Characteristics of Health Systems Research

In their article, Remme et al. (2010) argue that a shared understanding of what constitutes health systems research and how it is different from other forms of research is important not just for aiding those seeking to understand and use evidence and fund specific research initiatives, but it also adds to the credibility and progress of the field. Various research initiatives have led to confusion due to inconsistent terminology, overlapping definitions and scopes of operational research, implementation research, and health systems research from different research backgrounds.

These three research areas, operational research, implementation research, and health systems research, aim to strengthen health systems and improve population health. However, it is important that non-specialists, scientists, policymakers, and donors understand that they differ in their core research questions, organization, and interaction with the health system. By outlining the differences, overlaps, and complementarity characteristics of these three research domains, Remme et al. (2010) seek to enhance more effective collaboration among them for a greater impact on strengthening health systems.

The figure adapted from their paper below summarises how these three research areas differ in the type of research question that they address, in how they are organised, and how they interact with the health system. The figure defines these research domains according to three main characteristics: the focus of the research, the users of the research outputs, and the utility of the research outputs.

Research Domain	Primary Characteristic
	Focus of the Research	Users of the Research Outputs	Utility of the Research Outputs*
Operational	Operational issues of specific health programmes	Health care providers programme managers	Local
Implementation	Implementation strategies for specific products or services	Programme managers, R&D managers	Local/broad
Health System	Issues affecting some or all of the building blocks of a health system	Health system managers, policy makers	Broad

According to Remme et al. (2010), "health systems research addresses health system and policy questions that are not disease-specific but concern systems problems that have repercussions on the performance of the health system as a whole. It addresses a wide range of questions, from health financing, governance, and policy to problems with structuring, planning, management, human resources, service delivery, referral, and quality of care in the public and private sector". Health systems research is problem-, question- or challenge-driven, rather than methods driven, such as with epidemiology (Gilson, 2012). An example is research on the effectiveness of different policies that encourage nurses to rural areas. Health systems issues are often highly specific to the local context, and most case studies attempt to uncover a particular health system challenge within its specific environment. It is therefore focused on understanding the challenges within the health system, using a systems perspective to improve the health system for better outcomes for patients and health professionals.

Health systems research is multidisciplinary, involving social sciences, economics, and anthropology, focusing on descriptive, comparative, and evaluative studies. According to Ghaffar et al., (2017), health systems research is research that is embedded in the context of specific health systems and emphasises collaboration between researchers, implementers and policy-makers. This can lead to ownership of health systems and policy research (Ghaffar et al., 2017).