Is there good research evidence for health systems interventions?

March 21, 2012

Research evidence is key to developing strong health systems, but the assessment of such evidence is not always straightforward. This week in PLoS Medicine, the last paper in a three-part series on health systems guidance addresses the question of how much confidence to place in different types of research evidence, which the authors argue is key to informing judgements regarding policy options to address health systems problems.

Simon Lewin from the Norwegian Knowledge Centre for the Health Services in Oslo, Norway and colleagues say that useful tools are available to assess evidence of the effectiveness of various health systems interventions, but that there remains a need to develop tools to assist judgements regarding evidence from systematic reviews on other key factors such as the acceptability of policy options to stakeholders, implementation feasibility, and equity.

In a related Perspective article that reflects on the entirety of the three-part health systems guidance series, David Peters and Sara Bennett from Johns Hopkins University in Baltimore, USA (uninvolved in the series) say that the series offers important contributions to improving the quality of evidence-informed decision-making in health systems. But they also caution against being too rigid when developing approaches to the development of guidelines and applying evidence to policy.

Peters and Bennett conclude that “Recognizing the diversity of stakeholders and complexity of health systems issues, it will be important to ensure that evidence-informed guidelines that emerge are tested with continued humility and skepticism, and that they do not become rigid models for inquiry dominated by a limited number of disciplines. They should not serve to blind us toward the need to address a wide variety of questions and incorporate the different types of evidence brought to bear by many fields of science. Further guidance is one important way to shape policy, but we must not fail to situate it in the broader context of sustained dialogue between researchers and policy makers.”


Article by Simon Lewin and colleagues

Funding: The development of the Handbook was supported by a grant to the WHO by the Rockefeller Foundation, which had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The paper represents the views of the authors and neither WHO nor the Rockefeller Foundation.

Competing Interests: The Swiss Tropical and Public Health Institute and the Norwegian Knowledge Centre for the Health Services received funds from the WHO for the contributions of DD, PS, LB, SL, and XBC to developing a Handbook to produce health systems guidance, and some of this work is reported in this article. DG is a member of the PLoS Medicine Editorial Board. EAA and GEV are members of the GRADE Working Group. All other authors declare no competing interests.

Citation: Lewin S, Bosch-Capblanch X, Oliver S, Akl EA, Vist GE, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Assessing How Much Confidence to Place in the Research Evidence. PLoS Med 9(3): e1001187. doi:10.1371/journal.pmed.1001187

Simon Lewin
Norwegian Knowledge Centre for the Health Services

Perspective by David Peters and Sara Bennett

Funding: No specific funding was provided for writing this article.

Competing Interests: SB in the past has been a co-author on papers with authors of the health systems guidance series: Lucy Gilson (2011), John Lavis (2009), Gunn Vist (2008), Andy Haines (2004), and Rifat Atun (unpublished policy brief in 2008). SB was employed under the same grant programme during the 1990s with Gilson. John Lavis and Lucy Gilson have served on the Scientific and Technical Advisory Committee of the Alliance for Health Policy and Systems Research, and John-Arne Rottingen is the Chair of the Alliance Board, on which SB also serves. Fadi El-Jardali and Lucy Gilson are on the Editorial Advisory Board of the journal Health Policy and Planning, for which SB is a co-editor. DHP has declared that no competing interests exist.

Citation: Peters DH, Bennett S (2012) Better Guidance Is Welcome, but without Blinders. PLoS Med 9(3): e1001188. doi:10.1371/journal.pmed.1001188

David Peters
Johns Hopkins University Bloomberg School of Public Health
United States of America

First paper in PLoS Medicine series on health systems guidance, published March 6th:

Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, R√łttingen J-A, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development. PLoS Med 9(3): e1001185. doi:10.1371/journal.pmed.1001185

Second paper in PLoS Medicine series on health systems guidance, published March 13th:

Lavis JN, R√łttingen J-A, Bosch-Capblanch X, Atun R, El-Jardali F, et al. (2012) Guidance for Evidence-Informed Policies about Health Systems: Linking Guidance Development to Policy Development. PLoS Med 9(3): e1001186. doi:10.1371/journal.pmed.1001186

Contact: Clare Weaver
Public Library of Science


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