MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Bearing these limitations in mind, the studies carried out to date chart promising directions for
future research to uncover the causal mechanisms that lie behind both positive and negative GHIhealth
systems interactions. Looking across the case studies compiled here, five key directions
emerge for the next phase of research on positive synergies:
• Build consensus on metrics and methods for evaluating GHI-health systems
interactions: The emergent field of health systems research needs to progressively foster
consensus around a set of metrics for systems performance, as well as common metrics
and methods for assessing GHI-health systems interactions. MPS research partners have
advanced these discussions and the consensus-building process through their joint work.
By definition, the task reaches beyond the confines of any single consortium or project.
Moving forward, however, MPS research partners can continue to play a catalytic role.
Subsequent phases of MPS work could provide an appropriate platform for shaping the
needed consensus by convening an expanding network of multidisciplinary researchers,
GHI leaders, programme implementers, system managers and monitoring and evaluation
(M&E) experts.
• Move from description to explanation: MPS country case studies have achieved a new
level of descriptive detail in illustrating how GHIs and health systems are interacting in
country contexts. This wealth of data represents an advance in knowledge. In some
instances, MPS studies have already provided evidence that can enable the framing of
initial explanatory hypotheses about the positive or negative interactions that have been
observed. The next phase of research will involve waves of more tightly focused, multimethods
studies in countries that will successively: (1) “drill down” on specific areas (e.g.,
supply chain, health workforce) to generate additional data that may be needed to
generate explanatory hypotheses; (2) formulate and test such hypotheses on causal
relationships—tackling the critical “why?” questions. A new generation of
analytic/explanatory studies on positive synergies can assess evolving national
government policies, along with the internal structures, policies and management styles of
the different GHIs. The evidence obtained will inform the ongoing learning process that
has characterized major GHIs.
• Extend cross-country comparisons and document effective practices: In addition to
drilling down on causal questions within particular country contexts, the next phase of
research on positive synergies will capitalize on the large body of data already generated,
along with results from additional studies, to conduct cross-country analyses that can
compare policy and implementation strategies and results across countries. Comparative
analysis will enable researchers to build an inventory of the policy approaches countries
have adopted to manage GHI-health systems interactions, and then to begin the task of
systematically correlating policy and implementation options with outcomes measures.
Comparison of country experiences and results poses methodological challenges,
particularly for qualitative research. MPS researchers are beginning to address these
challenges as they analyse and compare the data collected during the first phase of work.
Comparative studies, even among relatively small groups of countries, will help identify
effective strategies with wider applicability and also point to key contextual factors in
countries that may facilitate or constrain synergies between GHIs and health systems.
Outputs of this phase of research might include an evolving inventory of best practices, as
well as a more systematic account of the contextual factors that influence positive or
negative GHI interactions with health systems.
• Strengthen civil society and community participation in research: The MPS process has
confirmed the importance of civil society participation in all aspects of research related to
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