Joint Health Systems Research Programme for Eastern and Southern Africa

Introduction

The Joint HSR Programme on Health Systems Research is a collaborative enterprise of the Ministries of Health in participating countries in the Eastern and Southern African Region, the World Health Organisation / (AFRO) , and International partners. It started in 1987 and is now in its third phase. The third phase started in January 1996 and will end in 2000. It has eighteen participating countries in the Region, namely: Angola, Botswana, Guinea Bissau, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Sao Tome & Principe, Seychelles, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe . Other countries may come in soon, e.g. Mali and Ethiopia .

Goal of the Programme

Main Objectives

• Strengthen structures and mechanisms to promote health systems research in participating countries
• Increase the capacity of health and health-related staff as well as of researchers to develop and implement health systems research
• Provide technical and financial support for the development and implementation of health systems research proposals
• Promote the utilisation of health systems research results at all decision-making levels
• Facilitate the mutual exchange of expertise and experience in health systems research among the countries of Eastern and Southern Africa

HSR Characteristics

• Problem and action oriented, aiming at feasible, practical and affordable solutions
• Participatory, active collaboration among researchers and potential users of the research results
• Multisectoral, involving social and economic sectors
• Intregrated & multi-disciplinary, requiring contributions from a wide variety of disciplines
• Timely and practical research, of short duration
• Replicable methodologies
• Focus on priority health problems

Strength of HSR

Major Project Activities

1. Advocacy/Sensitisation

   of decision makers and health managers on potential of HSR for decision making
   • By country support mission and inter-country meetings on HSR

2. Consensus building

   • National Consultative Meetings on needs and resources of HSR and or priority setting of HSR research

3. Training

   • Training courses on protocol development (18 days)
   • Training courses on data analysis and report writing (12 days)
   • Training of Trainers on HSR (10 days)
   • Training of HSR managers
   • Support of research projects, both technically and financially
   • Development of HSR training material

4. Strengthening HSR structures/processes

   • Establishment of HSR units or focal points in Ministries of Health and Universities

5. Coordination and networking

   • Annual meeting of Technical Advisory Committee, involving all heads of HSR units and HSR focal points for universities
   • HSR Programme Newsletter/Journal
   • Collaboration with other projects involved in health research (CRHCS, GTZ HSR Eastern & Southern Africa, COHRED, SOMANET)

Specific Target Groups

• Health managers, policy makers, district level health workers
• University staff
• NGOs involved in PHC delivery
• Communities

Achievements

• 1,250 health workers trained in HSR methodology
• 295 health and university staff trained as facilitators
• 145 studies completed

Publications

Research Topics

(developed in HSR workshops)

Management of health services, e.g.

• Low recruitement and high dropout rates of nurses
• Quality/extent of supervision of peripheral unit by District Health Teams
• Delays in servicing out-patients at Central Hospitals

Utilisation of specific health services, e.g.

• Availability and use of essential drugs at PHC
• Low use of child-spacing services
• Low use of TB-control services

Risk factors for health problems, e.g.

• Neonatal, perinatal, or infant mortality
• Maternal mortality
• Tuberculosis
• Malnutrition

K.A.P. Studies e.g.

• K.A.P. in relation to HIV and AIDS among teenagers
• K.A.P. of condom use

Policy-linked research

• Decentralisation
• Cost recovery
• Quality of care
• Home based AIDS care
• Cost of hospital care in AIDS patients

Major Constraints

• Structural Adjustment Programmes
• Droughts
• AIDS
• Internal wars (Angola and Mozambique)
• Brain drain
• High staff turnover
• Lack of career in research

The Future

• Development of new training approaches and materials (more cost-effective, and addressing community needs)
• Emphasis on efforts to include HSR in curriculum of universities and paramedical schools
• Strengthen utilisation and implementation of research results
• Focus on policy related research projects for Health Sector Reforms
• Development of local initiatives in HSR (e.g. development of National Long Term Plans for HSR)

Publications

1. Summaries of Health Systems Research Reports: 1988 - 1993. Joint Project on Health Systems Research for the Southern African Region. ISBN 0-7974-1351-0
2. Health Systems Research - It can make a difference. Joint WHO/RTI/DGIS Project on Health Systems Research.

   Volume 1:

   Availability, Provision and Use of Drugs.ISBN 0-7974-1307-3

   Volume 2:

   Factors associated with maternal mortality. ISBN 0-7974-1320-0

   Volume 3:

   Factors contributing to the under utilisation of out-patients services among tuberculosis patients.

   Volume 4:

   Functioning of Primary Health Care at Village Level. ISBN 0-7974-1366-9

3. Flyers, posters and calenders
4. HSR Newsletter / Journal (Quarterly). Joint HSR Project & GTZ HSR - Eastern & Southern African Region.

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