Promoting equity through health systems research in low- and middle-income countries : Practices of researchers

Background: Health systems research is increasingly identified as an indispensable means to achieve the goal of health equity between and within countries. While conceptual work has explored what form of health systems research in low and middle-income countries (LMICs) is needed to promote health equity, there have been few attempts to investigate whether it is being performed in practice. Methods: This paper describes the results of a survey undertaken with health systems researchers worldwide (n = 104) to assess how equity-oriented current practice is in LMICs. Respondents were asked to answer all survey questions in relation to the externally-funded health systems research project in a LMIC(s) on which they had spent the most time during the past five years—referred to as the “index study.” Results: Data analysis indicates that 30% of respondents participated in health systems research focused on populations in LMICs that are worst-off in terms of their health. All respondents participated in research that focused on improving equity in at least one aspect of health systems (e.g. service utilisation, quality of care, insurance coverage). Actors solely from high-income countries (principal investigators, co-investigators, funders) were primarily responsible for selecting research questions in 36% of index studies. 28% of studies that involved collaboration resulted in LMIC researchers being awarded a graduate degree. The most common forms of institutional capacity-building in collaborative studies were increased links with policymakers (72%), increased links with other institutions (64%), and the training of researchers in HSR (51%). Of the completed intervention studies that demonstrated efficacy, 50% of those interventions had been implemented poststudy and 25% would be implemented soon. Conclusions: These findings suggest that health systems research in LMICs is equity oriented in some respects, but has clear room for improvement, particularly in terms of the selection of populations upon whom to focus studies.