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International Health

From the Chair
Robert Black, MD, MPH

Robert E. BlackOperational research, implementation research and health systems research all attempt to provide information to improve the delivery of health services. All are multidisciplinary research efforts using quantitative and qualitative methods to improve the effectiveness of health interventions and programs. Operational research is action oriented in response to specific identified problems in intervention delivery or support services. Implementation research, as defined by the NIH Fogarty International Center which has made it a priority, “creates generalizable knowledge that can be applied across settings and contexts to answer central questions” (Madon et al. Science 318:1728-9, 2007). Questions—such as why do highly efficacious interventions have a lesser effect when implemented in resource-poor countries and how must interventions be modified in these settings to achieve the greatest benefits—must be prioritized. Health systems research addresses more complex problems of the health system.

In November 2010 the First Global Symposium on Health Systems Research in Montreux, Switzerland, drew 1,200 participants from more than 100 countries. Department faculty, students and alumni were prominent leaders and participants. The statement from the conference Steering Committee recognized the move toward a further agenda of “science to accelerate universal coverage.” A cosponsor of the symposium and an important organization taking this agenda forward for more than a decade is the Alliance for Health Policy and Systems Research, formerly directed by Associate Professor Sara Bennett and currently directed by IH alumnus Abdul Ghaffar, MD, PhD ‘01, MPH.

Since its inception 50 years ago, the Department has engaged in these areas of applied research to bring effective services to populations in low- and middle-income countries and to generate knowledge of global relevance. In this issue of The Globe we highlight the work of the Future Health Systems consortium led by Department faculty Associate Professors Sara Bennett and David Peters and funded by the UK Department for International Development. In addition to the University of Sussex, the consortium includes three Asian institutions and seven African schools of public health that work together to address local research priorities within overall program goals.

Other faculty have recently begun new applied research projects. Assistant Scientist Kate Gilroy was funded by USAID for implementation research to improve the quality of integrated community case management of serious childhood infectious diseases in Malawi and Mali. Professor Peter Winch is beginning an assessment of the treatment of malaria with combination anti-malarial drugs in Ghana with funding from the Clinton Health Access Initiative.

These areas of applied health systems and community research have been a priority for the Department throughout its history. They are essential to scaling up health services and improving health systems to achieve the largest and most equitable health benefits.