Research in action: the training approach of the Joint Health Systems Research Project for the Southern African Region.

Over the last two decades, capacity-building in health research has been recognized as a priority by the international research community. Since 1987 the Joint Health Systems Research (HSR) Project for the Southern African Region has been making efforts to increase the national expertise for operational health research, starting in ten Southern African countries, in order to strengthen decision-making in health care at all levels. Initially, its targets were health managers and public health staff. Step-by-step, staff of different levels and disciplines have, in small groups, developed and implemented research protocols on problems experienced in their own working environment. The recommendations resulting from over 200 studies could, to a large extent, be implemented by the teams themselves. The Project was characterized by a flexible approach, allowing countries to participate at their own speed and to determine their own activities and the support they needed. As Ministries of Health as well as research institutions, in an increasing number of Southern and Eastern African countries, choose to actively participate in HSR, this has contributed to bridge the gap between the academic world and the health field. Still, sustainability of HSR activities remains a challenge. This paper describes the approach of the Joint HSR Project over the first 10 years of its operation, and its major strengths and limitations.