How does health research systems strengthening work, for whom and under what circumstances? A realist evaluation

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T3 - Evidence into Practice T4 - Practice to Policy/PopulationA national health research system (NHRS) has been defined as "the people, institutions, and activities whose primary purpose in relation to research is to generate high-quality knowledge that can be used to promote, restore, and/or maintain the health status of populations; it should include the mechanisms adopted to encourage the utilization of research" (Sadana & Pang, 2003) A NHRS overlaps both the broader national research system and the national health system and consists of four primary functions: 1) stewardship, 2) financing, 3) creating and sustaining resources; and 4) producing and using research. Well capacitated NHRS are essential to resolving national health challenges(COHRED, 1990); however, NHRS capacity is limited in many low- and middle-income countries (LMICs) (Kirigia et al., 2016; Ralaidovy et al., 2020) and knowledge as to how best to support NHRS strengthening is undeveloped. This study seeks to understand the research functions/roles of research institutions/universities (sub-system) within the national health research system and - using the 'Developing Excellence in Leadership, Training, and Science in Africa' (DELTAS Africa) Programme as a case study - examine approaches to health research system strengthening. The study will use a realist evaluation approach to understand how health research systems strengthening works, for whom and in what contexts. The study will address four questions:1. What is the research function of a university within the national health research system?2. To what extent is the 'health research systems strengthening' theory (under the DELTAS Africa programme) plausible? 3. How does the DELTAS Africa programme interact with the context to generate intended and unintended health research system outcomes?4. What is the implication of the evidence on policy and practice?A multi-case study design will be used to evaluate three purposively selected consortia (covering lead and partner institutions) funded under the DELTAS Africa Programme Phase II. Realist evaluation approach will be employed to understand how the health research system strengthening has been conceptualised, examine the interventions being implemented, the mechanisms triggered, the health research system strengthening outcomes realised and how and why these differ across programme contexts. The study is anticipated to provide a broader framework within which evaluation of health research systems, and related research capacity strengthening efforts can be contextualised and implemented. Additionally, this study will build evidence and rationalise the application of complexity-aware evaluation methodologies in the context of health research systems strengthening.