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Time for innovative dialogue on health systems research.

A forthcoming report by the World Health Organization (WHO) on evidence for policy is already fuelling passionate debate, especially among scientists. Opinions are divided: some scientists believe strongly in the systematic assessment of evidence on the effectiveness of health system interventions and reforms; others are skeptical. At the country level, health decision-makers face huge uncertainties. The windows of opportunity are frequently unrelated to the rigour of any evidence available. The recent nationwide roll-out of a new treatment approach for pregnant mothers infected with the human immunodeficiency virus (HIV) in Malawi was based on expert opinion (and advocacy), not a randomized controlled trial.10 Similarly, the Burundian government may not wish to wait for a four-year study to end if it senses promise in a strategy that can meet pressing health needs today. All the more reason to innovate researchers’ dialogue with parties in the thick of it.