MAXIMIZING POSITIVE SYNERGIES - World Health Organization

To generate a list of country case study options, countries were filtered through the above criteria
and a final potential case study country pool was generated in consultation with WHO and civil
society. Partner institutions then selected case studies that corresponded to their current or future
research interests. In light of time constraints, project coordinators gave special consideration to
countries where research compatible with MPS goals was already underway at the time MPS was
formally launched. The academic consortium relied strongly on voluntary expressions of interest
from country-level researchers engaged in international networks and consortia.
Methods used by MPS research partners
The research previously undertaken and currently ongoing within MPS features multiple
components and distinct but related methodologies. The main MPS research products include:
• a systematic literature review
• mixed-method country case studies and facility-level studies
• cross-cutting comparative analyses of country studies
• multi-country studies and policy analysis
• cross-country quantitative analysis
• participant observation research led by civil society.
This document is a compilation of country case studies and facility-level studies. In many instances,
researchers are continuing to analyse their data and to refine their results as of this writing. The
summaries included in this report capture the state of findings and analysis as of mid-May 2009.
Ongoing analysis of the data obtained may yield additional insights..
Understanding complex systems: the strength of mixed methods
In recent years, new multidisciplinary approaches to health systems analysis have begun to
emerge, and innovative researchers have applied mixed-methods approaches to analyse the
health systems impacts of GHIs (see studies at www.ghinet.org).
MPS research builds on this pioneering work. It adopts the premise that multiple research
methods must be used in conjunction with each other to understand complex social systems. As
such, MPS contributes to the broader task of building a new field of multidisciplinary health
systems analysis. Many of the country-level case studies included in this report have adopted
mixed methods, collecting and analysing both quantitative and qualitative data, on the premise
that using quantitative and qualitative approaches in combination provides a better
understanding of research problems than either approach alone [12]. A multi-method approach
compensates for the weaknesses inherent in both quantitative and qualitative research and also
harnesses their complementary strengths [13, 14]. Mixed methods are best suited to build up a
nuanced picture of how complex entities like health systems and GHI programmes interact, and to
develop credible hypotheses about the factors that have favoured successful outcomes. In
particular, mixed methods enable investigators to capture non-quantifiable contextual influences
(for instance, historical and political factors) whose impact may elude more narrowly framed
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