Is there good research evidence for health systems interventions?

Research evidence is key to developing strong health systems, but the assessment of such evidence is not always straightforward. This week in PLoS Medicine, the last paper in a three-part series on health systems guidance addresses the question of how much confidence to place in different types of research evidence, which the authors argue is key to informing judgements regarding policy options to address health systems problems.

Simon Lewin from the Norwegian Knowledge Centre for the Health Services in Oslo, Norway and colleagues say that useful tools are available to assess evidence of the effectiveness of various health systems interventions, but that there remains a need to develop tools to assist judgements regarding evidence from systematic reviews on other key factors such as the acceptability of policy options to stakeholders, implementation feasibility, and equity.

In a related Perspective article that reflects on the entirety of the three-part health systems guidance series, David Peters and Sara Bennett from Johns Hopkins University in Baltimore, USA (uninvolved in the series) say that the series offers important contributions to improving the quality of evidence-informed decision-making in health systems. But they also caution against being too rigid when developing approaches to the development of guidelines and applying evidence to policy.

Peters and Bennett conclude that "Recognizing the diversity of stakeholders and complexity of health systems issues, it will be important to ensure that evidence-informed guidelines that emerge are tested with continued humility and skepticism, and that they do not become rigid models for inquiry dominated by a limited number of disciplines. They should not serve to blind us toward the need to address a wide variety of questions and incorporate the different types of evidence brought to bear by many fields of science. Further guidance is one important way to shape policy, but we must not fail to situate it in the broader context of sustained dialogue between researchers and policy makers."