Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States of America.
University of Miami, 230 Ashe Building, 1252 Memorial Drive, Coral Gables, Florida, 33146, United States of America.
Health Res Policy Syst. 2018 May 23;16(1):43. doi: 10.1186/s12961-018-0317-x.
We provide a historical analysis of the evolution of the field of health policy and systems research (HPSR) since 1996. In the mid-1990s, three main challenges affected HPSR, namely (1) fragmentation and lack of a single agreed definition of the field; (2) ongoing dominance of biomedical and clinical research; and (3) lack of demand for HPSR. Cross-cutting all these challenges was the problem of relatively limited capacity to undertake high quality HPSR. Our discussion analyses how these problems were addressed so as to facilitate growth and enhanced recognition of the field.
HPSR has benefitted significantly from increased recognition of the importance of strong health systems to health outcomes, particularly those linked to the Millennium Development Goals. In addition to this, some of the challenges described above have been addressed through (1) sustained advocacy for the importance of HPSR, (2) efforts to clarify the content and focus of the field, and (3) growing appreciation of and efforts to engage health practitioners and policy-makers in HPSR. While advocacy for the field of HPSR was initially fragmented, since the late 1990s there has been a consistent flow of focusing events and publications that have served to enhance the profile and understanding of the field. There have also been multiple efforts to establish greater coherence within the field, for example, interrogating the distinctions between health services research and health systems research, and how critical the "P" for policy is to HPSR. Finally, HPSR has developed at the same time as growing interest in evidence-informed policy and, more recently, implementation science, which have served to underscore the relevance and utility of HPSR to policy- and decision-makers.
During the past two decades, the field of HPSR has developed significantly, leading to enhanced clarity about its purpose, activity levels and utility. Several challenges remain that will need to be addressed in the decades ahead.
本文对 1996 年以来卫生政策和体系研究（HPSR）领域的发展进行了历史分析。20 世纪 90 年代中期，HPSR 主要面临着三个挑战，分别是（1）领域碎片化，缺乏单一的、公认的定义；（2）生物医学和临床研究持续占据主导地位；（3）对 HPSR 的需求不足。所有这些挑战都存在一个共同的问题，即开展高质量 HPSR 的能力相对有限。我们的讨论分析了如何解决这些问题，以促进该领域的发展和增强其认可度。
HPSR 因人们日益认识到强大的卫生系统对健康结果的重要性而受益匪浅，尤其是那些与千年发展目标相关的结果。除此之外，上述挑战中的一些已经通过以下方式得到解决：（1）持续倡导 HPSR 的重要性；（2）努力明确该领域的内容和重点；（3）提高对卫生从业人员和政策制定者参与 HPSR 的认识并努力促使其参与。虽然 HPSR 的倡导最初是零散的，但自 20 世纪 90 年代末以来，一直有聚焦活动和出版物不断涌现，这些活动和出版物提高了该领域的知名度和认知度。此外，还进行了多次努力以增强该领域的一致性，例如，探讨卫生服务研究与卫生系统研究之间的区别，以及政策对 HPSR 的重要性。最后，HPSR 是在人们对循证政策越来越感兴趣的背景下发展起来的，最近，实施科学也对其产生了影响，这些都突显了 HPSR 对政策制定者和决策者的相关性和实用性。
在过去的二十年中，HPSR 领域发展迅速，使其目的、活动水平和实用性更加明确。未来几十年仍将面临一些挑战，需要加以解决。
