[MUSIC] You've just learned about health policy and systems research, or HPSR for short, and how it seeks to contribute to policy outcomes and the achievement of collective health goals. As I'm sure you can imagine, this can involve many obstacles. So I'm going to introduce you to some of the challenges for HPSR and evidence informed policymaking, as well as some of the opportunities. To begin with, you've already heard that one of the biggest challenges has been the lack of clarity regarding the nature and scope in the field. However, another challenge is the lack of engagement between researchers of health services research in high income countries and health policy and systems researchers in low and middle income countries. This is a missed opportunity, given that both now increasingly share similar challenges, such as the development of antimicrobial resistance and the rise of non communicable diseases. But the most significant challenges facing the field relate to the generation of health policy and systems research and its use. I'm going to start with challenges related to the generation of research, which include methodological and capacity related challenges. In the early days, one main criticism of HPSR was a perceived lack of methodological rigor. This criticism mainly came from researchers from more traditional research disciplines, such as biomedical and clinical researchers, who are more accustomed to research under controlled conditions. On the other side of the debate were social science researchers, as well as implementers and evaluators, who were concerned with real world programs, settings and populations. They argued that traditional research methods were not relevant in various real world contexts. It's not enough to ask, what can work? But also how, why, and for whom it can work? This is particularly important when considering scaling up interventions or programs nationally, but even more so and trying to transfer knowledge across different countries and regions. This has provoked calls for national capacity building in the generation and use of HPSR, particularly in low and middle income countries. In the 1990s, the overall number of publications on HPSR in low and middle income countries was quite low, but has substantially increased since the foundation of the Alliance for Health Policy and Systems Research in 1999. Until recently, most of the lead authors of such research came from high income countries. But the number of lead authors from low and middle income countries has now increased. Regardless of the location, the most significant constraint for the generation of research is a lack of funding. The second major challenge facing HBSR is research use. There are many reasons for that, the most common of which are the unavailability of locally relevant research. Poor presentation of research findings, that make it difficult for decision-makers to understand, and inadequate communication between researchers and decision makers about policy relevant research. From 2008 onwards though, universal health coverage became an increasingly central rallying point for global health advocacy, which pushed the agenda for health policy and systems research. UHC has obvious and direct links to HPSR. Because moving towards UHC requires understanding of appropriate financing mechanisms and how best to organize and deliver health services to ensure that they are accessible, affordable, and accountable. This move towards the health system strengthening agenda certainly paved the way for an increased focus on HPSR. Other factors, which helped raise the profile of HPSR are ones that can be viewed as opportunities to increase the investment and generation of evidence in the space. These are sustained advocacy for each CSR, initiatives that clarify the field, and efforts to better engage policymakers and practitioners. All this helped to increase interest in the field. Initially, advocacy for HPSR was scattered and uncoordinated. But the creation of the Alliance for Health Policy and Systems Research in 1999 greatly helped to focus attention. And with the strong leadership for health systems within WHO, more harmonized approaches emerged. To summarize, some of the major challenges facing this field relate to the generation of health policy and systems research and its use. It's not enough to ask what can work, but also how, why, when, and for whom it can work. This is particularly important when considering scaling up interventions and programs nationally, but even more so when trying to transfer knowledge across different countries and regions [MUSIC]