Palestinian Health Research System: Moving Forward

The importance of a Health Research System (HRS), as an instrument for developing and enabling health systems, is increasing, particularly in developing countries. As a consequence of this growing awareness also within the World Health Organization (WHO), there are many new approaches and initiatives to ensure the national HRSs be strengthened and well-functioned to address the countries' health needs through formulating and analyzing these systems particularly in fragile and resources constraint countries. Assessing the perceptions of system performers is an essential part of a comprehensive system analysis, which seeks to recognize a system’s strengths and limitations with a perspective towards achieving improvements. The present study focused on investigating four key pillars of the system in Palestine. First, it assessed the HRS concept and its importance among systems performers. Second, it evaluated their satisfaction with overall HRS performance and the political attention towards health research. Third, it examined the stewardship functions, governance, policy, and priorities, as a central pillar of this system. Fourth, it analyzed stakeholders’ roles and the status of research capacity. Based on these four axes of analysis, key gaps and avenues of solutions towards achieving a comprehensive HRS strengthening in Palestine were identified. The study targeted three sectors, namely relevant government institutions, schools of public health and major local and international health agencies. A qualitative analytic approach was used where data was collected through 52 in-depth interviews and 6 focus group discussions (FGDs) with 104 policymakers, academics, directors, and experts.
In the first part, the study found the level of understanding of HRS concepts among health experts in Palestine is inadequate and not sufficiently conceptualized for the application. The second part found that the HRS in Palestine is remarkably underperforming with a significant lack of political support and engagement. The third part revealed that the stewardship functions are problematic, meaning that a system for health research in Palestine is still not embodied mainly due to a missing structural and regulatory framework and dispersed HR work. It is also found that the Ethical Review and Clearance (ERC) is weak, a policy or a strategy dedicated to health research is lacking, and low levels of knowledge and experience in research prioritization amid of lack of consensus. The fourth part found key findings: low involvement of society, private, local and the international sectors; a substantial weakness in the role of international agencies in supporting health research; and significant deficit in HRS capacity. This deficit is due to the fact that research in Palestine is externally and individually-funded, limited and unsustainable, and importantly, moderate research quality, as well as knowledge transfer and translation are not well-conceptualized and inappropriately performed. The study also identified main further common gaps as follows: lack of HR culture, systems values and principles; structure; policy; resources; defined roles; connection and network; evidence-informed concepts; and politic impacts.
The study has recommended further empirical research to be investigated whether in Palestine and could be so in the region. Understanding the reasons behind the apparent lack of knowledge on HRS concepts and assessing the HR performance and impact, based on defined quantitative indicators, are essential research. Moreover, assessments on HR stewardship functions with regards to the institutional functionality and applicability, as well as a national HR capacity assessment using qualitative and quantitative measurements are deserve to be implemented. Once the HRS is structured, a national comprehensive system analysis is required to investigate inputs, processes, and outputs dimensions.
The study offered crucial actions to be translated into policy-making levels. First, launching a strategic dialogue on HRS strengthening among actors to ensure a solid commitment, a collective involvement, and a national consensus. This move should pave the ways towards two substantial actions, building a unified national HR body and formulating a national strategy, both are integrated into the structure of Palestinian HCS, that has to include conceptual, regulatory, legal, technical and ethical aspects. Under this body and through this strategy, actions to improve HR prioritization, ERC, HRS awareness, HR performance, HR resources and capacity e.g. research quality, knowledge transfer, and translation, are fundamental components must be integrated and improved. In doing so, operational policies for HR resources and capacity have to be established, along with guidelines, indicators, and mechanisms for HR prioritization, performance, quality, knowledge diffusion and utilization that essentially required to be formulated and adhered. Also, effective networks communications, dynamic coordination, and systematic education and training programs are further feasible actions towards achieving a comprehensive HRS strengthening.
This study proofed very worthwhile because it met a longer-standing local demand, as well as was aligned with regional and global strategic directions. Consequently, getting the system pillars well-enabled is possible and yields meaningful benefits to the health system and other development sectors in Palestine. This system analysis attempt opened up new avenues for any future endeavors and for the new generation of health research, HRS, and health system strengthening in Palestine and in the region in general.