The Health Systems Research section: scope and future

Over the past decade, Health Policy and Planning’s Health Systems Research section has been a leading platform for advancing empirical and methodological scholarship on health systems in low- and middle-income countries (LMICs). Through sustained engagement with core domains of health systems, the section has generated insights into how systems operate within complex political, institutional, and social contexts, highlighting not only what works (or not), but why, and under what conditions. Key areas of contribution have included governance, priority setting, service delivery, the health workforce, health information and logistics systems, and the ways in which policies shape change in health system architecture, programmes and health services, and vice versa. This trajectory was shaped by foundational contributions to understanding health systems, notably the supplements Systems Thinking for Health Systems Strengthening in LMICs: Seizing the Opportunity (Adam and de Savigny 2012) and Science and Practice of People-Centred Health Systems (Sheikh et al. 2014), which foregrounded the importance of complexity, social context, actors, and human values in shaping health systems. This body of work has evolved in parallel with profound shifts in the global context. The past decade has been characterized by a series of systemic shocks and transitions that are reshaping both the practice of health systems strengthening and the research agendas that underpin it. The COVID-19 pandemic marked an inflection point, exposing fragilities in state authority, public trust, and global coordination. At the same time, intensifying geopolitical tensions, religious and ethnic divisions, and protracted conflicts have had direct and devastating impacts on health systems, including the targeting of facilities and health workers. The weakening of multilateralism, alongside an accelerated decline in development assistance, is further transforming the governance and financing landscape of health systems. These dynamics are accompanied by a renewed emphasis on national sovereignty and self-reliance, including increased focus on domestic financing and local production of essential medical products and technologies. Concurrently, the growing influence of commercial actors, including private equity and philanthropic organizations, is reshaping public sector-oriented understandings of health systems. Rapid advances in digital technologies, artificial intelligence (AI), and data infrastructures are reconfiguring health systems in real time, while also contributing to the proliferation of misinformation and disinformation. Taken together, these developments are redefining the scope and priorities of health systems research and underscore the need for conceptual and methodological approaches that more explicitly engage with governance, legitimacy, and political economy analyses of the forces driving health systems and system transformation in a rapidly changing world. Over the past decade, the Health Systems Research section has advanced knowledge across a set of core and evolving thematic areas, reflecting both enduring concerns and emerging priorities in the field. Equity and universal health coverage have remained central, with increasing attention on social justice and the structural determinants of access. This focus is exemplified in the 2023 supplement Health Equity: Access to Services and Caring for Underserved Populations (Lazo-Porras and Penniecook 2023), which highlighted the lived experiences of marginalized groups and the systemic barriers they face. Health systems preparedness and resilience have emerged as critical themes particularly in the wake of successive epidemics and the COVID-19 pandemic, with a dedicated article collection: From COVID-19 to stronger people-centred and equitable health systems. More recent work has extended beyond resilience, to examine how health systems innovate and manage change, repurpose resources, and adapt to dynamic reconfigurations across the public–private mix (Rodriguez et al. 2015). This body of work increasingly connects questions of sustainability and justice with domestic sovereignty and institutional capability in LMICs. The section has also engaged with broader system transformation and political economy questions. The forthcoming supplement Changing Health Systems: Advancing Justice and Sustainability through Research, Policy and Practice will further explore how systems transform, innovate, and adapt in response to systems shocks. Previous supplements, such as Experiences of African health system leadership and its development (2018) (Gilson and Agyepong 2018), Health Systems Performance in the Political Agenda (2024) (Maceira and Topp 2024), and Rethinking External Assistance for Health (2024) (Sparkes et al. 2024), have addressed related themes such as leadership, multisectoral collaboration, donor transitions, and the politics of international aid flows. Emerging cross-cutting concerns have also gained prominence. Climate change has been increasingly recognized as a health systems-level challenge, with the 2021 commentary, Climate change: an urgent priority for health policy and systems research calling for the integration of environmental stressors into health systems analysis (Marten et al. 2021) and the ongoing special collection Climate Change and Health. Gender equity has similarly been foregrounded, both as an analytical lens—as in How to do (or not to do) … gender analysis in health systems research (Morgan et al. 2016)—and as a policy priority, including in the 2017 supplement Leaving No One Behind: Gender Analysis in Health Systems (Theobald et al. 2017). Over the past decade, the Health Systems Research section has documented and helped shape key conceptual and methodological developments in the field. Contributions published in the section reflect a shift from analyses of discrete, technical interventions towards more critical examinations of governance and power in real-world settings (Abimbola et al. 2014), alongside more nuanced understandings of health systems ‘software’—the norms, relationships, ideas, and power dynamics that shape the success or failure of policy reforms (Burger and Gilson 2025). Methodological innovation has also been a consistent feature of this section. Studies have increasingly drawn on mixed-methods designs (Ozawa and Pongpirul 2014, De Allegri et al. 2018), realist evaluation (Shankardass et al. 2015), theory-driven approaches (Adam et al. 2020), and intersectionality-informed analysis (Larson et al. 2016). Authors have also applied systems thinking and complexity science to better account for uncertainty, feedback, and adaptation, including in analyses of governance processes (Kwamie et al. 2021). Across these contributions, there has been a growing emphasis on generating actionable evidence that can inform policy and practice, alongside advancing conceptual and theoretical insights (Kwamie et al. 2026). Co-production and participatory research are, moreover, gaining traction as important modes of inquiry in health systems research. Helping to move beyond extractive models of knowledge generation, they position communities, implementers, and policymakers as partners in defining research questions, generating evidence and interpreting findings (Lehmann and Gilson 2015). This orientation strengthens the relevance, legitimacy, and uptake of research, embedding it within learning processes that can drive institutional and systemic transformation (Ozano et al. 2020). Looking ahead, several priorities are emerging for health systems research, reflecting deeper transformations in the conditions under which health systems operate and evolve. These reflect interconnected domains that will shape research agendas as well as the practice of health systems research. First, the mainstreaming of digital technologies, AI, and machine learning into core health system functions—including diagnostics, supply chain management, and accountability mechanisms—raises critical questions for research around ethics, safety, power, equitable access, data sovereignty, and digital literacy. Second, human, animal, and environmental health threats, including zoonotic spillovers, antimicrobial resistance, and climate-related shocks, are placing increasing strain on health systems, particularly in LMICs. There is a growing need for research that translates ecohealth, One Health, and planetary health principles into actionable and sustainable system-level interventions. This will require interdisciplinary approaches, co-production, and methodological innovation, particularly in linking governance, intersectoral collaboration, and citizen engagement with resilience and climate justice. Third, the structural determinants of health—including urban design, food systems and the commercial determinants of health—are shaping health systems risks and responses. Rapid urbanization is positioning cities as sites of increased exposure to health threats, but also as centres of experimentation and innovative governance. Commercial, philanthropic, and digital actors are increasingly central to health system functioning. Research will need to examine how political economy forces, such as evolving market and institutional dynamics, influence service organization, financing, accountability, and equity. Fourth, democratic backsliding, political instability, conflict, and forced displacement—linked to broader shifts in the global order—are increasingly affecting health system performance and exacerbating vulnerabilities among marginalized populations. These dynamics call for contextually grounded, action-oriented research that can inform system responses under conditions of uncertainty and disruption. Finally, shifting power dynamics within the field—including the growing influence of emerging economies and new technological infrastructures—are reshaping how agendas are set and knowledge is produced. Future research will need to engage with community-led monitoring, participatory approaches, and south–south collaboration, while continuing to address enduring concerns such as migration, gender equity, and indigenous health. Questions around the decolonization of health systems research, including issues of authorship and readership, funding for health system research, and where research agendas get set, will remain critical. An emerging methodological frontier, meanwhile, is research that supports institutional learning and leadership focusing on how systems and actors within them generate, interpret, and use diverse forms of knowledge to navigate complexity and strengthen self-reliance, especially in LMICs. In the current context, where pressures on national sovereignty, human rights, international solidarity, and the equitable right to health are increasingly evident, rigorous and policy relevant research on health systems is as essential as ever, not only to document these shifts but to interrogate their implications and inform how systems are governed, financed, and transformed. While the contexts in which health systems operate continue to evolve, systems thinking and people-centred perspectives remain central to how we understand, analyse, and strengthen health systems. We invite submissions that examine the consequences of the current global, national, subnational, and local challenges for health systems, services and programme organization, and their implications for access, inclusion, and equity. In particular, we encourage analyses of how actors across the health system, including the private sector, adapt, innovate, and strengthen systems, in response to climate change, conflicts, pandemics, fiscal and market transitions, AI and digital adoption, and other systemic shifts. Health systems research has often been positioned within public health and has therefore an inherited dominant epistemological orientation, including the privileging of positivist approaches and established hierarchies of evidence, from which it has not fully disentangled itself. While these have contributed to important advances, they have also at times constrained the scope of inquiry. We encourage contributions that engage more explicitly with the political, social, and developmental dynamics that shape health systems as complex societal institutions, including analyses of power, contestation, and institutional change. The section will continue to prioritize methodological innovation. We particularly welcome submissions that draw on perspectives from disciplines beyond public health—such as sociology, critical anthropology, historical analysis, gender studies, management sciences, international relations, and security studies—and that employ comparative, interdisciplinary, and multi-level analysis. We are interested in papers that address the tension between contextual specificity and generalizable insight and that advance approaches for studying health systems across diverse settings. Recognizing the interrelationship between health systems and health policy, we wish, finally, to highlight the journal’s parallel section on ‘Health Policy Processes’. Research that generates ideas for policy directions and developments within health systems should be submitted to this section. We also encourage analyses that centre the perspectives and practices of health system actors in the implementation of policies and programmes. However, research on policy processes—that is, research that examines the political, economic, and organizational forces shaping agenda-setting, policy formulation, adoption, and implementation—should be submitted to our sister section. None declared. Not applicable. No ethical approval was required for this study.