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Whom is the health systems research course aimed at?

The health systems research (HSR) course has been developed for mid- and higher- level managers, health workers and health-related staff, as well as interested researchers.

What training method is used in the HSR course?

The training method applied is based on learning by doing. Course participants will themselves develop research proposals that they will actually carry out in the field.

Each participant and trainer brings to this course his or her own experiences in applied research and in the management of health or health-related projects. Thus, the course should not be perceived as having a teacher-student orientation. It should rather provide a forum for sharing information where everyone can contribute the benefits of his or her own experience and knowledge. This sharing will add greatly to the richness and relevance of the course.

What type of projects will be developed?

Together with community leaders and other health decision-makers from the district, provincial or even national level, course participants will select priority problems in their own work situations that cannot be solved unless more information is collected. Preferably, the topics will have been selected before the training starts, although they may need more specification. In most cases, a team of course participants will carry out the planned research alongside their regular duties. Therefore, the project will have to be of modest size. For example, a maximum of 30 days for fieldwork and preliminary analysis per group member, and between 4,000 and 8,000 US$ per research project would be advisable.

How long is the course?

The course, which includes three main components, will cover a period of about 7 months, with an additional fourth component for the implementation of research results over 18-24 months. Thereafter the new activities resulting from the study are supposed to form part of the regular planning.

Component 1. HSR proposal development

The first 2-3 week workshop will provide an introduction to HSR. If modules 1-4 are implemented in the field with guidance from a facilitator, which we recommend, the proposal development workshop can be limited to two weeks or less. Participants will work in small groups and design research proposals, step by step, on the priority problems they have selected. As each new step is introduced, new concepts and research procedures will be presented. The participants will immediately apply these in the proposals they are developing. Modules 1-18 deal with proposal development.

Component 2. Implementation of the proposal

During the following 4-6 months, the same groups of participants will implement their proposals. It is therefore important that the groups are composed in such a way that they can easily cooperate during the fieldwork. Modules 19 and 20 give guidelines for the fieldwork and for writing a short fieldwork report - including preliminary results.

Component 3. Analysis of the data and report writing

After project implementation, participants will meet again for a 2-week workshop to further analyse and interpret the data. At the end of this workshop, a research report with recommendations for action will be prepared and presented to health policy makers, health staff and communities. Modules 21-33 pertain to data analysis, report writing, dissemination of research results and preparing implementation of recommendations based on the findings.

Component 4. Development and implementation of action plans

Together with the relevant stakeholders, (policy makers, managers, staff, community members), teams will draft action plans to implement the recommendations that are agreed upon. Because many of the participants are in direct positions of managerial responsibility, and because higher-level decision-makers and community members have been involved, it is expected that action plans can be implemented soon after the studies are completed. The proposed activities will normally be integrated in the district, provincial or national health plan and be subjected to regular monitoring and evaluation.

How will the research proposal be developed?

A number of basic steps have to be taken when developing a research proposal. These steps are presented in the flowchart below.

This flowchart appears on the back of each of the pages that mark the beginning of modules 3-18. The step in the proposal development process that the module addresses is indicated by double lines around the appropriate box in the flowchart.

Flowchart: Steps in the development of a health systems research proposal

NB: Development of a research process is a cyclical process. The double-headed arrows indicate that the process is never linear.

It should be stressed that designing a research proposal is not a linear but a cyclical process. Throughout the course there will therefore be opportunities to review and, when the need arises, to revise parts of the proposal that have already been drafted. When developing the research methodology, for example, the teams may find that the objectives and even the statement of the problem need to be revised to be made more specific. When finalising the work plan and budget, the teams may determine that the research design, for financial reasons, may need to be revised so the project is more modest and thus less costly.

By the end of the first part of the course, each group will have developed a research proposal with the following chapters: (For details, see Module 18.)

EXECUTIVE SUMMARY

1. INTRODUCTION

2. OBJECTIVES

3. METHODOLOGY

4. WORK PLAN (including description of project staff)

5. BUDGET (including explanatory note on major budget posts)

6. PLAN FOR ADMINISTRATION, MONITORING, AND UTILIZATION OF RESULTS

In the second workshop for data analysis and report writing, a similar approach will be followed.

How may this set of modules be used?

The course has been organised in such a way that each module can be dealt with independently. A module includes:

• A presentation of the necessary theory and concepts to enable the participants to carry out this specific step in proposal development or data analysis and report writing. Presentations last between 30 minutes and an hour and include opportunity for questions and discussion.
• Group work during which groups, with assistance of their facilitator, utilise these concepts in the development of their proposal or in data analysis and report writing. The modules for proposal development, in particular, contain detailed instructions for group work. Group work may last from 1-4 hours per module, and sometimes longer.
• Reporting of the results of the group work in plenary by a member of each group, so that other groups and facilitators can comment. Plenaries are of crucial importance during the first workshop. During the data analysis workshop they are less frequent as not all modules are relevant for all groups. On the average, each group has 15 minutes for presentation and discussion, but for important topics this may be 30 minutes.
• Sometimes a module contains an exercise, either using examples provided during the presentation or using the group work results of other groups.

Depending on the level of the groups, it may be possible to combine certain modules and to shorten or lengthen the time allocated for presentations and group work and the total workshop time. For programme managers, for example, one week may be sufficient to prepare a first draft of a research proposal. Provincial and district level staff with some research experience may need 2 weeks, whereas novices to research will need the full 2 ½ weeks.

Trainer’s Notes

Module 1: COURSE ORIENTATION

Materials

• Name tags for participants and trainers
• Flipcharts and markers
• Course training materials for participants
• Overhead sheets for presentation

Personal introduction of participants and facilitators

If you were unable to do the mutual introduction of participants on the evening before the course begins, have all the participants (including the facilitators) introduce themselves. Make certain everyone indicates his or her profession, major activities and research experiences and interests. This may be done by having participants interview each other in pairs and then each introduces the person he or she interviewed. Names and a summary of the interview could be put on a flipchart and stuck to the wall.

The introduction may take 1 - 1½ hours.

Course orientation

• Present the major objectives of the course and stress its practical orientation. It should be clear to all participants that they will each work as part of a small group to develop a research proposal which they themselves will carry out. It should also be stressed that one important goal of the course is that the research findings will be used to help solve the problem the group has investigated. Therefore, decision-makers and users (government or non-government workers, and community members) should be involved in the choice of the topic, the review of the proposal, and the discussion of research findings and recommendations. Depending on the location of the course and the participants, each team should consider holding information sessions for interested persons on their return home. This will be discussed again later in the course.
• Emphasise the uniqueness of each participant’s background and experience, pointing out how important it will be for everyone to contribute to the development of the proposal and to learn from each other.
• Distribute the course-training document to the participants. Describe how the course will be structured and how the training document will be used. Show the flowchart that appears at the beginning of each module. Explain that each session contains a presentation and group work during which each group will apply the concepts presented in the development of its proposal. Indicate that directions for group work are presented in boxes with double lines around them. Mention that some sessions also have exercises, which are presented in boxes with single lines. Discuss the fact that in some modules annexes provide more details on research methodology for those who are interested.
• Stress that the end product of the first workshop will be a research proposal that will be written, step by step, by the participants according to the plan presented on page 6.

Administrative issues

• Present any other information concerning the course and administrative arrangements that may be necessary and ask for final questions.

Document(s) 4 of 27