Health policy and systems research: an inconsistent priority in South East Asia

Objectives and importance of study: The need for sufficient and reliable funding for health policy and systems research (HPSR) has attracted varying responses globally. Countries assisted by the South East Asian Regional Office (SEARO) of the World Health Organization (WHO) together make up one-quarter of the world's population. HPSR is not given a high priority in several SEARO countries, so there is a need to understand the barriers and facilitators that influence national HPSR funding. Our study aimed to fill this gap in the literature by studying the barriers to HPSR in five SEARO countries - Republic of Maldives, Nepal, Sri Lanka, Thailand and India - and the key political factors influencing HPSR funding.

Mixed methods.

We conducted an in-depth desk review to obtain a general overview of HPSR in the five SEARO member countries. The review findings were used to frame a discussion guide for semi-structured interviews with key policy makers, health system experts and academics in the intervention countries. During the interviews, we validated the data from the desk review and explored the following key themes: a) the existing health system landscape of the country; b) organisations involved with HPSR; c) the nature of HPSR funding in the country (demand/supply led); d) budgetary allocations for HPSR; e) barriers to HPSR funding; f) measures to strengthen HPSR funding; and g) suggestions for the right mix for future HPSR funding. The study was conducted from October to December 2020.

Thailand is the only country among those studied with a well-established institution dedicated to HPSR. India, Sri Lanka, Republic of Maldives and Nepal are still lagging in providing a solid foundation for HPSR. Most of the countries lack a common definition of HPSR and a dedicated stream for HPSR funding. There is also a lack of local capacity to independently lead and conduct HPSR in most of the study countries.

We have provided a profile of the existing landscape of health systems in the SEARO member countries and highlighted the determinants of HPSR funding. A common definition and interpretation of HPSR is required, which extends beyond geographical and disciplinary boundaries. There is a need for enhanced core domestic funding along with increased recruitment and availability of HPSR researchers in the study countries.