Setting health systems research priorities for Afghanistan: an application of the child health and nutrition research initiative (CHNRI) methodology to set a roadmap to 2030

Introduction Afghanistan's health system has faced considerable challenges since the Taliban takeover in 2021, leaving the population vulnerable to an increased risk of morbidity and mortality. Research to illuminate the current functioning of the health system and approaches for strengthening its key components is critically needed to address imminent and evolving health needs of the Afghan people. Methods A health systems' research agenda for Afghanistan that uses a systematic and evidence-based wisdom of the crowds' approach has yet to be developed. Using the Child Health and Nutrition Research Initiative methodology, this study identifies the top 20 health systems' research priorities among experienced Afghanistan health researchers. Priorities were also considered when disaggregating data by subgroups, such as Afghan versus non-Afghan respondents and those from low- and middle-income versus high-income settings. Results A total of 303 researchers were invited to score the research questions; 86 responded to the scoring survey and 55 completed it (60% were of Afghan origin). The highest priority questions were relatively diverse in terms of topic area, with questions spanning system-level factors, healthcare quality, community-based healthcare, improvements in the pharmaceutical sector, epidemiological trends, health management information systems and surveillance, access to care and approaches to improving service delivery in Afghanistan, among many others. € Delivery'-focused and € development'-focused questions were prioritised, demonstrating that participants assigned greater importance to more practical research questions that would explore features of and approaches to improving existing health system structures within the current Afghan context. Results were consistent across subgroups. Conclusion This research prioritisation exercise fills a gap by generating consensus and establishing a research agenda for strengthening Afghanistan's health system.