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2019

Gendered health systems: evidence from low- and middle-income countries

Gender is often neglected in health systems, yet health systems are not gender neutral. Within health systems research, gendered analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making. This paper synthesises findings from nine studies focusing on four health systems domains, namely human resources, service delivery, governance and financing. It provides examples of how a gendered and/or intersectional gender approach can be applied by researchers in a range of low- and middle-income settings (Cambodia, Zimbabwe, Uganda, India, China, Nigeria and Tanzania) to issues across the health system and demonstrates that these types of analysis can uncover new and novel ways of viewing seemingly intractable problems.

By Rosemary Morgan, Richard Mangwi, Debjani Barman, Stephen Buzuzi, Charles Ssemugabo, Nkoli Ezumah, Asha S. George, Kate Hawkins, Xiaoning Hao, Rebecca King, Tianyang Liu, Sassy Molyneux, Kelly W. Muraya, David Musoke, Tumaini Nyamhanga, Bandeth Ros, Kassimu Tani, Sally Theobald, Sreytouch Vong and Linda Waldman

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Local ownership of health policy and systems research in low-income and middle-income countries: a missing element in the uptake debate

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Health policy and systems researchers (HPSRs) in low-income and middle-income countries (LMICs) aim to influence health systems planning, costing, policy and implementation. Yet, there is still much that we do not know about the types of health systems evidence that are most compelling and impactful to policymakers and community groups, the factors that facilitate the research to decision-making process and the real-world challenges faced when translating research findings into practice in different contexts.

Drawing on an analysis of HPSR from LMICs presented at the Fifth Global Symposium on Health Systems Research (HSR 2018), we argue that while there is a recognition in policy studies more broadly about the role of co-production, collective ownership and the value of localised HPSR in the evidence-to-policy discussion, ‘ownership’ of research at country level is a research uptake catalyst that needs to be further emphasised, particularly in the HPSR context.

We consider embedded research, participatory or community-initiated research and emergent/responsive research processes, all of which are ‘owned’ by policymakers, healthcare practitioners/managers or community members. We embrace the view that ownership of HPSR by people directly affected by health problems connects research and decision-making in a tangible way, creating pathways to impact.

Link to the full paper…

By Kuda Vanyoro, Kate Hawkins, Helen Parry, Lynda Keeru and Matthew Greenall