Health Systems Research (HSR) represents a dynamic and multifaceted field of scientific inquiry that seeks to unravel the complexities of healthcare systems. It investigates the interplay of numerous factors—including social determinants, financing mechanisms, organizational frameworks, health technologies, and individual behaviors—that collectively influence healthcare access, quality, cost, and overall health outcomes. This comprehensive approach ensures that HSR can provide a holistic understanding of the intricate workings of health systems, which is essential for designing effective interventions and policies.1-3
HSR's relevance is underscored by its multidisciplinary nature, drawing expertise from various fields such as medicine, public health, sociology, economics, and management. This diversity enables researchers to examine health systems from multiple perspectives, ensuring that the findings are robust and applicable across different contexts. The ultimate goal of HSR is to generate actionable knowledge that can inform policy decisions, enhance healthcare delivery, and improve population health outcomes.4,5
According to the World Health Organization (WHO, 2000), health research is a broad term encompassing all organizations, individuals, and actions dedicated to promoting, restoring, or maintaining health. This definition highlights the inclusive nature of health research, acknowledging that it spans a wide array of activities and stakeholders. HSR, as a subset of health research, specifically focuses on understanding and improving health systems, which are the backbone of delivering healthcare services to populations.5-7
This review article aims to provide an exhaustive analysis of Health Systems Research, delving into its development, significance, types, essential elements, scope, and future directions. By examining the historical context and evolution of HSR, the article sheds light on how this field has grown to address the emerging challenges in healthcare. It also emphasizes the critical role of HSR in shaping health policies and practices, particularly in the Indian context, where healthcare systems face unique challenges and opportunities.
The review is structured to cover several key aspects of HSR: development, significance, types, essential elements, scope, and future directions. It begins with a historical overview of HSR's evolution, highlighting significant milestones and the role of international organizations like WHO. Following this, the review explores why HSR is crucial for improving healthcare systems, focusing on its impact on policy-making and resource allocation. It then delves into the different types of HSR, including operational research and health policy research, and their respective contributions to healthcare improvement. The essential elements that make HSR effective, such as its action-oriented approach, multidisciplinary nature, and focus on priority problems, are also examined. The review further analyzes the various areas HSR covers, including health policy, planning, community health needs, and resource management. Finally, it provides insights into the future of HSR, particularly in India, highlighting the need for more action-oriented research, standardized methodologies, and enhanced capacity-building efforts.
In the Indian context, HSR is particularly significant due to the diverse and complex nature of its healthcare system. India faces numerous health challenges, ranging from infectious diseases to non-communicable diseases, and a wide disparity in healthcare access between urban and rural areas. HSR can play a pivotal role in addressing these issues by providing evidence-based insights and practical solutions tailored to the specific needs of the Indian healthcare system. This review aims to underscore the importance of HSR in India and outline the steps needed to strengthen its research capacity and application.
This review article seeks to offer a comprehensive and detailed exploration of Health Systems Research, emphasizing its critical role in improving healthcare delivery and outcomes. By focusing on the development, significance, types, essential elements, scope, and future directions of HSR, particularly in the Indian context, the article aims to provide valuable insights for researchers, policymakers, and healthcare practitioners dedicated to advancing health systems worldwide.
Health Systems Research (HSR) is a relatively new entrant in the broader health research landscape, with its inception dating back to 1967. This period marked the introduction of Research in Epidemiology and Communication Science by the World Health Organization (WHO). This initiative led to the establishment of the Division of Research in Epidemiology and Communication Science, specifically aimed at health care services research. The journey of HSR can be traced through several key milestones. In 1967, the Division of Research in Epidemiology and Communication Science was established, laying the foundation for systematic health services research. By 1972, this division underwent restructuring to become the Division of Strengthening Health Services, transferring its health services research responsibilities to a more focused entity. This restructuring highlighted the growing importance of HSR in addressing global health challenges.
The year 1978 marked another significant milestone with the formation of the Global Advisory Committee on Medical Research and its Sub-committee on health services research. This formation was part of a broader initiative aimed at achieving "Health for All by 2000" through the Primary Health Care approach. This goal underscored the necessity of a comprehensive understanding of health systems to implement effective primary health care strategies. In 1980, WHO formally recognized Health Services Research as a critical area, leading to the establishment of Health Systems Research. This recognition was a pivotal moment, emphasizing the essential role of HSR in enhancing global health systems.
The evolution of HSR continued through the 1990s, characterized by significant developments and strategic discussions. In 1990, the Forty-Third World Health Assembly acknowledged HSR as an indispensable tool for health development. This acknowledgment was part of a broader strategy to achieve "health for all" by the year 2000. The assembly's recognition of HSR underscored its critical role in shaping health policies and interventions to meet this ambitious goal. As a result, four major themes within health research were identified, which included Health Systems Research, Research Capability Strengthening, Nutrition Research, and Science Research and Health Care. These themes highlighted the multifaceted nature of health challenges and the need for a comprehensive research approach to address them effectively.
During the mid-1990s, HSR was further integrated with the Division for Strengthening Health Services, reinforcing its significance within the global health agenda. This integration aimed to enhance the coherence and impact of HSR efforts. The turn of the millennium saw the launch of Health Policy and System Research in 2000 under the auspices of the Global Forum for Research. This launch represented a strategic move to stimulate a new generation of knowledge synthesis. It focused on developing capacity for knowledge dissemination and promoting the practical use of research findings to improve health systems. The emphasis was on creating actionable insights that could inform policy decisions and drive health system improvements.
Overall, the development of HSR has been marked by strategic initiatives, institutional restructuring, and a growing recognition of its critical role in achieving global health objectives. From its inception in the late 1960s to its current status, HSR has evolved to address the complex and dynamic challenges of health systems worldwide.
Health Systems Research (HSR) is an essential facet of applied health research, designed specifically to provide critical information that enhances the functioning of health systems. Its primary goal is to improve health outcomes by informing decision-making processes at various levels within the health system. HSR targets a wide range of stakeholders, including policymakers, clinic managers, and other key role-players within the healthcare infrastructure. By addressing the day-to-day concerns and challenges faced by health managers and decision-makers, HSR ensures that the available resources are utilized in the most efficient manner. For instance, it aids in balancing the allocation of funds across different health programs, ensuring that limited financial resources are deployed where they can have the most significant impact. This practical approach helps in making informed choices that enhance the overall efficiency and effectiveness of health services, ultimately leading to better health outcomes for the population.
While there is broad consensus on the critical importance of Health Systems Research, the field often faces challenges regarding its precise definition and scope. HSR is characterized by its adoption of methodologies that yield generalizable solutions, making it applicable to a variety of similar health-related problems across different settings. This universality is one of its strengths, as it enables researchers and practitioners to identify key elements of health issues, understand underlying causal relationships, and develop theoretical frameworks that can be applied broadly. By doing so, HSR fills significant knowledge gaps, providing a deeper understanding of health systems and their dynamics. This comprehensive approach ensures that research questions are highly relevant to the needs of policymakers and healthcare administrators. As a result, HSR delivers actionable insights that empower decision-makers to craft informed, evidence-based policies and strategies aimed at improving health outcomes. This relevance and applicability make HSR an indispensable tool in the continuous effort to optimize health systems and address pressing health challenges effectively.
Operational research is a crucial aspect of Health Systems Research (HSR) that zeroes in on the actual delivery of health services. It delves into the intricate details of how health services are provided, scrutinizing the resources utilized, the processes involved, and the outputs generated. The primary objective of operational research is to enhance the efficiency and effectiveness of service delivery by providing practical, evidence-based answers to questions posed by health service managers. For example, operational research might involve a detailed analysis of resource allocation within a health facility, identifying ways to optimize the use of available resources to maximize patient care outcomes. It could also involve streamlining administrative and clinical processes to reduce wait times, improve patient flow, and increase the overall quality of care. By focusing on these operational aspects, this type of research helps health facilities operate more smoothly and efficiently, ultimately improving patient care and satisfaction.
Health policy research, on the other hand, is oriented towards informing and shaping higher-level health policy decisions rather than the direct delivery of services. This type of research is concerned with broader systemic issues, such as how resources should be allocated between different levels of care or across various geographical areas. For instance, it might explore the most equitable and efficient ways to distribute the national healthcare budget among provinces or sectors, ensuring that funds are used where they are most needed and can have the greatest impact. Health policy research plays a critical role in making informed policy decisions that affect the overall health system. It provides policymakers with robust evidence and analytical frameworks to support decisions on funding formulas, policy interventions, and strategic health initiatives. By focusing on these high-level issues, health policy research ensures that the allocation of resources is aligned with the health needs of the population, promoting fairness, efficiency, and effectiveness in the healthcare system. This type of research is indispensable for developing policies that ensure optimal use of resources and improve the health outcomes of the population on a macro level.
Health Systems Research (HSR) is underpinned by several critical elements that collectively ensure its effectiveness and relevance in improving healthcare delivery. Firstly, HSR is action-oriented, meaning it is focused on developing practical and applicable solutions to health system problems. This ensures that the research outcomes can be directly implemented to enhance health services, addressing real-world challenges faced by healthcare providers and policymakers. By emphasizing actionable results, HSR bridges the gap between research and practice, making a tangible impact on health outcomes.
Another cornerstone of HSR is its multi-disciplinary approach. This element involves the integration of various disciplines such as medicine, epidemiology, economics, and social sciences. By drawing on diverse fields, HSR provides a comprehensive understanding of complex health system issues. This interdisciplinary collaboration enriches the research process, allowing for more robust analyses and innovative solutions that consider multiple perspectives and expertise areas.
HSR is also fundamentally participatory, engaging both researchers and the community throughout the research process. This engagement ensures that the solutions proposed are valid, reliable, and acceptable to the people they are intended to help. By fostering collaboration and stakeholder buy-in, participatory research enhances the likelihood of successful implementation and sustainability of interventions. It also ensures that the research addresses the actual needs and preferences of the community, leading to more relevant and impactful outcomes.
Timeliness is another crucial element of HSR. For research findings to be useful, they must be available when decisions need to be made. This means that HSR must be designed and conducted in such a way that results are produced promptly, ensuring that findings are relevant and can be acted upon quickly. Timely research helps policymakers and health managers make informed decisions that address current issues and emerging challenges within the health system.
Moreover, HSR emphasizes simple and effective design. Research designs should be straightforward, ensuring that studies yield clear and actionable insights. This simplicity makes it easier for policymakers and other stakeholders to understand and implement the recommendations derived from the research. Effective design also ensures that the research process is efficient and that resources are used wisely, maximizing the impact of the study.
Finally, the findings of HSR must be accessible and easily understood. This means that research results should be presented in a clear and comprehensible manner, and be readily available to all relevant stakeholders. By promoting the widespread dissemination and use of research results, HSR ensures that the knowledge generated is used to inform practice and policy, driving improvements in health systems.
A crucial aspect of HSR is its focus on priority problems. For HSR to make the greatest possible impact, it must concentrate on the most pressing issues faced by each level of the health system. By identifying and targeting these priority problems, HSR can develop solutions that address the most significant barriers to effective healthcare delivery. This targeted approach ensures that the research is relevant and that its findings can lead to substantial improvements in health services.
The ultimate goal of HSR is to develop solutions that are both affordable and effective, considering the practical constraints of health systems. This involves designing interventions that can be feasibly implemented within existing resource limitations and that provide the greatest benefit relative to their cost. By focusing on priority problems and developing practical, cost-effective solutions, HSR can drive significant improvements in health systems, ultimately leading to better health outcomes for the population.
Health Systems Research (HSR) is dedicated to enhancing the understanding of the structure and functioning of health systems, with the ultimate goal of identifying and addressing specific problems across various contexts. This broad objective encompasses several primary areas of focus, each critical to the effective functioning and improvement of health systems.
One major area of focus is health policy and planning. This involves a thorough analysis of the health needs of the population, the resources available, and the effectiveness of existing interventions. The aim is to ensure that health policies are not only responsive to the current needs of the population but also adaptive to future challenges. By focusing on health policy and planning, HSR helps to design and implement strategies that strengthen health systems, making them more resilient, equitable, and capable of delivering high-quality care.
Another crucial focus area is community health needs. This aspect of HSR considers factors such as mortality, morbidity, and disability within the community. By closely examining these health indicators, researchers can develop targeted interventions that address the most significant health challenges faced by the community. For instance, HSR might identify high rates of a particular disease in a community and work towards developing specific health programs to combat it. This focus ensures that health interventions are relevant and effective, directly addressing the critical health issues that impact community well-being.
Human and financial resources are also a key focus of HSR. This involves evaluating the various sources of funding for health systems, such as taxes, user fees, insurance contributions, and community support. By understanding how these financial resources are generated and allocated, HSR aims to ensure that health systems have the necessary resources to provide quality care. This includes analyzing the efficiency and equity of resource distribution, as well as exploring innovative funding mechanisms to support sustainable healthcare financing. Additionally, human resources are a critical component, as the availability of skilled healthcare professionals is essential for delivering effective health services. HSR examines workforce planning, training, and management to optimize the deployment and utilization of health personnel.
Lastly, program adequacy and coverage is a vital focus area of HSR. This involves evaluating the acceptability, affordability, and equitability of health interventions to ensure that they effectively reach all segments of the population. Adequacy refers to whether health programs meet the needs they are designed to address, while coverage examines the extent to which these programs are accessible to the entire population, including marginalized and vulnerable groups. By assessing these factors, HSR seeks to identify gaps in health service delivery and propose strategies to improve the reach and impact of health programs. Ensuring that health interventions are equitable and inclusive is fundamental to achieving universal health coverage and improving overall health outcomes.
In summary, the scope of Health Systems Research is broad and multifaceted, encompassing critical areas such as health policy and planning, community health needs, human and financial resources, and program adequacy and coverage. By focusing on these areas, HSR provides a comprehensive framework for understanding and improving health systems, ultimately leading to better health outcomes for populations worldwide.
The Health Systems Research (HSR) process is a structured series of steps designed to ensure effective research execution and meaningful outcomes. While there is no universally agreed-upon process, certain common steps are integral to conducting robust HSR.
Designs and Methods form the foundational step in the HSR process. This phase involves the selection and application of diverse approaches and methodologies drawn from multiple disciplines, ensuring a holistic analysis of health systems issues. Both qualitative and quantitative methods are employed to gather comprehensive evidence and draw well-rounded inferences. Qualitative methods might include interviews, focus groups, and case studies, providing in-depth insights into complex health phenomena. Quantitative methods, such as surveys and statistical analysis, offer measurable and generalizable data. The integration of these methods allows researchers to triangulate data, enhancing the validity and reliability of the findings. By leveraging the strengths of both approaches, HSR can address the multifaceted nature of health systems, capturing a wide range of perspectives and generating actionable insights.
The next critical step is the development of a work plan. This step involves creating a detailed schedule that outlines the tasks to be performed, the timelines for each task, and the individuals responsible for executing them. A well-defined work plan is essential for the smooth progression of the research. It ensures that all participants are clear about their roles and responsibilities, promoting coordination and collaboration among the research team. The work plan should also include contingency plans to address potential challenges or delays. By providing a clear roadmap, the work plan helps keep the research on track, ensuring timely completion and high-quality outcomes.
Report writing and result dissemination constitute the final key step in the HSR process. Once the research is completed, the findings need to be documented comprehensively and communicated effectively to stakeholders. The report should present the research methods, data analysis, and findings in a clear and accessible manner. Effective dissemination is crucial to ensure that the research results are utilized to inform and influence policy decisions. This can involve a variety of dissemination strategies, including academic publications, policy briefs, presentations, workshops, and media engagement. By sharing the findings with policymakers, health managers, and other stakeholders, HSR can drive improvements in health systems and practices. Ensuring that the research reaches and resonates with the right audience is vital for translating evidence into action, ultimately enhancing health outcomes and system performance.
In conclusion, the research process in Health Systems Research involves meticulously planned steps that include the selection of appropriate designs and methods, the development of a detailed work plan, and the effective dissemination of findings. Each of these steps plays a crucial role in ensuring that the research is conducted systematically, yielding insights that are both relevant and actionable. Through this structured approach, HSR contributes significantly to the understanding and improvement of health systems worldwide.
In India, the institutional framework for Health Systems Research (HSR) is robust and multifaceted, with the Indian Council of Medical Research (ICMR) serving as the nodal agency. Established in 1974, the ICMR's Task Force on Operational Research has been instrumental in shaping program strategies for health service delivery across the country. This task force plays a critical role in identifying priority research areas, coordinating research efforts, and ensuring that findings are translated into practical health interventions. Various national programs and research institutions contribute significantly to the HSR landscape in India. Notable among these are the National Institute of Health and Family Welfare (NIHFW), which focuses on health policy and training, the Indian Institute of Health Management Research (IIHMR), which specializes in health management research and education, and the Foundation for Research in Community Health (FRCH), which emphasizes community health and grassroots research. These institutions collectively enhance the capacity for HSR in India, fostering a collaborative environment for advancing health system improvements.
The utilization of HSR in India is pivotal in bridging the gaps between researchers, policymakers, and administrators. By coordinating research efforts, HSR helps avoid unnecessary duplication of studies, thereby optimizing resource use and enhancing the efficiency of health research initiatives. It provides a comprehensive framework for analyzing and interpreting data, generating the additional information required for informed decision-making. HSR serves as a vital tool for improving managerial and policy decisions, enabling stakeholders to develop evidence-based strategies that enhance health service delivery. Through scientific methods, HSR ensures that health policies are grounded in solid research, addressing the specific needs and challenges of the Indian healthcare system. This coordinated approach facilitates the integration of research findings into practice, leading to more effective and sustainable health interventions.
HSR has significantly influenced several key health policy and programmatic decisions in India. One prominent example is the implementation of the Community Health Workers Scheme, a primary health care delivery initiative. Research findings demonstrating the effectiveness of community health workers in improving health outcomes led to the decision to scale up this program nationwide. Another impactful area is the Malaria Control Program, where research on the efficacy of bio-larvicides informed the adoption of these agents as a part of the malaria control strategy. This evidence-based approach has contributed to more effective malaria prevention efforts.
The National Program for Control of Blindness (NPCB) is another area where HSR has made a significant impact. Research findings on program strategies and financial allocations have led to substantial improvements in blindness prevention and treatment. This includes the development of targeted interventions and efficient use of resources, resulting in better eye care services across the country. Furthermore, research on healthcare financing has played a crucial role in informing policy decisions. Studies on health expenditure have helped design more efficient and equitable financing mechanisms, ensuring that healthcare funding is allocated in ways that maximize impact and reach the most vulnerable populations.
Future of Health Systems Research in India16-22
Strategic Directions
The future of HSR in India is guided by several strategic directions aimed at enhancing the relevance and impact of research. A key focus is on action-oriented research, which involves conducting more studies that address practical problems and provide actionable recommendations for health system improvements. This approach ensures that research findings are directly applicable and can lead to tangible benefits in healthcare delivery.
Multi-centric studies are also promoted to standardize research procedures and improve the generalizability of findings. By conducting research across multiple centers, HSR can generate data that is more representative of diverse contexts, enhancing the applicability of the results. This strategy helps in comparing outcomes and identifying best practices that can be implemented across different settings.
Another strategic direction is the emphasis on human resource development. There is a need to enhance the focus on developing skilled researchers and practitioners who are capable of conducting high-quality HSR. This involves training programs, capacity-building initiatives, and professional development opportunities that equip researchers with the necessary skills and knowledge to undertake rigorous health systems research.
Health economics is another critical area for future research. Encouraging studies on healthcare financing mechanisms and cost evaluation provides valuable insights into sustainable health system funding. This research helps in understanding the economic aspects of health interventions, guiding policymakers in allocating resources efficiently and ensuring the financial sustainability of health programs.
Holistic Studies and Rapid Assessment Techniques
Conducting regular, comprehensive studies that cover all elements of the health system is essential for continuous improvement. Holistic studies provide a broad perspective on health system performance, identifying strengths, weaknesses, and areas for improvement. Additionally, developing rapid assessment techniques using epidemiological, statistical, and anthropological methods enables timely decision-making. These techniques allow for quick data collection and analysis, providing policymakers with the information needed to respond promptly to emerging health issues.
Effective mechanisms for sharing research results are also crucial. Proper reporting, conferences, and publications ensure that research findings are disseminated widely and reach all relevant stakeholders. This dissemination fosters a culture of evidence-based decision-making and encourages the uptake of research findings in policy and practice. Sustained impact requires ongoing communication and collaboration among researchers, policymakers, and healthcare providers, ensuring that the benefits of HSR are fully realized.
The strategic directions and focus areas outlined for the future of HSR in India aim to strengthen the research framework, enhance the quality and applicability of findings, and ensure that research contributes to meaningful improvements in the health system. By building on the existing institutional framework and fostering collaboration among key stakeholders, India can continue to advance its health systems research capabilities, ultimately leading to better health outcomes for its population
Health Systems Research (HSR) stands as a crucial discipline that delivers essential insights and practical solutions for the enhancement of health systems worldwide. Its multidisciplinary approach allows it to address complex health issues from various perspectives, ensuring comprehensive analyses and robust solutions. By focusing on priority problems and maintaining a strong link to decision-making processes, HSR serves as an invaluable tool for policymakers, health managers, and administrators. In the Indian context, the coordinated efforts of institutions such as the Indian Council of Medical Research (ICMR), the National Institute of Health and Family Welfare (NIHFW), and others, along with strategic initiatives aimed at action-oriented research and human resource development, underscore the importance of HSR in advancing healthcare delivery. The future of HSR in India looks promising with its emphasis on solving practical problems, conducting multi-centric studies for standardized research, and fostering human resource development to produce skilled researchers and practitioners. The focus on health economics will provide critical insights into sustainable healthcare financing, ensuring efficient resource allocation. Furthermore, the commitment to comprehensive studies and the development of rapid assessment techniques will facilitate timely and informed decision-making. Through comprehensive and participatory research, HSR can drive significant improvements in health systems, addressing both current challenges and future needs. By bridging the gap between research and practical application, HSR not only contributes to the academic understanding of health systems but also translates findings into actionable strategies that enhance health outcomes. Ultimately, the sustained impact of HSR will lead to better health for all, reinforcing its vital role in global health development.
Thomas CW, Corso L, Monroe JA. The value of the "system" in public health services and systems research. Am J Public Health. 2015 Apr;105 Suppl 2(Suppl 2): 13-18.
Health Systems Research. Available from: https://www.hsrd.research.va.gov/funding/what-is-hsr.cfm
Health services research. Available from: https://en.wikipedia.org/wiki/Health_services_research
McGinnis S, Moore J. The health services research workforce: current stock. Health Serv Res. 2009 Dec;44(6):2214-26.
About Us: Health Systems Research. Available from: https://www.unsw.edu.au/medicine-health/research-impact/excellence/health-systems-research/about-us
Health Systems Governance. Available from: https://www.who.int/india/health-topics/health-systems-governance
Health Care Systems. Available from: https://www.physio-pedia.com/Health_Care_Systems
Mills A. Health policy and systems research: defining the terrain; identifying the methods. Health Policy Plan. 2012;27:1–7.
Reader AM. Health Policy and Systems Research. 2012 [cited 2012 Oct 14]. Available from: http://www.who.int/entity/alliance-hpsr/resources/alliancehpsr
Gonzalez-Block MA. Health policy and systems research agendas in developing countries. Health Res Policy Syst. 2004;2:6.
Taylor CE, Salud OM. The uses of health systems research. WHO. 1984 [cited 2012 Sep 14]. Available from: http://whqlibdoc.who.int/php/WHO_PHP_78.pdf
Nuyens Y. Health system research and world health organization: facts, events, issues, perspectives and documents. Geneva, Switzerland: World Health Organization; 2000.
Sauerborn R, Nitayarumphong S, Gerhardus A. Strategies to enhance the use of health systems research for health sector reform. Trop Med Int Health. 1999;4:827–35.
Bhandari TR. Health System Research: Development, Designs and Methods. JHAS. 2013;3(1):68-72.
Health System Performance. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/health-system-performance
What is Health Policy and Systems Research (HPSR). Available from: https://ahpsr.who.int/what-we-do/what-is-health-policy-and-systems-research-(hpsr)
Kunwar R, Srivastava VK. Operational Research in Health-care Settings. Indian J Community Med. 2019 Oct-Dec;44(4):295-8.
Health Services Research. Available from: https://www.sciencedirect.com/topics/nursing-and-health-professions/health-services-research
Designing and Conducting Health Systems Research Projects. Available from: https://idrc-crdi.ca/sites/default/files/openebooks/069-1/index.html
Remme JH, Adam T, Becerra-Posada F, D'Arcangues C, Devlin M, Gardner C, et al. Defining research to improve health systems. PLoS Med. 2010 Nov 16;7(11): 19-24.
Health Systems Research. Available from: https://icmrnitm.res.in/health-systems-research/
Rao M, Mant D, Parkin D, Roberts H. Health systems research in the time of health system reform in India: a review. Health Res Policy Syst. 2014;12:37
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