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Health Systems Research (HSR) has proved to be a useful tool for health decision makers at all levels over the past 20 years, providing them with the necessary data for informed decision making.

The Joint HSR Project for the Southern African Region based in the WHO Office in Harare and supported by WHO Geneva, the Royal Tropical Institute (KIT) in Amsterdam and the Dutch Technical Development Co-operation (DGIS), has played a crucial role in the promotion of HSR in the African region since 1987. HSR was enthusiastically embraced by many Ministries of Health and universities. In 1996, the Regional WHO Office for Sub-Saharan Africa (AFRO) assumed full responsibility for implementing HSR. Following the recommendation of Health Ministers of the Region, WHO/AFRO in 1998 included HSR as a regular programme for all its 46 member states.

The present HSR training modules, developed by an interdisciplinary, international team of practical researchers, have been highly instrumental in raising the interest for HSR. Originally designed for health managers at different levels as a tool to develop problem solving research in the Southern African Region, the modules also proved useful in Malaysia and were further elaborated by staff of the School of Public Health The 1991 combined version, published by International Development Research Centre, Canada and WHO, Geneva,* was translated in French, Spanish and Portuguese, and sections of it appeared in Arabic, Vietnamese and Chinese. In different parts of the world the modules facilitated the development and implementation of hundreds of research protocols by health staff and researchers. The HSR modules are used in the Community Health and Social Science Departments of many African, Asian and Latin American universities to train students and prepare them for their fieldwork. They are also used by Masters of Public Health courses in Europe and the USA and by international research programmes interested in applied research.

This unanticipated application of the modules in academic as well as health management circles led to the rapid exhaustion of the 1991 edition and the several subsequent reprints. Various groups of users made many useful suggestions for changes and improvements. The HSR Unit in AFRO, with agreement from IDRC, therefore decided to organise a revision of the HSR modules. An interdisciplinary group of Southern African researchers reviewed and made revisions in two workshops in 1998 and 1999. Two of the three original editors finalised the present version. IDRC took on the final responsibility for the publication, which was financed by AFRO and IDRC and published by KIT.

It is hoped that this revised version of the modules will fulfil the same need as preceding ones have done. Certainly many new and persisting health problems urgently require operational research. How to support necessary health reforms and at the same time ensure equity in access to health care for high-risk groups remains a major challenge. HSR is one of the tools we have to obtain deeper insight in these challenges and optimally focus our resources.

Dr. Rufaro R. Chatora, Director of the Division of Health Systems and Services Development (DSD), WHO/AFRO, Harare

Dr. Christina Zarowsky, Senior Health Specialist, IDRC, Ottawa

Ms. Catherine Hodgkin, Head Health Department, KIT, Royal Tropical Institute, Amsterdam

* Corlien M. Varkevisser, Indra Pathmanathan and Ann Brownlee (1991) Designing and conducting Health Systems Research projects. Part I: Proposal development and fieldword; Part II: Data analysis and report writing. Ottawa: Health Sciences Division of the International Development Research Centre (IDRC) and Geneva:Programme on Health Systems Research and Development of the World Health Organisation.

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