Evidence from research and its implications for health reforms in Pakistan: the Gateway Paper perspective

Health reforms must be firmly grounded in evidence, which in turn, should be utilized for appropriate modifications as the reforms get on their way to being implemented. It must be appreciated that the generation of evidence and its utilization must proceed in tandem with the reforms process - an approach which allows action accompanied by rigorous evaluation and up-gradation of programs and policies. The individual components of health reforms being proposed in the Gateway Paper, which presents a viewpoint on the configuration of health reform in Pakistan also mandate robust evaluation. This can allow the evaluation of competing concepts and can, therefore, guide the up-scaling of appropriate initiatives for broader systems-wide adoption. With this as a context, the Gateway Paper stresses on the need to: develop a comprehensive policy on research, bridge gaps in technical capacity within institutions, particularly those with research as a core mandate, broaden the base of budgetary and extra-budgetary research funding sources, foster appropriate incentives and rewards for research and mainstream an institutional mechanism for ethical oversight of research within the country. The Gateway Paper also underscores the need to develop a comprehensive, sustainable public health surveillance system and flags the legal requirements in this regard. It lays emphasis on the need to define priorities for epidemiological research in specific domains, particularly with reference to defining targets for preventive initiatives. In addition, strong recommendations have been made to institutionalize health policy and systems and operational research and to invest in capacity building of decision-makers in order to enable them to recognize the benefits of evidence based decision-making.