Dear Neil, Simon and HIFA colleagues
Very interesting to follow this deep dive. A couple of reflections from me on the issues flagged by Neil, especially on the benefit and challenges of open access, as well as thoughts on how we should think about what health workers and managers of health systems might value:
(1) On open access: Accessible research papers, particularly those published under open access, present both opportunities and challenges for evidence use in health systems. On the positive side, open access practices have democratized access to research and made it easier to conduct evidence syntheses (such as systematic reviews of effectiveness or qualitative evidence syntheses) by removing paywalls that previously might have limited inclusion of relevant studies. This can have allowed researchers in low-resource settings to participate more fully in global evidence generation. Yet, this accessibility has probably also a downside: it has also contributed to a proliferation of low-quality or poorly designed studies that must be screened, increasing the workload of reviewers and making tools like machine learning-assisted screening increasingly central.. We have in our work experienced the challenge of not being able to access relevant research papers, even with substantial institutional access. Such barriers are likely to create more pronounced inequities for researchers and practitioners in settings without institutional subscriptions.
(2) On what research might be valuable: I think for most clinical and managerial contexts, people will benefit more from synthesized and repackaged evidence—such as guidelines, policy briefs, or decision-support tools—than from direct access to primary studies, which are often inconclusive in isolation. However, for questions related to health system organization, governance, and financing, access to local research remains particularly valuable. Local studies often contain contextual insights not necessarily present in global syntheses and can inform decisions about service delivery models or participatory mechanisms. Perhaps such local evidence together with global syntheses can be useful for interpreting and applying evidence meaningfully within local contexts.
Best wishes
Unni Gopinathan
Scientist
Centre for Epidemic Interventions Research
Norwegian Institute of Public Health
Mobile: +47 48 29 40 74
Email: unni.gopinathan@fhi.no
https://www.fhi.no/en/more/research-centres/ceir/
HIFA profile: Unni Gopinathan is a Senior Scientist at Norwegian Institute of Public Health, Norway. He is a principal, investigator with the HIFA Project on SUPPORT-SYSTEMS - How can decision-making processes for health systems strengthening and universal health coverage be made more inclusive, responsive and accountable? https://www.hifa.org/support/members/unni unni.gopinathan AT fhi.no