|
Title |
Health systems research in the time of health system
reform in India: a review |
Author(s) |
Krishna D Rao,Radhika Arora, and Abdul Ghaffar - Personal Name
|
Subject |
Health System and Policy |
Publisher |
BioMed Central Ltd. |
Publishing Year |
2014 |
Specific Detail Info |
Background:
Research on health systems is an important contributor to improving health system
performance. Importantly, research on program and policy implementation can also create a
culture of public accountability. In the last decade, significant health system reforms have
been implemented in India. These include strengthening the public sector health system
through the National Rural Health Mission (NRHM), and expansion of government sponsored
insurance schemes for the poor. This paper provides a situation analysis of health
systems research during the reform period.
Methods:
We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed
and IndMED. Articles were classified according to the WHO classification of health systems
building blocks.
Results:
Our findings indicate the number of publications on health systems progressively increased
every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery
(40%), with fewer on information (16%), medical technology and vaccines (15%), human
resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by
an author based in India, the majority by authors located in only four states. Several states,
particularly in eastern and northeastern India, did not have a single paper published by a lead
author located in a local institution. Moreover, many of these states were not the subject of a
single published paper. Further, a few select institutions produced the bulk of research. Of the
foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and
Switzerland).
Conclusions:
The growth of published research during the reform period in India is a positive development.
However, bulk of this research is produced in a few states and by a few select institutions
Further strengthening health systems research requires attention to neglected health systems
domains like human resources, financing, and governance. Importantly, research capacity
needs to be strengthened in states and institutions that have a scarcity of researchers, as well
as states that have been the focus of little research. While more funding for health systems
research is required, this funding needs to be targeted at deficient health systems domains,
geographical areas, and institutions. |
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