https://twitter.com/KeystoneHPSR

Building the HPSR Community Building HPSR Capacity

KEYSTONE

Inaugural KEYSTONE Course on Health Policy and Systems Research 2015

Health Policy & Systems Research Frameworks – 1

   

 

KEYSTONE

Health Policy & Systems Research Frameworks – 1

(Framing the Field)

Kabir Sheikh

24 Feb 2015 

   

 

KEYSTONE

What is Health Policy and Systems Research (HPSR)?

• Emerging cross-disciplinary global field with its own evolving standards for creating, evaluating and utilizing knowledge, and a particular orientation towards influencing policy and wider action to strengthen health systems 

• Family of approaches including implementation research, evaluation science, policy analysis, participatory research, and drawing from social sciences, public health 

• Critical element of action needed to achieve health-focused Millennium Development Goals, strengthen primary health care, and advance towards Universal Health Coverage

Also known as Health Systems Research

   

 

KEYSTONE

Health policy and systems research (HPSR) is an emerging field that seeks to understand and improve how societies organize themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes to contribute to policy outcomes. 

By nature, it is inter-disciplinary, a blend of economics, sociology, anthropology, political science, public health and epidemiology that together draw a comprehensive picture of how health systems respond and adapt to health policies, and how health policies can shape − and be shaped by − health systems and the broader determinants of health.

- AHSPR

   

 

KEYSTONE

Health Policy and Systems Research: • is a multidisciplinary research field, distinguished by the issues and

questions addressed through the research rather than by a particular disciplinary base or set of methods;

• includes research that focuses on health services as well as on the promotion of health in general;

• includes concern for global and international issues as well as national and sub-national issues, as global forces and agencies have important influences over health systems in low- and middle-income countries;

• encompasses research on or of policy, which means that it is concerned with how policies are developed and implemented and the influence that policy actors have over policy outcomes – it addresses the politics of health systems and health system strengthening;

• promotes work that explicitly seeks to influence policy, that is, research for policy.

- From HPSR reader

   

 

KEYSTONE

Scope & Nature

HPSR is not:– Clinical or basic science– Only rooted in health economics or focused on financing issues (though both important)

– Focused on disease distribution, causes and interventions (but rather generic  organisational & societal‘structures’ through which interventions implemented)

From CHEPSAA

   

 

KEYSTONE

Scope & Nature

Specific services/disease programmes:– Often a tracer for understanding systems issues e.g. maternal health services; the impact of district strengthening on child health outcomes

–May be researched because they have system wide effects e.g.  antiretroviral therapy

–Must think BEYOND the programme/service!

From CHEPSAA

   

 

KEYSTONE

Given its multiple perspectives, HPSR embraces…

• Complex causality• Generalisation via statistical and analytic approaches• Knowledge generation and learning as a process of 

active engagement between researchers and various policy actors, including through the research process itself 

From CHEPSAA

   

 

KEYSTONE

FRAMING THE FIELD

   

 

KEYSTONE

Framing the Research Field

• What do we want to investigate?

• Why do we want to investigate it?

• What and how can we know about it?

• How do we investigate it?

   

 

KEYSTONE

Ontology Epistemology Methodology Methods Sources

What’s out there to know? What & 

how can we know about it?

How can we go about acquiring that knowledge? 

Which precise procedures can we use to acquire it? Which 

data can we collect? 

   

 

KEYSTONE

Understandings of knowledge

• What is the nature of the social and political reality to be investigated? 

• What exists of which we might acquire knowledge?– there are a set of facts out there to be gathered (there is 

one reality, truth) VS. – truths and facts are dependent on different actors’ 

viewpoints

• Such understandings influence what questions you ask & what role you think researchers can and should play 

   

 

KEYSTONE

What is the nature of the social reality being investigated?

Epidemiology/Clinical science:

There are a set of facts to be gathered (one reality)

Social science: Reality is

constructed by actors drawing

on their ‘contexts’ (different parallel

realities)

Positivism Relativism

From CHEPSAA

   

 

KEYSTONE

Gilson et al 2011

   

 

KEYSTONE

Topics of Enquiry

Systems ‘Software’Ideas and interests, 

Relationships and power, Values and norms

Systems ‘Hardware’Human Resources, Finance, Medicines & technology, Organizational structure, Service infrastructure, Information systems

International

National

Subnational

Local

ARENA

   

 

KEYSTONE

Disciplinary views of behavioural drivers

Machine Perspective Economic Perspective

Socio-cultural Perspective

View of organisation

Clearly defined parts working efficiently together in routinised ways

Atomistic economic actors engaged in market relations

Reflective, responsive people forming a complex social system

View of human behaviour

Compliant :  Humans simply comply with organisational changes

Calculating :  Humans are individualistic & motivated by self-interest

Social :  Human behaviour is influenced by social networks and relationships

Coordinating mechanisms

Formal rules & procedures

Authority

PricesCompetitionFinancial incentives

NormsValuesTrustShared meanings

From CHEPSAA

   

 

KEYSTONE

Thinking about levels• Macro level 

– architecture and oversight

•  Meso level– functioning of organisations (interventions or programmes as 

tracers for that)

• Micro level– the individual in the system

• Cross-level– for example: how global influences shape architecture, so 

influencing local systems and individuals’ behaviour

From CHEPSAA

   

 

KEYSTONE

HPSR Methodological Considerations

Applied:– Starts with topic or problem rather than method (vs. 

epidemiology) or discipline– ‘Real world’ vs laboratory– Policy relevant

No single methodological gold standard study design– Range of study designs or research strategies depending on 

purpose and question

Data collection methods:– Qualitative or quantitative, often mixed methods

From CHEPSAA

   

 

KEYSTONE

Methodology (cont.)

Must consider complexity:>> Investigator has little control over events– Numerous interacting elements, open systems (complex adaptive systems)

– Different actors with different experiences & different questions: managers, citizens, patients

– Social phenomena important: culture, interests, leadership etc.

– Contextual influences

From CHEPSAA

   

 

KEYSTONE

Methodology (cont.)

No single methodological gold standard e.g. RCT– Range of study designs or research strategies depending on 

purpose and question• Cross-sectional• Longitudinal• Experimental• Case study• Ethnographic• Action-research

Range of “epistemologies” (philosophies of knowledge)– Different paradigms– Positivism, relativism, realism

From CHEPSAA

   

 

KEYSTONE

Being systematic, principled, ethical

• The four steps of HPSR

Step 1: Identify the research focus and questions Step 2: Design the study Step 3: Ensure research quality and rigourStep 4: Apply ethical principles

From CHEPSAA

Open Access PolicyKEYSTONE commits itself to the principle of open access to knowledge. In keeping with this, we strongly support open access and use of materials that we created for the course. While some of the material is in fact original, we have drawn from the large body of knowledge already available under open licenses that promote sharing and dissemination. In keeping with this spirit, we hereby provide all our materials (wherever they are already not copyrighted elsewhere as indicated) under Creative Commons Attribution-NonCommercial 4.0 International License. To view a copy of this license visit http://creativecommons.org/licenses/by-nc/4.0/ This work is ‘Open Access,’ published under a creative commons license which means that you are free to copy, distribute, display, and use the materials as long as you clearly attribute the work to the KEYSTONE course (suggested attribution: Copyright KEYSTONE Health Policy & Systems Research Initiative, Public Health Foundation of India and KEYSTONE Partners, 2015), that you do not use this work for any commercial gain in any form and that you in no way alter, transform or build on the work outside of its use in normal academic scholarship without express permission of the author and the publisher of this volume. Furthermore, for any reuse or distribution, you must make clear to others the license terms of this work. This means that you can:

 

read and store this document free of charge

distribute it for personal use free of charge

print sections of the work for personal use

read or use parts or whole of the work in a context where no financial transactions take place

gain financially from the work in anyway

sell the work or seek monies in relation to the distribution of the work

use the work in any commercial activity of any kind

distribute in or through a commercial body (with the exception of academic usage within educational institutions such as schools and universities

However, you cannot: