Health research systems in low-resource settings: From system analysis, understanding, to system building and strengthening: Palestine Case Study

Introduction: The World Health Organization has proposed a global strategy to build a robust Health Research System (HRS) resources and infrastructural capacity. The existing global health challenges, e.g. COVID-19 pandemic and climate change, underlined the need for research and evidence. There is a growing recognition from the global health community of research to tackle these challenges, and calls for urgent investment in establishing, rebuilding, and strengthening national HRS. The best prospect to better prevent, control, manage, and respond to the current and future epidemics and crises is founding the HRS to address the knowledge gaps, boost research use, and inform public health policies and interventions, specially in low-resource settings. There are different challenges in the settings, including absence of HRS, fragmented systems, and limited capacities and resources.

Aim: To address these challenges particularly in the settings that have not initiated yet or are in the process building their own national HRSs, a comprehensive system analysis that uses a qualitative methodology and framework includes different levels of the health system and relevant sectors and disciplines is an essential start towards understanding and strengthening HRS. This study opens new avenues in the field of health policy and system research through conducting this system analysis approach in Palestine as an example of low-resoruce setting and it can be a transferable exercise to any other similar context. Perceptions of HRS actors and performers were analysed to understand the status of system, identify its gaps, and propose policy solutions to strengthen the system.

Methods: This qualitative methodology targeted 3 health sectors: government, academia, and local and international organizations. Fifty-two in-depth interviews and 6 focus group discussions were conducted with key informants who were selected purposively. Data were analysed using MAXQDA 12.

Findings: Conceptually, stakeholders have limited understanding of HRS concepts, importance, and application. Stakeholders describe HRS as underperforming and research is not on the leadership agenda. Regarding stewardship functions, they are insufficiently established, and there are substantial political, structural, resource and capacity gaps, weak Ethical Review and Clearance ERC, and lack of national policy and consensus on priorities with limited knowledge and experience of research prioritization. The HRS stakeholders’ involvement is low, especially society and private sector, with poor representation of academia in decision-making. Stakeholders’ roles are undefined, international contribution is weak, and resources for research are deficit, misallocated, and unsustainable, and mainly funded individually and externally with donors’ conditionalities. Despite the availability of competent personnel, the overall HRS resources and capacity, such as human and financial resources, and facilities, forms a central challenge. Despite the improved HR growth, health research quality is moderate and its evidence is not considered an essential decision-making source due to lack of knowledge prodecuers and users interfance, awareness, and applied research crediability and availability. Knowledge transfer and translation is not well conceptualized and inappropriately performed. Lack of governance and regulatory frameworks, coordination, stakeholders involvement, strengthening strategy, resource allocation, systematic and reliable data, evidence-informed culture, and environmental impacts and political fluctuations are the main common gaps.

Conclusion: The overall status of HRS in Palestine is still lacking and major challenges persist where the pace of strengthening efforts is steady. There is an emphasis that building a successful HRS and strengthening its capacities is an imperative step and real investment opportunity for evidence-based and knowlegd-oriented health system. Political commitment, consolidated leadership structure, operational capacity building strengthening strategy, resources mobilization, and sovereignty are key requirements. The study provides a roadmap that includes three directions of actions and this roadmap could be transferred and applied in Palestine and any other similar settings based on the following recommendations.

Keywords: health research system, system analysis, understanding, strengthening, low-resource setting, Palestine