Health systems and policy research

Weak health systems have increasingly been highlighted as major barriers to achieving global health goals. Work within the programme tackling this area is multidisciplinary, with strong links to other research areas within KEMRI/Wellcome Trust and international collaborators. It is focused around understanding and influencing provider and household behaviours, and developing and evaluating interventions and policies to strengthen research and service provision.

Two key areas of health systems research are centred in our Nairobi offices:

• Improving the delivery of care. After initial work on the quality of hospital care in 2002, work on means to improve services for newborns and children began in earnest in Nairobi in 2004. By 2006 the scope of work spanned evidence synthesis (see www.ichrc.org) to inform development of national hospital guidelines that drew heavily on programme work, meningitis surveillance (www.netSPEAR.org), vaccine cost-effectiveness analysis, and conduct of a 3 year trial in which hospitals were randomised to receive a multi-faceted intervention or a control intervention with evaluation using quantitative and qualitative methods. By 2009 the scope of research initiated had broadened further to include national and international methodological work on measurement of quality of hospital care, economic evaluation of complex health interventions and pragmatic clinical work evaluating case management guidelines.
• Consortium for Research on Equitable Health Systems. In 2005 a new stream of health systems work funded by the UK's Department for International Development (DFID) was initiated under the auspices of the Consortium for Research on Equitable Health Systems (CREHS) (see www.crehs.lshtm.ac.uk/index.html).CREHS aims to generate knowledge to help strengthen health systems policies and interventions in ways which preferentially benefit the poorest. In Kenya CREHS staff are working on a range of health systems issues, including health care financing, human resources, policy implementation, and scaling up of key interventions.

Both these streams of work have helped build close links between the programme and the Ministry of Public Health and Sanitation and the Ministry of Medical Services and, in the more clinical areas, with the University of Nairobi.

Many other groups within KEMRI/Wellcome Trust also have a strong focus on health systems and policy issues, including work of the Social Behavioural Research group, and the Malaria Public Health and Epidemiology group.