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TDRnews June 2009 Health systems and implementation research: integrating lessons learned

The structural weakness of health systems in many developing countries remains a fundamental barrier to effective service delivery. Creative, effective mechanisms are needed to translate available research evidence into health programmes and policies.

These issues are the focus of a new Thematic Reference Group (TRG) on Health Systems and Implementation Research (TRG-3), which held its first meeting on 4-8 May in Abuja, Nigeria. This international expert group includes members with health system perspectives from South America, Asia and Africa. The TRG is chaired by Professor William Brieger of Johns Hopkins University and co-chaired by Professor Layi Erinosho of Olabisi Onabanjo University, Nigeria.

The Thematic Reference Group on Health Systems and Implementation Research will operate out of Nigeria for the next four years with the support of the WHO Representative Office of Nigeria. To facilitate the group’s work, a stakeholder consultation was held on 5 May to discuss the planned framework for the TRG’s activities, and to identify current health systems and implementation challenges in the context of Nigeria, with a particular focus on health care costs and financing. The consultation brought together TRG members, Nigerian

Expert group on health systems and implementation research

government officials, the research community, non-governmental organizations, international donors and WHO (TDR, Nigeria Office and African Regional Office). The consultation’s objectives and the work of the TRG were strongly supported by Nigeria’s Federal Ministry of Health and the Federal Ministry of Science and Technology, which co-sponsored the meeting. In his opening address, Professor Babatunde Osotimehin, Nigerian minister of health, noted the significance of the TRG deliberations in helping to further Nigerian efforts to develop a new National Strategic Health Development Plan.

Ayoade Oduola , TDR’s Stewardship leader, set the context for the consultation by describing TDR’s new vision and its role through its Stewardship function as a knowledge manager and facilitator to support stakeholders. He drew attention to the vital need to apply the knowledge already gathered, and challenged participants to consider critical research questions to tackle infectious diseases of poverty.

Presentations at the meeting related to the roles of the state and private sectors in Nigeria, public-private partnerships, national health accounts and alternative service delivery mechanisms to reach poorer communities. Programmes funded by international donors in Nigeria were also discussed.

Participants underlined that currently the health system is highly fragmented, and that countries such as Nigeria critically need effective co-ordination across sectors and among the many different health implementation actors. The country is also distinctive in that the majority (around 70%) of all health expenditure comes from out-of-pocket expenditure by households, representing a major burden on families. Malaria remains significant across Nigeria, accounting for 20-30% of mortality in children under five. An important synergy was the launch of intensified malaria control efforts during the week of the TRG meeting.

The TRG members incorporated issues raised by the stakeholders into review and finalization of the group’s work plan for the coming year. A Nigeria-specific project will form part of this work plan, and proceedings of the Stakeholder Consultation also are being prepared for publication. y

Contact:

Dr Shenglan Tang