Improving the synthesis of health systems research: the Advisory Group

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Why does the WHO need an Advisory Group on Health Systems Research Synthesis?

Although there is growing recognition of the importance of systematic reviews to both inform policy decisions and produce guidance for health systems, a number of important methodological challenges remain.

There is a need to better understand the processes supporting the transparent use of review findings in complex health systems decisions, and while there is a multiplicity of initiatives in the field, better coordination is needed.

The Alliance for Health Policy and Systems Research (Alliance), a partnership housed within the World Health Organization (WHO), therefore convened an Advisory Group on Health Systems Research (HSR) synthesis to bring together different collaborations, groups and institutions interested in HSR synthesis and its use in the decision-making processes.

How did the Advisory Group form?

Since 2009, a series of consultative meetings led to the development of recommendations to improve international collaboration on HSR synthesis, with a focus on low- and middle-income countries’ needs and capacity building.

The consultations focused on two broad issues pertaining to HSR synthesis: the benefits and challenges associated with collaborative efforts to synthesise and translate health systems evidence; and the range of approaches to evidence syntheses needed to address the types of questions raised in decision-making processes for strengthening health systems.

The Advisory Group was established to play a central role in advancing the science of HSR synthesis and knowledge translation by developing and strengthening networks among individuals, groups, institutions and collaborations that have an interest in this field.

Why is it important to include representatives of the Cochrane and Campbell Collaborations?

Cochrane and the Campbell Collaboration play a leading role in promoting decisions about health and health care systems which are informed by high-quality, relevant and up-to-date synthesized research evidence.

These institutions support evidence-informed health systems decision-making by encouraging and producing robust, relevant, and accessible systematic reviews and other synthesized research evidence. In addition, they both foster global co-operation, teamwork, and open and transparent communication and decision-­making, thus supporting the Advisory Group’s efforts to strengthen networks in HSR synthesis.

What are the main aims of the Advisory Group?

The main aims of the Advisory group are the following:

1. Advancing the science of HSR synthesis by developing and strengthening networks between individuals, institutions, collaborations and groups that have an interest in HSR synthesis and translation.

2. Providing support, information sharing, and coordination related to setting priorities for HSR synthesis regionally and globally and increasing capacity building in HSR synthesis and translation (particularly in relation to low- and middle-income countries).

3. Expanding the range of study designs that can be included in reviews of the effectiveness of HSR interventions.

4. Piloting a system for producing policy relevant syntheses/systematic reviews of HSR addressing questions other than effectiveness.

5. Advocating for and supporting a common global database for all types of systematic reviews of HSR.

6. Advocating for and supporting prospective registration of all protocols for systematic reviews when they are planned.

What has the Advisory Group achieved so far?

The group shares information, identifies where further methodological work or training is needed, and builds cross-institutional links. Thereby, with its anchoring at the Alliance and WHO, it serves as a global focal point for coordination around the issues.

The Advisory Group, together with the Alliance more broadly, has contributed to setting priorities for health systems research on a global scale.

The Advisory Group, together with the Alliance more broadly, has contributed to setting priorities for health systems research on a global scale. The systematic review centres funded by the Alliance have developed priority-setting approaches for HSR syntheses and, in doing so, have implemented different mechanisms to engage with decision-makers to increase the likelihood of the synthesised evidence being applied in practice.

Additionally, the Advisory Group advocates for, and supports the development of, user-friendly summaries of HSR syntheses, and stresses the importance of sensitization workshops for users of HSR syntheses, institutionalized mechanisms for researcher-user interactions, and knowledge translation activities.

The Alliance, in collaboration with the Harvard School of Public Health and with guidance from the Advisory Group, organized a workshop in 2013 on the integration of quasi-experimental studies into effectiveness reviews of health systems interventions and reforms.

One of the outputs of the workshop and the background work commissioned by the Alliance is the identification of five quasi-experimental study designs frequently employed in health systems research: natural experiments, instrumental variable analyses, regression discontinuity analyses, interrupted times series studies, and difference studies including controlled before-and-after designs, difference-in-difference designs and fixed effects analyses of panel data.

In addition, the Advisory Group acknowledges the utility, and promotes the use, of repositories of evidence synthesis in the field such as Health Systems Evidence, a database for all types of systematic reviews of HSR.

The Advisory Group also initiated discussions with PROSPERO, the International prospective register of systematic reviews, regarding how the full range of health systems systematic reviews could be accommodated. This feedback led to modifications to provide a system sufficiently flexible to accommodate a range of review types.

What’s next on their agenda for the Advisory Group?

The Advisory Group continues to identify and address key challenges faced by those undertaking HSR synthesis, including issues relevant to strengthening dialogue and collaboration between producers and users of evidence syntheses, as well as the uptake of findings from these reviews. Further work of the Advisory Group aims to address these challenges, including capacity development and methods development.

Ongoing work by members of the Advisory Group includes developing norms and standards for qualitative and mixed-methods reviews, and designing approaches to assess how much confidence to place in evidence from different types of health systems research syntheses.

We believe a coordination mechanism like the Advisory Group can fulfil the need for aligning interests, methods and approaches, and for securing interest and investments in the field of health systems research synthesis globally.