Editorial BMJ Glob Health: first published as 10.1136/bmjgh-2020-004684 on 18 December 2020. Downloaded from Embedded research to advance primary health care
1 2 2 3 Soumya Swaminathan, Kabir Sheikh , Robert Marten , Martin Taylor, 4 3 5 6 Manoj Jhalani, Ogochukwu Chukwujekwu, Luwei Pearson, Pascale Allotey , Jean Gough,7 Robert W Scherpbier,8 Anuradha Gupta,9 Marijke Wijnroks,10 Muhammad Ali Pate,11 Gaston Sorgho,11 Orin Levine,12 13 14 15 Felicity Goodyear-Smith , Thiagarajan Sundararaman, Hernan Montenegro, 15 2 Suraya Dalil, Abdul Ghaffar
To cite: Swaminathan S, Realising renewed efforts to accelerate on the philosophies of research coproduc- Sheikh K, Marten R, et al. progress towards universal health coverage, tion and the institutionalisation of research Embedded research to advance primary health manage health emergencies and create both endorsed and advocated for in the care. BMJ Global Health healthier populations requires integrated WHO Strategy on Health Policy and Systems 2020;5:e004684. doi:10.1136/ action on system-wide challenges. One of the Research (2012) and the WHO World Health bmjgh-2020-004684 best ways to do this is to focus on primary Report on Research for Universal Health health care (PHC). Advancing PHC needs the Coverage (2013). Since these reports, this Received 7 December 2020 support of a robust learning agenda—encom- approach has grown in the scale of its applica- Accepted 8 December 2020 passing questions on how to improve both tion and achieved demonstrable impact. essential and emergency services, engage Embedded research has strengthened and empower communities and address the efforts to improve PHC—from helping develop broader determinants of health through guidelines and support packages for village multisectoral action. Nowhere has the impor- health committees in India5 to the creation of tance of learning been more compellingly action plans in Nigeria for improving immu- exposed than during the ongoing COVID-19 nisation services in underserved areas. For pandemic, where the ability of countries to example, immunisation coverage in parts of learn from experience has often determined Nigeria increased from 61% to 91%.6 The
the success or failure of their responses. current COVID-19 pandemic also exempli- http://gh.bmj.com/ How research informs policy and action fies how countries focused on learning can is variable, and in low- and middle-income improve their responses. For instance, Thai- countries, the contribution of research to land’s long-standing investments in PHC and decision-making is often limited. Tradition- in embedded research within the Ministry of ally, PHC research priorities are determined Health have provided the basis for its response 7 by funders or researchers based in high- to COVID-19. on September 29, 2021 by guest. Protected copyright. income countries.1 This has constrained Most importantly, embedded research is the utility of this research by overlooking now embraced by its end users—health policy- important local context. Furthermore, tradi- makers. Policymakers increasingly depend on tional approaches to research are often static support from researchers and communities to and not responsive.2 Embedding research to develop and implement policies to respond support policymaking is a demand-driven and to the ongoing COVID-19 pandemic. In July contextually sensitive approach to redress this 2020, one hundred and thirty policymakers imbalance and create a learning approach to and researchers from more than 20 coun- advance PHC.3 tries in Asia and the Pacific came together to © Author(s) (or their employer(s)) 2020. Re-use Embedded research is research carried endorse the embedded research approach permitted under CC BY. out as an integrated and systematic part of and highlight PHC research priorities with Published by BMJ. decision-making and implementation.4 It a focus on the COVID-19 response.8 Embed- For numbered affiliations see involves a continuous role for policymakers, ding research needs to become an integral end of article. implementers and communities to collabo- part of the global push for PHC. Considering Correspondence to rate and conduct research. It improves owner- the ongoing COVID-19 pandemic, embedded Dr Robert Marten; ship, and consequently the utilisation of PHC research should focus on scaling up and martenr@ who.int findings by its end users. The approach builds managing critical emergency services and
Swaminathan S, et al. BMJ Global Health 2020;5:e004684. doi:10.1136/bmjgh-2020-004684 1 BMJ Global Health BMJ Glob Health: first published as 10.1136/bmjgh-2020-004684 on 18 December 2020. Downloaded from continuing essential health services. In alignment with Funding The authors have not declared a specific grant for this research from any the 2018 PHC Astana Declaration, it is equally important funding agency in the public, commercial or not-for-profit sectors. to engage communities and address broader health Competing interests None declared. determinants and multisectoral engagement. Patient consent for publication Not required. As countries plan massive new COVID-19 vaccination Provenance and peer review Not commissioned; externally peer reviewed. efforts, embedded research will be crucial. Operation- Data availability statement All data relevant to the study are included in the alising this agenda requires catalysing local researcher– article. policymaker collaborations. Mainstreaming learning into Open access This is an open access article distributed in accordance with the the PHC effort requires allocating human and financial Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits resources for embedded research and greater efforts others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, to build capacity for PHC research. External funders and indication of whether changes were made. See: https://creativecommons.org/ can also provide catalytic support for locally produced licenses/by/ 4.0/. research as well as strengthen local capacities to under- take and use research. Investing resources in embedded ORCID iDs Kabir Sheikh http://orcid. org/0000- 0003-4755- 2075 research will contribute relevant, timely and contextual Robert Marten http://orcid. org/0000- 0002-2416- 2309 knowledge to improve and inform health policies—this Pascale Allotey http://orcid. org/0000- 0002-6942- 5774 is critical to advance PHC, manage COVID-19 and create Felicity Goodyear-Smith http://orcid. org/0000- 0002-6657- 9401 a healthier post-COVID-19 future. Abdul Ghaffar http://orcid. org/0000- 0002-8629- 4526
Author affiliations 1Science Division, Organisation Mondiale de la Sante, Genève, Switzerland 2Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland REFERENCES 3World Health Organization Regional Office for the Western Pacific, Manila, 1 Reidpath DD, Allotey P. The problem of 'trickle-down science' Philippines from the Global North to the Global South. BMJ Glob Health 4World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, 2019;4:e001719. 2 Sheikh K, Agyepong I, Jhalani M, et al. Learning health systems: an India 5 empowering agenda for low-income and middle-income countries. UNICEF, New York, New York, USA Lancet 2020;395:476–7. 6IIGH, United Nations University International Institute for Global Health, Cheras, 3 World Health Organization. Strategy on health policy and Kuala Lumpur, Malaysia systems research: changing the Mindset. Geneva: World Health 7UNICEF, Kathmandu, Nepal Organization, 2012. http://apps.who.int/iris/bitstream/10665/77942/1/ 8UNICEF, Geneva, Switzerland 9789241504409_eng.pdf 9 4 Ghaffar A, Langlois EV, Rasanathan K, et al. Strengthening health GAVI Alliance, Geneva, Genève, Switzerland systems through embedded research. Bull World Health Organ 10 The Global Fund to Fight AIDS, Tuberculosis and Malaria, Grand-Saconnex, 2017;95:87. Genève, Switzerland 5 Ved R, Sheikh K, George AS, et al. Village health sanitation and 11World Bank, Washington, DC, USA nutrition committees: reflections on strengthening community health 12Bill & Melinda Gates Foundation, Seattle, Washington, USA governance at scale in India. BMJ Glob Health 2018;3:e000681. 13 6 Akwataghibe NN, Ogunsola EA, Broerse JEW, et al. Exploring factors General Practice, University of Auckland Faculty of Medical and Health Sciences, influencing immunization utilization in Nigeria-A mixed methods study. http://gh.bmj.com/ Auckland, New Zealand Front Public Health 2019;7:392. 14 People's Health Movement, Mumbai, India 7 Tangcharoensathien V, Witthayapipopsakul W, Panichkriangkrai W, 15World Health Organization, Geneva, Switzerland et al. Health systems development in Thailand: a solid platform for successful implementation of universal health coverage. Lancet Twitter Kabir Sheikh @docsheikh, Robert Marten @martenrobert and Pascale 2018;391:1205–23. Allotey @PascaleAllotey 8 World Health Organization. Embedded primary health care research: asking policy-makers the questions, 2020. Available: https://www.
Contributors KS and RM led the drafting of this piece with overall direction from who.int/alliance-hpsr/news/2020/embedded-phc-research-asking- on September 29, 2021 by guest. Protected copyright. SS and AGh and inputs from all other authors. policy-makers/en/
2 Swaminathan S, et al. BMJ Global Health 2020;5:e004684. doi:10.1136/bmjgh-2020-004684