Co-production of knowledge must move further and faster to strengthen health systems

There is widespread and growing interest in the role the co-production of knowledge can play in bridging the gap between evidence and policy implementation to improve health policies and strengthen health systems. Since 2012 the World Health Organization (WHO) and the Alliance for Health Policy and Systems Research have recommended an enhanced focus on co-production to ensure greater collaboration between researchers and the intended users of knowledge and to enable the embedding of research into health systems and policies. [1] This work to strengthen health policy and systems research builds on a growing movement of researchers, patients and health professionals among others, engaged in testing, documenting and refining approaches to the co-production. 

Despite this momentum, knowledge which is co-produced with shared power and responsibility between researchers and research users such as patients, caregivers, clinicians, programme managers and policymakers, is still not the norm. Co-production exists in pockets of good practice and in piecemeal projects, but the vision of a research ecosystem with co-production at its centre remains aspirational. It is difficult to envisage what such a system might look like. While the challenge of unequal power dynamics between stakeholders may be resolved at a local level, what does this mean for national and international research communities and health systems? What structures, institutions and cultural changes can the WHO, the Alliance for Health Policy and Systems Research and others support to create co-produced research to improve health systems?  

Power at the health system level often lies in the hands of governments, health system leadership and funders. These decision-makers need to know why a co-production approach is worth the investment. The current mindset is often that co-production is expensive, takes a long time and the benefit gained may not offset the cost. This is often the case in low-and middle-income countries (LMICs) where resource constraints persist. However, we know that investing in a more inclusive approach to the generation of knowledge not only helps to improve trust and reduce power inequalities among stakeholders, but it also contributes to strengthening decision-making for complex health systems and policy challenges. [2] 

A more collaborative approach to understanding and addressing wide-ranging health systems challenges, from the rising burden of non-communicable disease, to covid-19, to the impact of climate change on health, can help to ensure the decisions produced have more relevance and impact on the health outcomes of vulnerable communities and populations. Because LMICs are disproportionately affected by these challenges, advancing co-production in these settings is critical for the creation of more responsive and resilient health systems.

Although the evidence-base on co-production is rapidly expanding, as highlighted by Agyepong and colleagues in this collection, high-income country researchers still lead most work. [3] Strengthening both the capacity and capabilities of researchers and policymakers in LMICs is a key focus of the Alliance’s efforts, as well as deepening understanding of the contextual factors which influence implementing co-production in different settings.

Nobody is suggesting that co-production is easy. There are interdisciplinarity and ethical challenges, which require additional resources for practical issues such as longer-time periods for engagement. [4,5] However, we need to know more about what works, and what does not, in the co-production of knowledge to further inform the design and development of co-production. For example, policymakers and researchers alike recognize it is necessary to expand the involvement of patients, caregivers and communities in the production of knowledge, however, few empirical studies detail the methods to do this effectively in practice. Advancing the research agenda and evidence-base for co-production is a priority.  

We hope the insights from this collection will help shape the conversation, provoke debate and advance coproduction as the default approach for bridging policy and research to improve health outcomes for all.  

Read the full collection online here.

Robert Marten is a Scientist at the Alliance for Health Policy and Systems Research at WHO.  

Rachael Hinton works for The BMJ as a freelance editor. She is a social scientist and researcher with extensive experience in the international health and development fields.  

Cat Chatfield is The BMJ editorial lead for the Collection on Co-production of Knowledge to Strengthen Health Systems.  

Abdul Ghaffar serves as Executive Director of the Alliance for Health Policy and Systems Research. 

Twitter: @AllianceHPSR @martenrobert

Competing interests: RH: This article is part of a collection of papers on the co-production of knowledge. As an Associate Editor for The BMJ I handled many of the papers to be published within the collection. CC: This article is part of a collection of papers on the co-production of knowledge. As an editor for The BMJ I handled some of the papers to be published within the collection. RM and AG declare no conflicts of interest.

This article is part of a series produced in conjunction with the WHO and the Alliance for Health Policy Systems and Research with funding from the Doris Duke Charitable Foundation. The BMJ peer reviewed, edited, and made the decision to publish.



  1. Ghaffar A, Tran NT, Reddy KS, Kasonde J, Bajwa T, Ammar W, Ren M, Rottingen JA, Mills A. Changing mindsets in health policy and systems research. Lancet. 2013 Feb 9;381(9865):436-7. doi: 10.1016/S0140-6736(12)61858-3. Epub 2012 Nov 1. PMID: 23122651.
  2. Williams I, Essue B, Nouvet E, et alPriority setting during the COVID-19 pandemic: going beyond vaccines. BMJ Global Health. 2021;6:e004686.
  3. Agyepong I, Godt S, Sombie I, Binka C, Okine V, et al. Strengthening capacities and resource allocation for coproduction of health research in low-and-middle income countries. BMJ. 2021
  4. Mol A, Hardon AWhat COVID-19 may teach us about interdisciplinarityBMJ Global Health 2020;5:e004375.
  5. Reddy K.S, Ghosh-Jerath S, Sadanandan R. Health Policy and Systems Research: Ethical Challenges in Co-production of Knowledge BMJ. 2021.