Health System Research


Careful selection of research methodology is vital if research is to contribute to the development of health systems and to an adequate comprehension of the many health systems variables that determine effectiveness. Traditional health research methodologies have often been unable to generate a good understanding of health systems for various reasons:


  • The inherent complexities and variations of health systems makes it difficult to construct a classical experimental approach to research;
  • Health systems are often in a state of flux, so that research findings at a particular point in time can rapidly become outdated, even over the course of a study; 
  • The social nature of health systems - influenced by local cultures, management styles and organizational cultures - often requires mixed methods of study; and
  • Health systems themselves consist of a variety of inter-locking and overlapping sub-systems, the units of which often require study in and of themselves.


This project is cognizant of the importance and complexities of selecting a methodology suitable for studying the health systems determinants of sustainable and scalable health care improvements.

The overarching study design for the project is a longitudinal, multiple 'case study', with the 'case' being a 'health district'. The case study is a methodology or research approach that has been used to study a variety of subjects including real-life events, organizations, networks, communities and managerial processes. It is especially useful when the boundaries between phenomena and context are not clearly evident. It permits a holistic, multi-faceted and multi-disciplinary approach to research and therefore responds to the kind of health systems research that many experts have long been calling for. Implicit in the adoption of the case study approach is the use of mixed methods. However, at the same time as producing a holistic and comprehensive understanding of a case, it allows for the nesting of discrete and detailed sub-studies aimed at examining particular aspects or sub-components of the case in much greater specific detail.

Nitayarumphong, Mercenier and others elaborated a basic methodological framework for health systems research (see figure). The numbers in the figure refer to conceptual and chronological elements in the health systems research approach while the letters refer to feedback flows. As the figure shows, the seven stages interact dynamically: after consideration of the results of the situation analysis (stage 1), past knowledge (stage 3) and the conceptualization of the reference model (stage 2), a change is introduced into the health system (stage 4). This empirical decision is then investigated and validated, and translated into action (stage 5). The next steps are the evaluation of the process (stage 6) and the evaluation of the results (stage 7).

A basic methodological scheme for health systems researcConcept 

We will apply this approach for the MOMI project because it provides a platform for conceptualizing and systematically investigating the impact of planned changes in health delivery on maternal and newborn health in the postpartum.