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The present volume ‘Designing and conducting Health Systems Research’ is a thorough revision of Volume 2 of the Health Systems Training Series which the International Development Research Centre (IDRC) in Canada and WHO HQ in Geneva published in 1991 and reprinted several times under the same name. It became necessary to revise the modules, because over the years inevitable shortcomings and gaps were detected which needed to be addressed.

Health managers, for example, stressed that implementation of the research findings and recommendations were somewhat underexposed in the modules. This point is now taken care of in Module 1 by adding a fourth, implementation phase to the Health Systems Research (HSR) training cycle which initially consisted of three phases: HSR proposal development (15 days), fieldwork (roughly 6 months) and data analysis and report writing (2 weeks). The implementation of research findings and recommendations is further elaborated in Module 33. Furthermore, health managers pleaded, understandably, for shorter courses. This wish has been taken care of by stressing more explicitly in Modules 1 and 3, as well as in the Course Guidelines (annexed to Part 1 of this volume) that the proposal development phase can be shortened by having research teams select their research topic in the field before the onset of the course, preferably under guidance of a facilitator. In addition, the WHO/AFRO HSR Programme based in Harare, is at present developing modules for participatory rapid action in health research at health centre and district levels which can be carried out and integrated in the day to day activities of staff and community members.

Research staff from Community Health, Social Science and other university departments/ research institutes in Sub-Saharan Africa or other parts of the world who are using the modules had other wishes. They advocated that, in addition to the already well-emphasized problem-solving, analytical research approaches, more weight should be given to descriptive research. A descriptive diagram has therefore been added to the problem analysis diagram in Module 4. In all subsequent research steps, if relevant, the distinction between analytic and descriptive studies has been elaborated. Qualitative research methods have also been given more weight and they were more thoroughly integrated with quantitative methods in the research methodology (Modules 8-14). This applies, for example, to Modules 10 (Data collection techniques) and 11 (Sampling techniques). Furthermore, two new modules have been added to Part 2 (Data analysis and report writing) of the volume: one on Measures of association based on risk (Module 25), which used parts of Module 30 in the 1991 version, and one on the difficult issue of Confounding variables (Module 26). This need for extension was also reflected in the most recent evaluation of HSR training (1997).*

Facilitators, finally, desired more elaborate examples of crucial research and data-analysis techniques. Therefore, Module 10B (Development of research instruments) has been elaborated with a section on interview techniques with interview exercises, and Module 10C (FGDs) now contains an example of a transcribed focus group discussion with codes in the margin. To Module 13 (Plan for data analysis), an example of a full-fledged questionnaire and of a master sheet have been added, and Module 23 (Analysis of qualitative data) now provides an example of a filled-in compilation sheet. Module 5 (Literature review), has been extended with an example of a literature review.

Apart from these additions, in all modules parts that had proven to be unclear or incomplete were rewritten, and many examples and references were replaced by more recent ones or elaborated.

The present revision was initiated in a workshop held from 2-11 November 1998 in Arusha by a group of interdisciplinary researchers and managers convened by the manager of the WHO/AFRO HSR Programme (since 1992 Gabriel Mwaluko). All participants had thorough experience with the modules and with HSR: Sambe Duale, Lawrence Gakuri, Pilate Khulumani, Steve Kinoti, Gabriel Mwaluko, Jude Padayachi, Brian Pazvakavambwa, Corlien Varkevisser and Godfrey Woelk. In August 1999 a group of three people (Alasford Ngwengwe, Corlien Varkevisser and Godfrey

* 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.

Woelk) made further revisions and synchronised the different texts in the WHO/AFRO/HSR office in Harare, supported by staff of the HSR office (since 1999 headed by Isabel R. Aleta, with Makhamokha Mohale and Eric Naterop as APOs). Corlien Varkevisser and Ann Brownlee finalised and edited the modules, with the blessing of Indra Pathmanathan who this time could not participate. Deborah Karugonjo (Harare) and Merel Gallée (Amsterdam) provided highly valued assistance in the production of successive computerised versions. Funds for revising and publishing the HSR modules were made available by DGIS (Dutch Development Co-operation); SARA/AED, Washington; GTZ, Germany through the GTZ MCH/FP network for Health Systems Research in Southern Africa; WHO/AFRO and by WHO HQ, Geneva. IDRC, Canada assists in subsidised distribution of the modules.

A highly varied collection of people assisted in the production of earlier versions of the HSR modules. The cradle of the modules stood in Western Africa, where in the early eighties the Project for Strengthening Health Delivery Systems (SHDS), based in Boston University, USA, at the request of AFRO developed training materials in research protocol development. SHDS followed the step-by-step approach which till today is a major key to the success of HSR courses. Modules 1-17 in this volume are heavily adapted or new versions of the original SHDS modules.* The first adaptation took place in 1988, with 12 researchers from countries that participated in the Joint HSR Project ( Omondi (Kenya), Sebatane and Makatjane (Lesotho), Chimimba and Msukwa (Malawi), Kitua and Savy (Seychelles), Tembo (Zambia) Munochiveyi, Taylor and Woelk (Zimbabwe) and Joint Project staff which also finalised the version (Corlien Varkevisser and Martien Borgdorff). These ‘green modules’* found their way to Malaysia, where Indra Pathmanathan further developed them, with assistance from Maimunah Abdul Hamid, K. Mariappan and C. Sivagnanasundram (Sri Lanka), in the course of numerous protocol development workshops. The same occurred in Southern and Eastern Africa. At the initiative of Yvo Nuyens, who fathered the Joint HSR Project in WHO Geneva, and supported by IDRC (Annette Stark), the five volumes of the Health Systems Research Training Series emerged, of which Designing and Conducting Health Systems Research Projects formed Volume 2. These ‘pink modules’, published in 1991 in Ottawa by IDRC and WHO, form a thorough merge of the ever developing Southern African and Malaysian versions. They were integrated in Harare (Corlien Varkevisser and Leon Bijlmakers), in consultation with Indra Pathmanathan, and with thorough editing support from Ann Brownlee, one of the authors of the original SHDS modules. The present HSR modules are therefore a truly global production. It is even impossible to mention every contributor, because many HSR course facilitators and participants through their questions and critical remarks inspired further changes.

With such a colourful and interactive origin it seems highly unlikely that the present reprint will be the last one. Whenever the modules are used, they will be adapted. We hope, however, that in their present form they will last for some years and will be of use to health staff as well as university students.

Dr. Corlien M. Varkevisser, Royal Tropical Institute/University of Amsterdam

Dr. Ann Brownlee, University of California, San Diego

June 2003

* Regional Assessment of Health Systems Research Training in Eastern and Southern Africa. HSR Project and SARA/AED,Harare/Washington. SS Ndeki, 1997.

*Ann Brownlee, Thomas Nchinda and Yolanda Mousseau-Gershman (1983) Health Services Research Course: How to develop proposals and design research to solve priority problems. Boston: Boston University Health Policy Institute.

* Joint World Health Organisation/Royal Tropical Institute/Dutch Technical Development Co-operation Project on Health Systems Research for the Southern African Region (1988) Health Systems Research Training Course: How to develop research proposals to solve priority health problems. Geneva: World Health Organisation. WHO/SHS/HSR/88.3.

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