MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Conclusion: Directions for future research
on positive synergies
Research on positive synergies to date is part of a broader effort that is expanding the tools
available for health systems analysis [1-5]. Today, a growing number of investigators are placing
practical health systems policy and implementation problems at the centre of their research, then
selecting and combining research methods and data sources to produce evidence that can guide
real-world action [6,7]. Their work is feeding strategically into change processes by which new
policies are proposed, approved, implemented and evaluated [8-10]. Key to this focus on
informing practical action is the understanding that both quantitative and qualitative data are
required to build policy-relevant knowledge on the factors that influence health systems
performance and health outcomes [4,11-13]. As they look to provide evidence that policymakers
and implementers can apply to concrete problems, researchers also increasingly recognize the
need to situate health systems challenges and solutions within countries’ specific environmental,
epidemiological, economic and political contexts—acknowledging how context shapes options
for change [5,14].
As these approaches come together, a new multidisciplinary field of global health systems
research is emerging. Though it builds on intellectual traditions reaching back to the dawn of
modern public health [15], this multidisciplinary field is still in its early stages. But it is acquiring
new rigour today, as well as new methodological breadth. It marshals learning strategies from
many domains—from epidemiology and clinical medicine to the social sciences, law, political
economy, systems engineering, and management sciences—to analyse health delivery systems as
complex social systems [3]. As it develops, this emergent field will produce distinctive forms of
evidence that will equip policymakers and implementers to make better management decisions;
direct health resources where they can do the most good; accelerate delivery of new technologies
and clinical innovations in resource-constrained settings; improve health outcomes; and
strengthen equity [16]. Maximizing Positive Synergies (MPS) research to date is situated within this
long-term agenda. MPS has contributed to mapping opportunities and challenges for
multidisciplinary health systems research; honing methodological questions; testing the field’s
limits; and confirming its strengths.
The initial phase of country-level research on positive synergies has produced a rich body of data,
reflected in the case studies that make up this report. MPS case studies have brought
understanding of GHI-health systems interactions to a new level of breadth, detail and contextual
specificity. As with any research, however, there are limitations to the work that has been done in
this first phase. In particular, the case studies focus mainly on the one-directional effect of GHIs on
health systems, and provide little information on how specific health system attributes have
affected GHIs’ ability to achieve their objectives in improving health outcomes. In addition, the
quantitative component of the mixed-methods case research was limited by the lack of available
data on health care processes and outputs at the facility level. Finally, as the research is
observational and retrospective, researchers are appropriately cautious in attributing observed
effects to GHI action per se. In the epidemiological, political and social contexts under study,
complex causal interactions and “feedback” patterns exist, which make precise attribution difficult
[3].
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