My first year as Executive Director of the Alliance has been a tremendous privilege. Working with a formidable Board and highly talented team, and being hosted in WHO’s Science Division, has been incredibly enriching. This has been further enhanced by the engaged and committed health policy and systems research community. It has been a busy year, with significant change while continuing to fulfil our core mission.

We consulted extensively on a new strategy for 2024–28. These consultations, across five continents, convened our core constituency as well as new partners. The discussions led to an increased focus on how health policy and systems research can create more impact. I am enormously grateful to the hundreds of people who gave us their time and their insights. There remains a clear mission for the Alliance, even if this has changed over the past 25 years. Our new strategy outlines five priority areas: universal health coverage through primary health care; digital health; noncommunicable disease prevention; climate change; and emergency preparedness and response. Our efforts in 2023 have already planted a footprint in each of these areas from which to expand.

There were also many other highlights. These included country case studies on primary health care in the context of the COVID-19 pandemic; implementation research on integrating noncommunicable disease management into primary care; the culmination of a multi-country programme on rethinking external assistance for health; work on health taxes and climate change; and the conclusion of a four-year, institutional capacity strengthening initiative. All this work has been undertaken in close collaboration with the relevant WHO departments.

The work of the Alliance extends well beyond our Secretariat, involving researchers, policy-makers, practitioners, implementers and communities in countries, and supported by development partners at the global level. We are fortunate to have long-term support and funding from the governments of Norway, Sweden and the United Kingdom of Great Britain and Northern Ireland, along with numerous other funders and partners. I am thankful for the new funding that we received this year, which has enabled us to launch new programmes in line with the strategy.

Health policy and systems research can make a much greater contribution during these uncertain times. As we aim for impact, our community will be crucial to our success. We look forward to your continued comment, critique and partnership.

– Kumanan Rasanathan 

A year in review

Monitoring progress

The Alliance for Health Policy and Systems Research (the Alliance) supports the generation and use of health policy and systems research to strengthen health systems. We address social determinants of health to contribute to significant progress in reducing health inequities and achieving major global health targets. The Alliance is a partnership hosted by the World Health Organization (WHO).

The Alliance has been tracking progress on a set of indicators across the three strategic objectives outlined in our strategic plan in 2021, each with a five-year target. This year, we conducted extensive consultations to shape a new strategy and will transition to a new reporting framework in 2024.

As we conclude this current reporting cycle, we are pleased that, out of the nine indicators we have been tracking, we have already achieved the five-year targets on four. A further three indicators have broadly met the three-year progress markers, indicating that they were on track to meet their targets within the original timeframe had the strategy not been updated.

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

Enabling relevant and actionable health policy and systems research that contributes to change is at the heart of how the Alliance works. 

We embrace a wide array of research topics and methodologies –looking more than ever beyond health systems to the wider social determinants of health. Through this diversity, we contribute to the global understanding of how health systems can adapt, survive and thrive in the face of adversity. 

This year, the Alliance concluded a six-country research programme on managing transitions from external financing, informing how external assistance can be designed and implemented. Findings have led to actionable knowledge for governments, funders and civil society, ensuring the continuation of essential health interventions post-donor support. These insights have been shared broadly, including through presentations to the Sustainable Health Financing Accelerator, health advisors at the United Kingdom of Great Britain and Northern Ireland Foreign, Commonwealth and Development Office, and at a side event during the 76th World Health Assembly. Additionally, in collaboration with the WHO Department of Health Financing and Economics, a special issue of the Health Policy and Planning journal has been developed. This issue features 14 articles and five practitioner commentaries on new models of donor assistance, aiming to foster equitable partnerships and enhance local capacities in low- and middle-income countries.

The Alliance has emphasized the crucial role of research and learning in advancing primary health care through its active participation in international conferences in Astana, Kazakhstan, and in Addis Ababa, Ethiopia, engaging in plenary sessions, roundtable discussions and partner-led events. We launched 26 case studies on primary health care in the context of the COVID-19 pandemic in collaboration with the WHO Special Programme on Primary Health Care, regional offices and country offices. Furthermore, we initiated four new projects focusing on primary care financing, vaccination coverage for zero-dose children, the impact of health care reforms on universal health coverage in India, and digital health solutions to support primary care managers in eight countries. These initiatives are part of our broader strategy to set research priorities that address the evolving needs of global health.

Health taxes on tobacco, alcohol and sugar-sweetened beverages can save lives, but they can directly conflict with the interests of commercial actors. The Alliance, with support from the Government of Norway and in collaboration with WHO and the Inter-Agency Working Group on Health Taxes, established a research programme in 2021 to provide health policy analysis for health taxes in eight countries and in 2023 expanded this work to include another eight countries: Colombia, Egypt, India, Lebanon, Mongolia, Nigeria, Uganda and Zambia. In October, on the side-lines of the World Bank’s meetings in Morocco, the Alliance launched a special collection of BMJ Global Health on health taxes. With more than 20 articles, the collection comprises analysis, commentary, original research and practice articles offering both theoretical and methodological insights, along with empirical research findings. Continued support has strengthened the capacity of researchers to conduct high-quality health systems research and disseminate findings at the highest levels of government.

Quality and equity: a shared agenda for universal health coverage 

by Amy Stevens, Matthew Neilson, Kumanan Rasanathan, Shamsuzzoha Babar Syed and Theadora Swift Koller in BMJ Global Health.

What research evidence can support the decolonisation of global health? Making space for deeper scholarship in global health journals 

by Sudha Ramani, Eleanor Whyle and Nancy Kagwanja in The Lancet Global Health.

Embedding rapid reviews in health policy and systems decision-making: impacts and lessons learned from four low- and middle-income countries 

by Reid C. Robson, Sonia M. Thomas, Étienne V. Langlois, Rhona Mijumbi, Ismael Kawooya, Jesmin Antony, Melissa Courvoisier, Krystle Amog, Robert Marten, Ivdity Chikovani, Devaki Nambiar, Rajani R. Ved, Soumyadeep Bhaumik, Nur Zahirah Balqis-Ali, Sondi Sararaks, Shakirah Md. Sharif, Rugare Abigail Kangwende, Ronald Munatsi, Sharon E. Straus and Andrea C. Tricco in Health Research Policy and Systems.

Institutional roles, structures, funding and research partnerships towards evidence-informed policy-making: a multisector survey among policy-makers in Nigeria

by Chigozie Jesse Uneke, Ijeoma Nkem Okedo‑Alex, Ifeyinwa Chizoba Akamike, Bilikis Iyabo Uneke, Irene Ifeyinwa Eze, Onyekachi Echefu Chukwu, Kingsley Igboji Otubo and Henry C. Urochukwu in Health Research Policy and Systems. 

Evolution and lessons from an integrated service delivery network in North West Syria 

by Sophie Witter, Karin Diaconu, Ibrahim Bou-Orm, Zeina Jamal, Zubin Cyrus Shroff, Abdulbaki Mahmoud, Mahmoud Daher and Vinod Varma in Conflict and Health.

Development of the Systems Thinking for Health Actions framework: a literature review and a case study 

by Jenna Thelen, Carmen Sant Fruchtman, Muhammad Bilal, Kebabonye Gabaake, Shahid Iqbal, Tshiamo Keakabetse, Aku Kwamie, Ellen Mokalake, Lucia Mungapeyi Mupara, Onalenna Seitio-Kgokgwe, Shamsa Zafar and Daniel Cobos Muñoz in BMJ Global Health.

Introduction and implementation of an immunization information system in the Indonesian province of Daerah Istimewa Yogyakarta: lessons for scaling-up

by Sulistyawati Sulistyawati, Trisno Agung Wibowo, Rokhmayanti Rokhmayanti, Andri Setyo Dwi Nugroho, Tri Wahyuni Sukesi, Siti Kurnia Widi Hastuti, Surahma Asti Mulasari and Marta Feletto in BMC Health Services Research.

Global challenges often require local solutions. The Alliance partners with policy-makers, researchers and practitioners to use knowledge and learning to catalyse change.

Through these collaborations, the Alliance not only amplifies the impact of innovative health policies but also ensures that these strategies are grounded in rigorous research and are tailored to meet unique local and national needs. 

In collaboration with WHO’s Environment, Climate Change and Health Department, the Alliance extended its research initiative applying health policy and systems research to the climate crisis in another six countries to expand the knowledge base and identify more lessons. This builds on an existing portfolio of six countries that have concluded their studies this year. In October, the Alliance brought together these six new research teams with its first cohort of six teams for a workshop in Amman, Jordan. The original six studies are already informing the development of both Mozambique’s and Nepal’s Health National Adaptation Plan. The Alliance has also initiated a new area of focus on the health co-benefits of climate mitigation activities, which will shape the Alliance’s future engagement in this space.

The Alliance and the WHO Noncommunicable Diseases Rehabilitation and Disability Department, alongside WHO regional and country offices, are embarking on a new collaborative implementation research initiative to improve the integrated management of noncommunicable diseases in primary care. Specifically, these collective efforts aim to generate locally relevant evidence to inform policy and practice, thereby enhancing the management of chronic conditions in primary care; strengthening the capacity of countries and regions to produce this crucial evidence; facilitating networking opportunities for shared learning and support; and advocating for increased funding and political commitment by championing a research agenda that identifies key challenges and priorities. Following a call for proposals (which received more than 200 applications), four research teams were selected in Ethiopia, Ghana, India and Nepal to kick off this work.

This year marked the conclusion of BIRD, a significant four-year project focusing on institutional mentorship for research evidence generation and uptake. The project involved six institutions across Cambodia, Georgia, Indonesia, Trinidad and Tobago and the United Arab Emirates, and a mentor institute in Lebanon. A final event in Beirut, Lebanon, in April celebrated the achievements, gathering country teams and policy-makers. Key outcomes include the training of 106 policy fellows, and the publication of over 30 knowledge products (including policy dialogues, briefs and reports). Notable impacts were seen in organizational and network changes among policy-makers and researchers in the participating countries, for example, the formalization of research procedures and the creation of networking and training opportunities. Critically, mentee institutions are now viewed as the go-to organization for evidence, with expert teams called upon to support government decision-making. In some cases, this has resulted in new international funding for teams. A final journal supplement is in preparation.

This project concluded its catalytic small grants to five regional institutions in Costa Rica, Ghana, India, the Philippines and Switzerland. The SYSTAC hubs have continued activities to strengthen systems thinking in their regions. In Asia, the second regional short course on systems thinking was conducted in the Philippines, and a methods casebook was developed out of a partnership between the teams in India and Thailand. The European hub initiated a webinar series on intersectoral applications of systems thinking. In Latin America, the team used systems thinking to strengthen existing networks on primary health care and equity, holding a face-to-face workshop to build on partnerships with the Pan American Health Organization and external stakeholders. Cross-regionally, the European and Latin American hubs are collaborating on new initiatives. The Alliance conducted a formative evaluation to understand how the community of practice’s origins, structure, cohesion, external and internal factors, membership, resources and outcomes – along with the Alliance’s approach to capacity strengthening – have contributed to the development and sustainability of SYSTAC.

Through targeted mentoring and support, we enhance the skills and visibility of emerging leaders, particularly in underrepresented regions and groups.

Our initiatives encourage the development of locally led courses and promote the creation of robust professional networks. This strategic empowerment ensures that leaders are not only prepared to face current challenges but are also equipped to innovate and inspire within their communities and beyond.

The Alliance, in collaboration with Health Systems Global, finished the third iteration of the publication mentorship programme for early-career women researchers. This culminated in the launch in November 2023 of a journal supplement, which focuses on equity and access to services and caring for underserved populations. The supplement includes seven articles and one editorial written by first-time authors from India, Kenya, Malawi, Nigeria and Peru. Topics covered include: health facility redress mechanisms, adolescent pregnancy in urban settlements, informal payments in maternal health services, and food security and mental health in Indigenous communities.

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. 

Several short courses have been released on the Alliance's courses platform, including an introduction to health policy and systems research. Long courses on embedded implementation research and learning health systems are also available. The format and duration of the different courses and modules varies, but they all include a knowledge check that, once passed, produces a certificate of completion. A number of students have already enrolled in and successfully completed these courses.

The Alliance held a series of events to mark its 25th anniversary. The events took place on the sidelines of existing programme activities in different locations around the world – from London to Addis Ababa, from Oslo to Beirut, from Geneva to Washington, DC. These events have provided an important opportunity to connect with the wider health policy and systems research community in these geographies, to highlight the role of the Alliance in building the field and look to the future of health policy and systems research, to reflect on the Alliance’s achievements and to seek inputs on its future direction. To complement the anniversary events and continue the conversation, the Alliance produced a series of videos with members of the health policy and systems research community looking at the biggest challenges facing the field. In a nod to the disruption that emerging digital technologies are playing, the Alliance tapped into artificial intelligence, asking ChatGPT to provide its own insights.

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.

The Alliance was part of the research and learning task force of the Future of Global Health Initiatives programme. This programme brings together bilateral and multilateral agencies as well as leading academics working in the areas of health systems strengthening and health financing to better understand the future of the global health architecture, particularly in light of major shifts in development assistance and national epidemiological profiles. The Alliance discussed its work on managing donor transitions for sustained intervention coverage in early June at an event convened by the initiative that enabled a high degree of engagement with major stakeholders in this area.  

The Alliance convened the first of a series of policy-makers based in low- and middle-income countries in partnership consultations in partnership with the Medical Research Council in London, United Kingdom of Great Britain and Northern Ireland. The main goal of the consultation was to define a policy-maker-led applied research agenda to guide calls for funding by the Medical Research Council and other donors, as well as to serve as an input for related work within WHO. The topic of the first consultation process was digital health technologies and their potential for improving health. The Alliance engaged 14 policy-makers from diverse geographies to understand their priorities for digital health, including barriers and topics where research could inform and support their work. The process has brought forward valuable perspectives on digital health, has furthered the Alliance’s collaboration with the Medical Research Council and the WHO Digital Health and Innovation Department, and will likely inform future digital health funding priorities and approaches.

As part of the BIRD capacity strengthening initiatives, different research institutions were encouraged to work with policy-makers and on relevant issues in their respective countries. In Cambodia, the team developed policy options for integrating diabetes services within primary health care. In the United Arab Emirates, the team worked with the Ministry of Health and Prevention to establish a child mental health policy. And in Indonesia, the team facilitated civil society inputs into a parliamentary bill on sugar-sweetened beverages.

2023 donors

The Alliance gratefully acknowledges core financial support in 2023 from the Norwegian Agency for Development Cooperation (Norad) and the Swedish International Development Cooperation Agency (Sida).

The Alliance also acknowledges significant ongoing programme support from the Bill and Melinda Gates Foundation; the Department of Health and Social Care, United Kingdom of Great Britain and Northern Ireland; and Gavi, the Vaccine Alliance. 

We also received specified funding from the Ministry of Foreign Affairs, Sweden and the Norwegian Agency for Development Cooperation (Norad), the Medical Research Council and the United Nations University Institute for Global Health.

Governing bodies

NOTE: People listed in this section served on the Board or STAC or were staff members employed by the Secretariat at some point during 2023. They do not necessarily reflect the current composition of these bodies.