Needs and challenges of health systems

Needs and challenges of health systems

Stream A— The design of RIH

The aim of this project was to take stock of the scientific literature that examined the needs and challenges of health systems across the world and that can inform the design of RIH.

While health services research is increasingly concerned about the way health systems can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. This project thus explored the “demand” for RIH by: 1) reviewing the available body of scientific knowledge on the challenges health systems across the world face; and 2) analyzing the ways in which the principles of RIH help to address these challenges and support more sustainable technological development in health systems.

To gather a multidisciplinary scientific literature, we performed a structured search on 8 bibliographic databases covering health services and policy research, public health, management, public administration and political science. We screened all scientific papers published between January 2000 and April 2016 and included 292 articles in our scoping review.

The challenges reported in the articles were classified using the dynamic framework of van Olmen and colleagues (2012), which connects the key components that influence how a health system successfully reaches its goals.

HS_Analysis_modelFigure 1 – Analytical model for health system analysis

Figure adapted from: van Olmen et al. (2012). The health system dynamics framework: The introduction of an analytical model for health system analysis and its application to two case-studies. Health Culture and Society, 2(1):1-21.


The countries where these studies were conducted were classified using the Human Development Index (HDI), which combines indicators that are relevant to population health: life expectancy at birth, mean years of schooling and expected years of schooling, and gross national income per capita.

A 1st article identified the kind of research that has been conducted on health system challenges, where it was performed, in which health sectors and on which populations. This article provides a quantitative description of the categories of challenge that have been researched, illustrate the key challenges reported by researchers and examines how these challenges vary across countries whose HDI is very high, high, medium or low.

A 2nd article that focuses more specifically on the challenges that Responsible Innovation in Health (RIH) should seek to address was subsequently published.

Former project lead : Federico Roncarolo

Project contact : Pascale Lehoux