Decision-makers demand answers to HPSR questions which are best informed by a large evidence base spread across multiple disciplines and domains. They have little time to survey the knowledge landscape. Research synthesis includes a range of methods to efficiently bring together knowledge on particular questions in ways that are accessible, appropriate to context, and ready to apply.

Why is this an important issue?

If research is not produced in a timely manner and made available to decision-makers in a format that provides answers to their most pressing challenges, evidence informed policy is unlikely. One of the Alliance’s core mandates is to increase the utility of HPSR and its relevance to decision makers. Research synthesis plays a vital role in this.

Systematic reviews are probably the most well-known method of synthesising evidence. But traditionally these have not adequately addressed: the politics and complexity of real-world health systems; their hardware and software; and the interactions and connectivity that occur within them. Other synthesis methods such as qualitative reviews, mixed methods reviews, realist reviews and rapid reviews can stand in for, or complement, systematic reviews at different points in the policy and implementation process.

Alliance track record

The Alliance has a long history of providing capacity development support on evidence synthesis to LMICs. We believe in the importance of centring the knowledge of decision-makers and implementers within the evidence synthesis process. Building the capacity of researchers in LMIC settings to work with their colleagues in policy and practice to conduct and communicate evidence synthesis is at the core of what we do.

Since 2007 we have established and supported systematic review centres including those in Bangladesh, Chile, China, Lebanon and South Africa. These focus on how to improve the ways in which systematic reviews for HPSR are conceptualised in their local political and socioeconomic settings.

In 2015, we established the Health Systems Research Synthesis Advisory Group which brings together some of the foremost thinkers on this issue to inform the development of study designs, pilot them and manage knowledge generated through this process so that it is available to those who need it.

We are also a co-founder of the Global Evidence Synthesis Initiative (GESI) which enhances the capacity of LMIC partners in synthesizing evidence, and using synthesized evidence to support practice and policy. 

We have also provided support to the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI). They have produced valuable knowledge on the importance of decision-maker involvement to create an optimal understanding of the policy problems that are being faced.

Issue in practice

Developing partnerships to expand the HPSR community’s understanding of, and capacity to execute evidence synthesis is key to the Alliance’s approach. We have also been at the forefront of bringing together experts from different areas of the HPSR world to develop the conceptual and practical thinking that underpins evidence synthesis. Through this process we have developed a suite of methods that can be applied to evidence synthesis for HPSR in LMICs. This culminated in the publication of a comprehensive Methods Guide in 2018.

GRADE-CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’) was developed by a group of researchers supported by the Alliance. It provides guidance on assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). It reviews their methodological limitations, coherence, the adequacy of data, and relevance. Guidance on this approach was laid out in a seven paper special issue of Implementation Science which was sponsored by the Alliance.

In response to the COVID-19 pandemic the Alliance has been working to support institutional capacity for rapid evidence review. This has led to a review from South Africa on health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services in response to changing ways of working during the outbreak. Teams from our Embedding rapid reviews in health systems decision-making (ERA) programme in India and Georgia have produced reviews on frontline health workers and policy options respectively.

Key resources