Making health systems research work: time to shift funding to locally-led research in the South.

This week, the global health systems research community is gathered in Vancouver, Canada, for the Fourth Global Symposium on Health Systems Research. The current movement for health systems research developed out of a need to strengthen health systems in low-income and middle-income countries. More than 25 years ago, the Commission on Health Research for Development published a report that represented a pivotal change in thinking about health research for development. The main argument of the report was that research contributed little to health in low-income and middle-income countries, because it matched poorly with needs in the global South, was dominated by researchers from the North, and had a narrow biomedical focus. While health systems research has taken off in some high-income countries, progress in low-income and middle-income countries has not kept up. The 2008 Global Ministerial Forum on Research for Health in Bamako, Mali, concluded with the recommendation to increase invest ments in health systems research and organise a global symposium specifi cally focused on improving health systems in low-income and middle-income countries. Since then, the fi eld has expanded rapidly. To contribute to the debate concerning the status and future of the health systems research fi eld, we assessed the research presented at the previous global symposia. We systematically analysed the 1816 abstracts that were presented at the global symposia in Beijing (2012) and Cape Town (2014) and the participant lists of the Cape Town, Beijing, and Montreux (2010) symposia. Our fi ndings present several promising developments but also highlight that research inequities persist. While we observe a gender balance (51% of fi rst authors are female) and substantial contributions from countries such as India, China, and South Africa, the North-South imbalance that was described 26 years ago remains. The fi gure shows the countries in which most primary data have been collected and the countries in which most fi rst authors were based. While 96% of the primary data were collected in low-income and middle-income countries, 56% of fi rst authors were based in highincome countries, compared to only 8% in low-income countries. An even more striking, and largely neglected, imbalance is that health systems research mainly takes