what role can health policy and systems research play in supporting responses to covid 19 CORD-Papers-2022-06-02 (Version 1)

Title: What role can health policy and systems research play in supporting responses to COVID-19 that strengthen socially just health systems?
Published: 2020-10-06
Journal: Health Policy Plan
DOI: 10.1093/heapol/czaa112
DOI_URL: http://doi.org/10.1093/heapol/czaa112
Author Name: Gilson Lucy
Author link: https://covid19-data.nist.gov/pid/rest/local/author/gilson_lucy
Author Name: Marchal Bruno
Author link: https://covid19-data.nist.gov/pid/rest/local/author/marchal_bruno
Author Name: Ayepong Irene
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ayepong_irene
Author Name: Barasa Edwine
Author link: https://covid19-data.nist.gov/pid/rest/local/author/barasa_edwine
Author Name: Dossou Jean Paul
Author link: https://covid19-data.nist.gov/pid/rest/local/author/dossou_jean_paul
Author Name: George Asha
Author link: https://covid19-data.nist.gov/pid/rest/local/author/george_asha
Author Name: Guinaran Ryan
Author link: https://covid19-data.nist.gov/pid/rest/local/author/guinaran_ryan
Author Name: Maceira Daniel
Author link: https://covid19-data.nist.gov/pid/rest/local/author/maceira_daniel
Author Name: Molyneux Sassy
Author link: https://covid19-data.nist.gov/pid/rest/local/author/molyneux_sassy
Author Name: Prashanth N S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/prashanth_n_s
Author Name: Schneider Helen
Author link: https://covid19-data.nist.gov/pid/rest/local/author/schneider_helen
Author Name: Shawar Yusra
Author link: https://covid19-data.nist.gov/pid/rest/local/author/shawar_yusra
Author Name: Shiffman Jeremy R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/shiffman_jeremy_r
Author Name: Sheikh Kabir
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sheikh_kabir
Author Name: Spicer Neil
Author link: https://covid19-data.nist.gov/pid/rest/local/author/spicer_neil
Author Name: Van Belle Sara
Author link: https://covid19-data.nist.gov/pid/rest/local/author/van_belle_sara
Author Name: Whyle Eleanor
Author link: https://covid19-data.nist.gov/pid/rest/local/author/whyle_eleanor
sha: a27c95e8f75378b7599ff94a2c8055d7c3477e88
license: no-cc
license_url: [no creative commons license associated]
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 33020815
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/33020815
pmcid: PMC7665452
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665452
url: https://www.ncbi.nlm.nih.gov/pubmed/33020815/ https://doi.org/10.1093/heapol/czaa112
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Keywords Extracted from Text Content: building-among others-on people line collateral shouldernot COVID-19 lines donors national-sub-national longoverdue CPVI-19 women Arts-based LGBTQIþ fed-back HPS cultures-as human root Loewenson questing people-and line health V C COVID bodies e-learning/online Shamasunder LGBTQIþ service etc.-preferably COVIDprovoked Wuhan Buse, 2008 patients lockdowns NGOs PPE humans Author(s LMICs single-women households London School of Hygiene
Extracted Text Content in Record: First 5000 Characters:To say that we live in turbulent times is a massive understatement. COVID-19 ruthlessly exposes the fault lines of health services and systems, and the responses put in place to prevent its spread or mitigate its effects may affect people more than the actual infection. The outbreak in Wuhan quickly grew to a pandemic that has affected countries and regions all over the world in many, and as of yet, little understood ways. This is a global infectious disease outbreak of a scale not seen since the Spanish Flu. For many countries, it is an extreme stress test of the health system and of society at large. All over the world, people, patients, providers, health service managers, health and other sectoral policymakers and politicians, are dealing with high levels of uncertainty and severe challenges to the resilience of their systems. The governance not only of health, at national and global levels, but also of trade, communication and globalization itself is under scrutiny. The virus exposes, yet again, the structural determinants that lead to health inequalities (Shadmi et al., 2020) , including racism and colonial legacies. Many see this as a key moment of reckoning, nationally and globally: the pandemic and its responses have precipitated unprecedented economic, social and health crises that may shape the decades ahead. At the same time, the role of health systems in responding to COVID-19 and the need to (re-)invest in these systems through the state offers transformative opportunities. In the light of this, we outline how health policy and systems research (HPSR) can both address current short-term challenges, and support the system transformations needed to strengthen peoplecentred and equitable health systems over the long term. The HPSR community has responded to the COVID-19 pandemic quickly, following the wave of publications on epidemiological and clinical aspects of the disease. Initial studies have included those describing the capacity of hospitals, intensive care units and first line health V C The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com services required to respond to the disease, and those reporting specific experiences at community and local levels, including the denial of care and the inequitable effects of disease control measures. Many commentaries and calls for action have been published (COVID-19 Clinical Research Coalition, 2020; English et al., 2020; Shamasunder et al., 2020) . Inevitably, however, due to the acute nature of the crisis, few papers have yet focused on how health systems are coping with or adapting to the pandemic, or how health policy-making and decision-making has (or has not) changed in this time of crisis. Yet, there is an urgent need to develop a structured research agenda to inform health policy and system responses to COVID-19 that can move us beyond the current crisis, and into the future. This commentary makes proposals towards such an agenda. In line with the audience of Health Policy and Planning, we specifically focus on low-and middle-income country (LMIC) HPSR needs, drawing on our collective experience as a group of HPS researchers based around the world. The Health System Research and Health Policy Processes section editors initiated the process and purposefully sought inputs from HPS researchers in a range of LMICs . The process was also supported by both the Alliance for Health Policy and Systems Research and Health System Global. We organized an online consultation process, whereby the first authors invited the coauthors to identify research priorities, questions and themes. In a second round, these were compiled and categorized in themes and sent out for further comment. In a final round, the issues and questions within each theme were examined and gaps and overlaps eliminated. We consider, first, key dimensions of the overall approach of HPSR to frame the further work needed, and second, in an annex, we suggest an initial categorization and listing of possible research topics. We present these ideas to prompt wider reflection-and we conclude by proposing ways of engaging further with these ideas, acknowledging the fast-changing nature of the pandemic and the need to review research priorities regularly. We start by reviewing how the defining features of HPSR, including the systems approach, multi-disciplinarity and the emphasis on policy and power may be applied to the pandemic. One defining feature of HPSR is its systems approach. This frames COVID-19 and the responses to it in a critical-analytical perspective, zooming out from specific experiences to seek the root causes of the differential impact of the pandemic across individuals and population groups as a function of society's power structures and dominant cultures-as reflected in their social, political and economic position, and
Keywords Extracted from PMC Text: long-overdue Wuhan root human fed-back Shamasunder cultures— collateral lockdowns humans women COVID-19 people COVID LGBTQI+ single-women households shoulder— people's HPS patients Arts-based line LMICs Loewenson Buse, 2008 people- bodies initiatives,1 's
Extracted PMC Text Content in Record: First 5000 Characters:To say that we live in turbulent times is a massive understatement. COVID-19 ruthlessly exposes the fault lines of health services and systems, and the responses put in place to prevent its spread or mitigate its effects may affect people more than the actual infection. The outbreak in Wuhan quickly grew to a pandemic that has affected countries and regions all over the world in many, and as of yet, little understood ways. This is a global infectious disease outbreak of a scale not seen since the Spanish Flu. For many countries, it is an extreme stress test of the health system and of society at large. All over the world, people, patients, providers, health service managers, health and other sectoral policymakers and politicians, are dealing with high levels of uncertainty and severe challenges to the resilience of their systems. The governance not only of health, at national and global levels, but also of trade, communication and globalization itself is under scrutiny. The virus exposes, yet again, the structural determinants that lead to health inequalities (Shadmi et al., 2020), including racism and colonial legacies. Many see this as a key moment of reckoning, nationally and globally: the pandemic and its responses have precipitated unprecedented economic, social and health crises that may shape the decades ahead. At the same time, the role of health systems in responding to COVID-19 and the need to (re-)invest in these systems through the state offers transformative opportunities. In the light of this, we outline how health policy and systems research (HPSR) can both address current short-term challenges, and support the system transformations needed to strengthen people-centred and equitable health systems over the long term. The HPSR community has responded to the COVID-19 pandemic quickly, following the wave of publications on epidemiological and clinical aspects of the disease. Initial studies have included those describing the capacity of hospitals, intensive care units and first line health services required to respond to the disease, and those reporting specific experiences at community and local levels, including the denial of care and the inequitable effects of disease control measures. Many commentaries and calls for action have been published (COVID-19 Clinical Research Coalition, 2020; English et al., 2020; Shamasunder et al., 2020). Inevitably, however, due to the acute nature of the crisis, few papers have yet focused on how health systems are coping with or adapting to the pandemic, or how health policy-making and decision-making has (or has not) changed in this time of crisis. Yet, there is an urgent need to develop a structured research agenda to inform health policy and system responses to COVID-19 that can move us beyond the current crisis, and into the future. This commentary makes proposals towards such an agenda. In line with the audience of Health Policy and Planning, we specifically focus on low- and middle-income country (LMIC) HPSR needs, drawing on our collective experience as a group of HPS researchers based around the world. The Health System Research and Health Policy Processes section editors initiated the process and purposefully sought inputs from HPS researchers in a range of LMICs . The process was also supported by both the Alliance for Health Policy and Systems Research and Health System Global. We organized an online consultation process, whereby the first authors invited the co-authors to identify research priorities, questions and themes. In a second round, these were compiled and categorized in themes and sent out for further comment. In a final round, the issues and questions within each theme were examined and gaps and overlaps eliminated. We consider, first, key dimensions of the overall approach of HPSR to frame the further work needed, and second, in an annex, we suggest an initial categorization and listing of possible research topics. We present these ideas to prompt wider reflection—and we conclude by proposing ways of engaging further with these ideas, acknowledging the fast-changing nature of the pandemic and the need to review research priorities regularly. We start by reviewing how the defining features of HPSR, including the systems approach, multi-disciplinarity and the emphasis on policy and power may be applied to the pandemic. One defining feature of HPSR is its systems approach. This frames COVID-19 and the responses to it in a critical–analytical perspective, zooming out from specific experiences to seek the root causes of the differential impact of the pandemic across individuals and population groups as a function of society's power structures and dominant cultures—as reflected in their social, political and economic position, and their race, gender, caste, class and more. Groups that become vulnerable due to systemic and structural inequities include those living in informal settlements in cities or in geographically isolated areas, informa
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