in looking at how the accumulated impact evaluation evidence in the social sciences is distributed — perhaps with an eye toward making the case for where to concentrate new funding — there is a tendency to categorize studies by sector. with this lens, it is clear that the evidence base remains dominated by health, social protection, agriculture, sanitation.
.
this does not reflect the actual research questions or topics asked by these studies. for example, there are many ‘health’ studies — distributing health products, generally — but very few on health systems. the line is, of course, not clear: would vouchers to encourage entering the health system in terms of institutional/hospital-based delivery of babies fall in the distributing ‘stuff’ or building ‘systems’ category? such parsing would take further and careful thought.
.
nevertheless, for those looking at where the bulk of the literature falls — and where new research is needed — it may be helpful to move beyond sector codes (which are easier to find and seem to dominate the classification strategies of IEs) and start teasing apart ‘stuff’ from ‘systems’/institutions work. to do otherwise is fairly lazy thinking.
.
a small addition, added on 31 october 2015, based on a new paper called ‘when will we ever learn… to change policy?”
In terms of topical focus, a majority of evaluations in health focus on prevention, control and treatment of specific diseases or on the effects of specific health technologies while less research focuses on the health systems that would support these interventions at scale.4 There are critical evidence gaps, for example, regarding front line health workers (Frymus et al., 2013) as well as managers in health systems (Rockers and Bärnighausen, 2013). An ongoing, wide-ranging systematic review of strategies to improve healthcare provider performance rated only 14% of 490 included studies as having a “low” risk of bias (Rowe et al., 2014).
.
This relative lack of quality impact evaluations in health systems research may be due in part to a lack of funding as donors in health prefer to support other types of health research that is seen as more prestigious or science-driven (Hafner and Shiffman, 2013). Health systems are also complex, involving multiple elements that affect ultimate service delivery (Hafner and Shiffman, 2013). This relative lack of rigorous evaluations of approaches to strengthen health service delivery in developing countries is not for a lack of policy interest or resources devoted to this issue (Hafner and Shiffman, 2013, Willey et al., 2013).
.
Strengthening health systems is one of the top priorities of the WHO and numerous multi- and bi-lateral organizations have been working in partnership with ministries of health in efforts to improve health service delivery (Hafner and Shiffman, 2013, Willey et al., 2013)… Learning from existing efforts to strengthen health delivery, particularly those at scale, requires collaboration between researchers and implementing agencies…
Heather E. Lanthorn 