A bibliometric analysis of health systems research in Pakistan

Background: Health systems research and publication are vital for improving healthcare at all levels of care. They provide evidence for policy and for better service outcomes. Aims: To assess published health systems research in Pakistan from 2011 to 2020 and to model and forecast the publication trend. Methods: This cross-sectional study searched health systems research publications database for Pakistan in Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Tables and graphs were created using Microsoft Excel, visualization was produced on VoS Viewer, and SPSS version 29.1.0 was used for analysis, while R software was used to plot the time series data. Results: A total of 697 articles with an average of 16.6 citations were published between 2011 and 2020. The highest number of publications (240) per single institution was from Aga Khan University (including Aga Khan University Hospital), Karachi. There was a significant difference between the number of publications before and after the midpoint (2015) of the bibliometric analysis (t =-3.08, P = 0.015, 95% CI-87.78--12.61). We observed a strong relationship between publications and citations over the same period (Correlation coefficient 0.809, P = 0.002, CI 0.46-0.98) but there was no significant difference between the number of citations before and after the midpoint. Conclusion: There was an acute dearth of health systems research publication at the beginning of the study period. A few medical institutes are now taking the lead in conducting and publishing health systems research. Technical and financial support is needed to strengthen the capacity of Pakistani medical institutions and researchers to contribute more to knowledge generation within the country.