Mapping the evolution of priorities for health systems evidence synthesis in a low-income country: A case study of Uganda from 2013 to 2023

RATIONALE Resources for conducting health systems research are often limited and yet millions of research articles, systematic reviews, technical reports, and policy briefs are published annually with a significant proportion hardly read, let alone used for decision making. We aimed to identify health systems research priorities for evidence synthesis; assess the availability, evolution and alignment of this evidence with dynamic priorities; and contextualized our findings in Uganda’s health policies and systems. APPROACH This was a multiple methods study between 2013 and 2023, consisting of a mini–Delphi technique to identify health systems research priorities, an uncontrolled before–and–after assessment of availability of research evidence to support the identified priorities, and a qualitative documentary analysis of evolving health policies and systems in Uganda. MAIN FINDINGS Our findings highlighted financial arrangements as a resilient priority area for health system evidence synthesis in Uganda. Secondly, we found an abundance of existing evidence syntheses from the PDQ-Evidence database, in all the areas including health systems governance and human capital development. Third, we mapped the evolution of health systems priorities in Uganda together with the evidence in PDQ-Evidence over the past decade with the emergence of human capital development as a priority policy concern that received massive investment by the Ministry of Health, and indeed highest increase in researched evidence. The organizational realignment of Uganda’s Ministry of Health responded to the evolving health systems priorities in line with agenda 2030 of the sustainable development goals (SDG). CONCLUSIONS Our study findings suggest that access to evidence by decision makers remains an important challenge in bridging the “know–do–gap”. This calls for health systems researchers in Uganda to constantly engage decision makers about where and how to find relevant research evidence, and further refine their information needs. A key starting point is empowering the Uganda National Health Research Organization to provide an integrated knowledge translation platform for the health sector.