Health systems research

Edwine Barasa

Edwine Barasa is a DPhil student at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya. He describes and evaluates the priority setting practices in county hospitals in Kenya.

The KEMRI-Wellcome Trust research programme

The KEMRI-Wellcome Trust Research Programme is a major Wellcome Trust’s overseas programmes. Its work has had a major influence on national and international health policy. Research spans a wide variety of topics and disciplines including research on malaria and bacterial and viral infectious diseases, work to map disease risk and intervention coverage and work on research ethics and health systems strengthening.

Edwine Barasa: Economics of hospitals

My background is a pharmacist; I started out as a pharmacist, and then worked as a clinical pharmacist in a hospital for two years. I then realized I had interest in research and so then branched off to get into health systems research, specifically into health economics research. My current research focuses on the priority setting in hospitals. Essentially, what I am looking at is how hospitals decide on their healthcare priorities and how they locate the resources that they have to the different competing priorities around the hospitals. So looking at how they go about making decisions about which resources go to which department, which resources go to services and how much, in terms of the relative competing priorities.

This is a very important area of study in health systems of developing countries and globally. When you look at the resources that a country has, the budget that a country has, about 50% of the budget actually goes to hospitals. It is very important for a health system to think very carefully about how this large chunk of resources that they allocate to hospitals is actually spent. Because hospitals are avenues for delivering important interventions within a country and they consume the bulk of the resources in the country and so it is very important that the resources are used well. That is why I find that thinking about how the resources that go in to hospitals are allocated, becomes a very important topic.

The methods that I use in my area of research are primarily qualitative. Looking at describing exactly what happens, examining what happens in these hospitals and trying to draw relationships between what is observed and what is examined.

The interesting thing about what I am doing currently is that I have come to find that in as much as hospitals are supposed to be public facilities, providing services in a non-for-profit model, what is happening in hospitals currently is that as hospitals depend a lot on the user fees that they collect from patients, when managers think about which places to give higher priority, they focus a lot on the areas that generate the most revenue. In essence the hospitals have been turned into profit maximising organisations. The problem with that is that then you have departmental services that do not generate a lot of user fees so managers tend to overlook those departments. That creates a lot of inequalities because you end up with having a certain services favoured and other services skipped over.

So far, what I can say is that the area of health systems research in developing countries is still a young and growing field so not a lot of work has been done in health systems research in general. Specifically looking at priority setting at the institutional level, very little has been done. But, what we are doing as a research group is not just doing the research but also trying to engage policy makers. In that way we are beginning to get policy makers to think very critically about the way that hospitals are run. We are very hopeful that the work that we are doing will eventually make an impact.

What I would like to tell young people about venturing in to health systems research is that it is very important that they choose an area that they have passion for, if it’s an area that they have a lot of interest in, it takes time to build competence to do the research and the only way that you can survive in research is if you are keenly interested in what you do.