Support for research is key to improving health services

Defining priorities and incorporating scientific findings help guide actions and strengthen health systems in Brazil

There is nothing novel about the push to use research findings to strengthen health systems worldwide, promoting sustainability and directly affecting people’s living conditions and health.

Applying research findings to health services and systems is in everyone’s best interest: researchers, funding agencies, and society. However, it is not yet a simple task.

Since the 1970s, with advances in evidence-based medicine, researchers from various parts of the world have been looking into ways to incorporate research findings into not only clinical decision-making but also into the development, improvement, and implementation of health programs and policies.

A particularly strong movement has come out of Canada and has set the tone for our expectations in relation to knowledge translation, a concept recognized beyond the dissemination of research findings, as a dynamic, interactive, and iterative process that involves knowledge production, synthesis, contextualization, dissemination, and ethical application, for the good of the population.

Currently, the World Health Organization (WHO) has been hard at work in this area, and in 2021 released a guide on evidence-informed decision-making (EIDM) titled Evidence, Policy, Impact.

This guide details the entire knowledge translation cycle, which includes:

Interaction among researchers and decision-makers;
Prioritize health problems;
Produce knowledge through evidence synthesis or primary studies.

Additionally, this knowledge is contextualized to the specific environment where it will be applied, democratized, and implemented.

It is important to emphasize that everything is governed within the framework of equity, so that research findings do not magnify inequalities and vulnerabilities within the population, but rather promote the sustainable use of scientific evidence.

The issue is so important that WHO has been developing a research agenda for knowledge translation and evidence-informed decision-making.

Incorporating findings

In Brazil, processes for incorporating findings are also being pursued. In the latest public calls for research in the health field issued by the National Council for Scientific and Technological Development (CNPq), all proposals must include a knowledge translation plan.

In other words, researchers’ applications must detail how they intend to present their findings so that they can be incorporated by various government sectors.

This has encouraged the scientific community to reflect on the purpose of the research they are conducting, particularly when funded by the government.

In São Paulo, the São Paulo Research Foundation (FAPESP) has also been requiring researchers responding to public calls to include information about the incorporation of research findings, as required in their Research in Public Policies Program (PPPP), for example.

This movement is important for society as a whole, which can benefit from research findings that help resolve problems, guarantee more effective treatments and more efficient services, and strengthen health system management.

Another good example of this movement is the Research Program for the Unified Health System (PPSUS), a research initiative developed by the Brazilian Ministry of Health that, since 2004, has supported research whose findings can be applied to improve the health system.

This program is innovative in several respects. There are 27 programs, one in each state, and each program must involve key players from the state in a shared approach to managing the program. Some of the funding comes from the Ministry of Health and some comes from the Research Funding Agencies (FAP) in each state.

The goal is to fund research related to high-priority health and health sector management issues at a local level, which can help provide solutions to the major health problems faced by the population, as well as issues related to systems and services, which must be addressed through scientific knowledge.

As such, each state defines its priorities, evaluates and commissions the projects using its own resources, and monitors the call for proposals and research findings.

To this end, in addition to the FAP, representatives from Brazil’s State Health Secretariats (SES) are recruited to help define research priorities, evaluate and monitor research initiatives, and incorporate their findings into the health systems, services, and policies at a local level.

Benefits for the health system

In the state of São Paulo, the PPSUS has already issued eight public calls since 2004, with over 250 studies conducted and an investment of more than 41 million reais. The São Paulo State Health Secretariat (SES-SP) has been represented by the Health Institute since 2006.

The program has achieved quite impressive results:

Developing lines of care;
Drafting policies;
Implementing programs;
Suggesting processes for evaluating the health system and training programs for SUS personnel;
Developing products and social innovations, among other actions.

The program has achieved such significant success because all PPSUS managers have ensured that it is conducted in an aligned manner. Additionally, the scientific community has understood the program and is dedicated to presenting proposals with the potential to benefit the health system.

However, this was not a simple process, nor was it immediately adopted from the first edition.

This culture of developing research projects with the possibility of incorporating the findings into services or the health system has evolved through actions that have been implemented to increasingly integrate knowledge translation and the PPSUS.

An example of this is the attempt to create closer ties between public players such as researchers and managers involved in project development. This has been encouraged since designing the project that would forge a partnership between academia and an institution under the SUS umbrella.

Another example of this is the presence of state and municipal managers and public oversight representatives at program events, in which the researchers present their findings, and dialogue on implementation is encouraged.

Managers are also involved in the process of defining high-priority lines of research addressed by the public calls.

Recently, two meetings were held to define the priorities for the next PPSUS public call.

The first was to survey the state’s main health issues and concerns and was attended only by the State Health Secretariat’s Coordinating Offices.

The second, larger meeting was attended by over a hundred people, including researchers, managers, and community representatives, who came up with 14 lines of research for the new call for proposals.

This exercise was deemed a successful first step in bringing these public players together. The next step will be issuing the call for proposals, which should occur shortly. The PPSUS expects to receive proposals that can truly seek answers to the issues identified.

There are still many challenges to incorporating research findings into services and the health system. However, applying knowledge translation processes has been fundamental to reducing the gap between research and management.

An example of this is the PPSUS in São Paulo, which has successfully demonstrated that this is possible.

Maritsa Carla de Bortoli has a Bachelor’s degree in Nutrition (UFPR), a Master’s degree in Applied Human Nutrition (USP), and is a researcher and director at the Center for SUS/SP Health Technology for the São Paulo State Health Secretariat’s Health Institute, where she coordinates the Evidence Center¾affiliated with the Evidence-Informed Policy Network (EVIPNet).

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