Center for AIDS Research

Mission Statement
The aim of the UW/FHCRC CFAR Health Systems and Strategies Research (HSSR) Scientific Working Group is to enhance research to improve health service delivery systems in poor countries to optimize treatment and prevention of HIV and related STIs. Weak health systems are the major obstacle to delivering adequate quality services to populations in most developing countries. Through the incorporation of applied research techniques, HSSR aims to identify major bottlenecks within health systems and to implement and test interventions designed to improve the efficiency and quality of those systems.

Definition of HSSR
Health Systems and Strategies Research (HSSR) is the application of research methods to improve the efficiency and quality of health service delivery in functioning health systems. As such, HSSR is closely related to the fields of operations research and quality improvement. One important part of this definition is that research is applied directly to the realities within a specific functioning health system, with the primary goal of improving decision-making of managers and policy makers within that health system. HSSR can be generalizable, offering "best practices" to other health systems that experience similar types of programmatic problems. Typically, a programmatic problem (or "bottleneck") is identified in the course of program implementation, and then research methods are applied to determine how the program problem can be best resolved. HSSR methods usually incorporate the use of routine health service data, strengthening and data collection and analysis in the field. HSSR may also include the development of models to improve the efficiency of existing systems, the development and testing of interventions to overcome programmatic bottlenecks, or applying qualitative or policy-analysis techniques to better understanding the system and identify potential solutions.

Relevance to CFARs
The University of Washington's experience in applying health services research in developing countries spans many years. Much of this work has been done as program evaluation for service projects in Mozambique designed to improve multiple aspects of primary health care. With increased funding for antiretroviral (ARV) medication to treat those living with HIV/AIDS in developing countries, underdevelopment of health systems has been identified as a major obstacle to assuring that ARVs reach the people who need it. In this context, there is an increased urgency to identify evidence-based approaches that improve the efficiency and quality of health systems, and inform decision-makers are they aim to improve the health outcomes for the populations they serve.