Health services management and research

Professional knowledge aims at improving practice. It reduces uncertainty in decision-making, improves effectiveness in action and relevance in evaluation, stimulates reflexivity, and subjects practice to ethical standards.


We used experiential learning and action research to test strategies to improve access to care and quality of care, and to strengthen the professionalism of physicians and caregivers. These strategies were intended to


  • To improve medical professionalism with “non managed-care” techniques and enhance the symbolic, intangible motivation of health professionals in publicly-oriented health services


Unger JP, Vargas I & Vázquez ML. Non managed care techniques to improve clinical decision making. In: Unger JP, De Paepe P, Sen K, Soors W, editors. International health and aid policies; the need for alternatives. Cambridge: Cambridge University Press; 2010.


  • To secure access to essential generic drugs (in Senegal)


Unger JP, Mbaye AM & Diao M. Finances and Drugs at the Core of District Health Service Rehabilitation. A Case-Study in Senegal: the Kolda District. Health Pol Plan. 1990; 5,4:367-377


  • To improve access to first-line health services (in Ecuador)


De Paepe, P., Rojas, E., Abad, L., Van Dessel, P., & Unger, J. (2010). Improving access. In J. Unger, P. De Paepe, K. Sen, & W. Soors (Authors), International Health and Aid Policies: The Need for Alternatives (pp. 210-224). Cambridge: Cambridge University Press. doi:10.1017/CBO9780511902512.028


  • To train and coach mid-level health managers (in Senegal)


Public Health Research and Training Unit of the ITM. The Training of District Medical Officers in the Organization of Health Services: a Methodology Tested in Senegal. Health Policy and Planning 1989; 4(2): 148-156.


  • To organize local health systems (in Senegal, Burkina Faso, and Niger)


Unger JP. PhD thesis: "Role of health districts and methodology of their development in Africa” 1991, Free University of Brussels, Faculty of Medicine (in French)ôle-des-districts-sanitaires-et-méthodologie-de-leur-développeme


  • To disseminate medical audits in health services, enhance medical reflectivity and care coordination across institutional divides (in Belgium) and derive improvements in service organization from clinical evaluation


Unger J.-P., Marchal B., Dugas S., Wuidar M. J., Burdet D., Leemans P. & Unger J. Interface flow process audit: using the patient's career as a tracer of quality of care and of system organisation. Int J Integr Care. 2004;4:1568-4156.


  • To promote family medicine-like healthcare practice by paramedics (in LMICs)


Unger JP, Van Dormael M, Criel B, Van der Vennet J, & De Munck P. A plea for an initiative to strengthen family medicine in public healthcare services of developing countries. Int J Health Serv. 2002;32,4:799-815.


  • To enhance the contribution of academic departments to the universal right to care (in Latin America and Belgium)


Unger, J., De Paepe, P., Sen, K., & Soors, W. (2010). Reorienting academic missions: How can public health departments and public health teaching in particular best support access to good quality comprehensive health care? In International Health and Aid Policies: The Need for Alternatives (pp. 240-246). Cambridge: Cambridge University Press. doi:10.1017/CBO9780511902512.030 


  • To strengthen public services with mother and child programs (in Senegal)


  1. Unger J.-P. Can intensive campaigns dynamize front line health services ? The Evaluation of a Vaccination Campaign in Thiès Medical District, Senegal. Soc Sci Med 1991; 32(3): 249-259. Notice that this article also shows the importance of preventive medicine in public health


  • To improve the national drug distribution system (in Burkina Faso)


Unger JP & Yada A. Should Medication be Distributed in Africa by Health Services and/or pharmacies? A Preliminary Evaluation of the Boulgou project in Burkina Faso. Health Pol Plan 1993;8,3:240-246.


  • To use semi-quantitative epidemiological information to control diseases (in African local health systems)


Unger JP & Dujardin B. Epidemiology's contribution to health service management and planning in developing countries. Bulletin of WHO. 1992; 70,4:487-497


  • To control malaria (in Mali)


Unger JP, d'Alessandro U, De Paepe P, & Green A. Can malaria be controlled where basic health services are not used? Tropical Med Int Health. 2006; 11,3: 314-322.


  • To stimulate GPs’ practice of family therapy (in LMICs)


Quinet A et al. Family Therapy in Developing Countries Primary Care. J Fam Med Dis Prev 2015;1:006


  • To improve social assistance in medical practice (in Belgium)


Unger JP, Shelmerdine S, van der Veer C, & Roland M (2016) How can GPs Best Handle Social Determinants in Practice? Application in the Brussels Environment. J Fam Med Dis Prev. 2016 ;2:025 ;2, 1 


  • To improve care coordination (in Latin America)


Vázquez ML, Vargas I, Unger JP, et al. Evaluating the effectiveness of care integration strategies in different healthcare systems in Latin America: the EQUITY-LA II quasi experimental study protocol. BMJ Open. 2015;5:e007037. doi:10.1136/bmjopen-2014- 007037


  • To control physicians’ and health professionals’ burnout


Unger JP. Physicians' Burnout (and That of Psychologists, Nurses, Magistrates, Researchers, and Professors) For a Control Program. Int J Health Serv. 2020;50(1):73-81. doi:10.1177/0020731419883525


  • To improve clinical services with public health programs


J.-P. Unger. How could disease specific programs strengthen health systems delivering comprehensive health care? Strategic and technical guidelines. European Commission, DG DEV, 30 Sept 2008, Brussels


  • To get hospitals to strengthen regional healthcare services and professionals that sent patients to them


Unger J.-P. Les responsabilités systémiques des hôpitaux à finalité publique. 2005, 1: 27-34.


  • To improve care coordination between healthcare tiers and introduce reflective thinking in health services


Unger J.-P. Les systèmes locaux de santé. Santé Conjuguée Oct 2004, 30: 29-32.  (in French) 


  • To disseminate bio-psychosocial care in first line health services (in Ecuador)


Unger J. P., Van Dormael M., Criel B., Van der Vennet J., De Munck P. A plea for an initiative to strengthen family medicine in public health care services of developing countries. Int J Health Serv. 2002; 32(4): 799-815


  • To stimulate interdisciplinary teamwork with appropriate management of hospitals, health centres and in general, health services organization

Unger J.-P., Macq J., Bredo F., Boelaert M.Through Mintzberg's glasses: a fresh look at the organization of ministries of health. Bull WHO2000; 78(8): 1005-1014.

Unger, J. P., Macq, J., Bredo, F. & Boelaert, M. (‎2000)‎. Through Mintzberg's glasses: a fresh look at the organization of ministries of health.. Bulletin of the World Health Organization, 78 (‎8)‎, 1005 - 1014. World Health Organization.

We concluded this series of studies on the desirable, heuristic particularities of research in professional, medical practice - what distinguishes this research from scientific research.


Unger, JP., Morales, I. & De Paepe, P. Medical heuristics and action-research: professionalism versus science. BMC Health Serv Res 20, 1071 (2020).