Establishing health systems financing research priorities in developing countries using a participatory methodology

Donor funding for health systems financing (HSF) research is inadequate and often poorly aligned with national priorities. This study aimed to generate consensus about a core set of research issues that urgently require attention in order to facilitate policy development. There were three key inputs into the priority setting process: key-informant interviews with health policy makers, researchers, community and civil society representatives across twenty-four low- and middle-income countries in four regions; an overview of relevant reviews to identify research completed to date; and inputs from 12 key informants (largely researchers) at a consultative workshop.Nineteen priority research questions emerged from key-informant interviews. The overview of reviews was instructive in showing which health financing topics have had comparatively little written about them, despite being identified as important by key informants. The questions ranked as most important at the consultative workshop were:. 1.How do we develop and implement universal financial protection?2.What are the pros and cons of the different ways of identifying the poor?3.To what extent do health benefits reach the poor?4.What are the pros and cons of implementing demand-side subsidies?5.What is the cost-effectiveness of service delivery models and health systems strategies?It is hoped that this work on HSF research priorities will complement calls for increased health systems research and evaluation by providing specific suggestions as to where new and existing research resources can best be invested. The list of high priority HSF research questions is being communicated to research funders and researchers in order to seek to influence global patterns of HSF research funding and activity. A " bottom up" approach to setting global research priorities such as that employed here should ensure that priorities are more sensitive to user needs.