Health Policy and Planning
Volume 27 Issue 1 January 2012
http://heapol.oxfordjournals.org/content/current

Commentaries
Anne Mills
Health policy and systems research: defining the terrain; identifying the methods
Health Policy Plan. (2012) 27(1): 1-7 doi:10.1093/heapol/czr006
Abstract
Across low- and middle-income countries on the one hand, and high-income countries on the other, there is confusion in the terminology relating to the study of health services and health systems. This commentary discusses health policy and systems research (HPSR) methods, drawing on the health services research literature and on recent work on HPSR. An earlier version of the text was written to contribute to discussions at a meeting organized by the Alliance for Health Policy and Systems Research, an agency set up in 1998 to promote and support such research in low- and middle-income countries. The paper comments on the field of HPSR methods, suggests priorities and identifies challenges facing the field of HPSR.

Thomas J Bossert
Health systems
Health Policy Plan. (2012) 27(1): 8-10 doi:10.1093/heapol/czr008
Abstract
There is an avalanche of interest in health systems with countries, donors, international experts and academic institutions all rushing to promote, fund or build capacity to address this wave of interest. As Anne Mills documents in an article in this volume, there is also a growing literature on how to think about health systems, how to use research on health systems to improve their performance, and pleas for greater investment in knowledge about health systems. We are probably riding on the crest of this new wave and it will be important to make use of it to further our knowledge about how to achieve health system effectiveness. With continuing global economic uncertainty, this wave may pass if we do not take advantage of it now.

It is useful to reflect on why there is such interest in this theme now. There are probably many converging causes but the most important, to my mind, is a replay of an old debate between vertical programmes and horizontal, integrated approaches that has experienced swings of interest at least since the Alma Ata Conference in 1978 emphasized the integrated primary health care approach. During the last decade or more, there has been a major focus on vertical disease-specific programmes supported by greatly increased funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Global Alliance for Vaccines and Immunisation (GAVI), US President’s Emergency Plan for AIDS Relief (PEPFAR), Bill and Melinda Gates Foundation, among other donors. The major claim of these programmes was that by focusing on clear disease-specific objectives they would be more effective in shorter time periods and they could be held more accountable to donors (since the results could be more measurable) than the difficult and diverse efforts to improve the many elements of a health system through the horizontal …