researchers to be able to offer HPSR training in the region, and account for a notable increase in the number of masters’ level students exposed to HPSR concepts taught locally in French.

Now in its third cohort, this initiative paired first-time women authors from India, Kenya, Liberia, Malawi, Nigeria, Peru, Yemen and Zimbabwe with mentors for one-to-one engagements that supports them through the process of submitting their manuscripts for publication. The programme is conducted in partnership with Health Systems Global and the academic journal Health Policy and Planning.

The programme aims to launch its special journal supplement in November 2023. The issue is co-edited by two researchers from Latin America, as this year's initiative was linked to HSR2022 held in Bogotá, Colombia. In its third cohort, the programme has adopted several lessons from its previous iterations, including building in more support from the journal, increasing timeframes to allow more interactions between mentor-mentee pairs – as well as across the cohort – and more opportunities for reflection. HSR2022 provided an occasion for a face-to-face working session of mentor-mentee pairs, as well as a public panel featuring the programme’s experience to date. The result is a set of higher quality manuscripts of significance to the field of HPSR as compared to previous years. 

The Alliance Courses platform was launched at HSR2022 and is open and accessible to all free of charge. The platform includes a mix of standalone courses and modules. Each has a knowledge check that, once passed, produces a certificate of completion. The platform launched publicly with its first course, ‘Embedded implementation research for health programme managers’. A course on ‘Learning health systems’ is being piloted in partnership with the Universitas Gadjah Mada in Indonesia. Additionally, the Alliance has been working with a team from Delhi, India, to convert a selection of its existing readers and manuals into a set of introductory modules for the new Alliance online platform for teaching and training..

The Systems Thinking for Strengthening District Health Systems (ST-DHS) project has been working in Timor-Leste since 2020 to strengthen routine district management through the use of systems thinking tools and approaches in two districts (Dili and Viqueque). Based on the successful use of systems thinking as part of the vaccination roll-out during the COVID-19 pandemic, the national health ministry, with the support of an Australian nongovernmental organization, has adapted training curricula for district managers based on the experience of the ST-DHS. The health ministry is training an initial cohort of 30 managers in systems thinking from across the country.

Heightening Institutional Capacity for Government Use of Health Research (HIGH-Res) has been working over the last three years to strengthen existing structures for evidence use within ministries of health in Kenya, Malawi and Uganda This included testing a suite of interventions, such as getting research technical working groups within health ministries functional, training research focal persons, developing evidence synthesis and rapid review mechanisms, writing evidence dialogues into health ministry annual workplans, creating health ministry-led policy streams during local science conferences, and developing evidence-informed decision-making curricula at government training institutions. In Kenya, this has involved training 84 health ministry and KEMRI staff on systematic reviews, and further mentoring 12 health ministry staff in-depth. So far, seven policy briefs have been produced. Of these briefs, two were used to inform health ministry policy decisions: the first informed the breast cancer screening guidelines 2021-2025; the second informed policy on countering misinformation and myths undermining the uptake of COVID-19 vaccines.

2022 finances and donors

The Alliance gratefully acknowledges core financial support in 2022 from the Norwegian Agency for Development Cooperation (Norad) and the Swedish International Development Cooperation Agency (Sida).

Other donors and those supporting specific ongoing activities in 2022 include the Bill & Melinda Gates Foundation; the Department of Health and Social Care, United Kingdom of Great Britain and Northern Ireland; Gavi, the Vaccine Alliance; the Medical Research Council (MRC); and the Republic of Korea. We also received specified funding from the Ministry of Foreign Affairs, Sweden and the Norwegian Agency for Development Cooperation (Norad).

Governing bodies

NOTE: People listed in this section served on the Board or STAC or were employed by the Secretariat at some point during 2022. They do not necessarily reflect the current composition of these bodies.