Building evidence to strengthen global health systems

The NIHR Global Health Policy and Systems Research (HPSR) programme aims to provide evidence that can improve access to appropriate and affordable health services for the world’s poorest. This is funded by UK Official Development Assistance (ODA), and aligned with the aims of Universal Health Care and UN Sustainable Development Goal 3 - to ensure healthy lives and promote well-being for all at all ages.

The first phase of the Global HPSR programme has funded 13 projects to strengthen health systems and improve health outcomes. This month, NIHR announced funding awards to eight new researcher-led projects spanning 12 LMICs.  

With a new Global HPSR call now open, this feature looks at the impact of two projects funded through the first phase of the programme. We highlight how health systems research can make a positive and lasting difference to people and communities around the world.

The burden of non-communicable diseases (NCDs) has risen rapidly in Africa, affecting adults of all ages. Diabetes and hypertension alone lead to about two million deaths a year on the continent. Currently, health care services for HIV, diabetes and hypertension are organised separately, wasting scarce resources.

Over the past five years, the NIHR Global Health Research Group on the Management and Prevention of HIV infection, Diabetes and Hypertension, led by the Liverpool School for Tropical Medicine with partners in Tanzania and Uganda, has worked to address this through an intervention trial. They found that integrating care services into ‘one-stop clinics’ resulted in greatly improved patient outcomes for people with diabetes or hypertension, without adversely affecting HIV outcomes. 

The Group’s findings, published in BMC Medicine, showed that this integrated care saved money as well as improving lives. This was the first such study to report the detailed economics on real-life integrated care across several disease programmes.

In 2020, the team was awarded Global HPSR project funding to explore a community-based integrated care model. This is known as the INTE-COMM study - Controlling chronic diseases in Africa: development and evaluation of an integrated community-based management for HIV-infection, diabetes and hypertension in Tanzania and Uganda. It builds on their previous work by evaluating how community workers and nurses can play a leading role in helping people manage chronic conditions. This is important as the burden from HIV, diabetes and hypertension is too great to be managed by health facilities alone. 

Professor Shabbar Jaffar, Director of both the original Group and the HPSR project, said:

“This study was considered high-risk as it involved a major change to health care delivery, and we were delighted to receive support from NIHR to fund this. It led to a further £4 million in EU funding, which we used to conduct a large cluster-randomised trial in Tanzania and Uganda comparing integrated care for HIV, diabetes and hypertension with standard vertical care. The trial confirmed the findings from the NIHR-funded study. The evidence for the two studies combined have informed changes in policy in the two countries.”

Road traffic collisions are one of the most common causes of trauma and related deaths in LMICs. Nepal is a very mountainous country, and its roads are among the most dangerous in the world. A recent road building programme and increase in vehicle ownership has led to a rapid rise in road traffic injuries and deaths across the country. 

Since 2017, the NIHR Global Health Research Group on Nepal Injury Research has been addressing this problem through a ‘safe systems’ approach. Strengthening health systems to provide urgent and effective post-crash care is a vital part of this. It was led by Professor Julie Mytton at the University of the West of England, and Professor Sunil Kumar Joshi at Kathmandu Medical College.

The Group established the Nepal Injury Research Centre (NIRC) to address the impact of injury around the country and move injury prevention onto the public health agenda. They successfully engaged stakeholders and communities around Nepal to understand how and why injuries happen, and to develop and evaluate system-wide interventions to prevent harm.

In 2019, they were awarded a NIHR Global HPSR Development Award to identify research priorities specifically around road safety. With a successful track record, the partnership has now secured a further four years’ funding through the Global HPSR programme. 

Their new £4 million NIHR HPSR award is for a 'Safe Systems' Approach For Enabling Traffic Injury Prevention in Nepal (SAFE TrIP Nepal). This will focus on 3 main areas:

1. to support local and provincial governments in Nepal to identify and address road safety challenges;
2. to bring together stakeholders across the bus transport system to identify actions that can improve passenger safety when travelling by bus;
3. to improve care for victims of road traffic crashes by developing a standardised pathway for the handover of road traffic injury patients from ambulance staff to hospital services.

Professor Julie Mytton explains:

“Our programme identified the inequitable and previously unreported burden of injuries for Nepali communities. The ‘Safe Systems’ approach to road safety acknowledges that individuals using roads inevitably make mistakes. We are trying to strengthen these systems to ensure these mistakes do not inevitably lead to injury and death.”

Developing health systems to identify and respond to population needs is a strategic priority for NIHR. Our current portfolio of 13 projects is generating the evidence to strengthen health systems and improve people’s health across diverse low and middle income countries, and our new Global HPSR call aims to increase that impact even further.

Find out more about the latest Global HPSR funding call or watch our webinar on YouTube.