González-Block Miguel Angel
Health Systems Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
Health Res Policy Syst. 2009 Sep 30;7:22. doi: 10.1186/1478-4505-7-22.
Health systems research is being increasingly called upon to support scaling up of disease control interventions and to support rapid health sector change. Yet research capacity building and pay-back take years or even decades to be demonstrated, while leadership and institution building are critical for their success. The case of Mexico can be illustrative for middle income countries and emerging economies striving to build health research systems.
Historical reflection suggests the relationship between health sector reforms and economic crisis, on the one hand, and research capacity building and payback, on the other. Mexico's post-revolutionary background and its three health sector reforms are analyzed to identify the emphases given to health systems research.
The first wave of health reform in the 1940s emphasized clinical and epidemiological research. Health systems research was not encouraged in a context of rapid economic development and an authoritarian regime. In contrast, health systems research was given a privileged place with the second wave of health reforms in the 1980s, which addressed health system coordination, decentralization and the universal right to health in a context of a deep economic crisis. The third wave of health reforms between 2003 and 2006 was based on the health system models proposed through research in the 90s. The credibility gained by research institutions was critical to ensure government uptake. Research influence can be traced through the role it played in defining a problem, in designing innovative insurance mechanisms and in establishing evaluation frameworks. It is argued that the Ministry of Health's budget increase of 56% between 2003 and 2006 and the reductions in inequity are pay-back to research investments since the 1980s.
卫生系统研究越来越多地被要求支持扩大疾病控制干预措施，并支持卫生部门的快速变革。然而，研究能力建设和回报需要数年甚至数十年才能显现，而领导力和机构建设对其成功至关重要。墨西哥的案例对于努力建立卫生研究系统的中等收入国家和新兴经济体具有借鉴意义。
历史反思揭示了一方面卫生部门改革与经济危机之间的关系，另一方面研究能力建设与回报之间的关系。分析墨西哥革命后的背景及其三次卫生部门改革，以确定对卫生系统研究的重视程度。
20世纪40年代的第一轮卫生改革强调临床和流行病学研究。在经济快速发展和威权政权的背景下，卫生系统研究未得到鼓励。相比之下，20世纪80年代的第二轮卫生改革给予了卫生系统研究特殊地位，这轮改革在深度经济危机背景下解决了卫生系统协调、权力下放和健康普遍权利问题。2003年至2006年的第三轮卫生改革基于90年代通过研究所提出的卫生系统模式。研究机构获得的信誉对于确保政府采纳至关重要。研究的影响力可以通过其在界定问题、设计创新保险机制和建立评估框架中所起的作用来追溯。有人认为，2003年至2006年期间卫生部预算增加56%以及不公平现象的减少是自20世纪80年代以来对研究投资的回报。
