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Recognising your starting points
IHPSR Presentation 5
www.hpsa-africa.org
@hpsa_africa
www.slideshare.net/hpsa_africa
Introduction to Health Policy and Systems Research
Multiple perspectives of researchers
Different disciplines, different questions, different methodological leanings: management, anthropology, psychology, economics, public health/epidemiology …
How do your ‘lenses’ affect your view?
Because HPSR is multidisciplinary…
• HPSR as multidiscipline vs field (e.g. ‘public health’)
• HPSR = real world issues, creative new ways of thinking outside the box
• Often requires stepping outside comfort zones
• Multidisciplinary, interdisciplinary, transdisciplinary– becoming ‘undisciplined’– reaching ‘adequacy’
• A LOT of mixed methods and multidisciplinary teamwork – so critically important to understand different perspectives
Machine-like organisations that can
be controlled from the top
through rules and incentives
Complex social and political
phenomena, constructed
through human
perception and action
What are health systems?
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 and what role you think researchers can and should play
Paradigms of knowledge
• Single vs multiple realities? Reality ‘out there’ vs socially constructed?
• Is knowledge generated only by observation of facts and/or by meanings people make of reality and how they make it?
• Research as analysis of facts vs as generation of working hypotheses?
• Researcher influence over subject of investigation?
• Which research strategies and methods? What is the role of theory? How to generalise?
Positivism
Critical realism
Relativism(Interpretivism/Constructivism)
What is the nature of the social reality being
investigated?
Epidemiology/Clinical
scienceThere 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
Epistemological self-diagnosis
A totally unscientific self-diagnosis … this is not a test – try to be honest with yourself
Q1 Which do you trust more?
‘hard science’ or ‘soft science’?A. Hard science
B. Both/either/it depends
C. Soft science
Q3 Is knowledge discovered or created?
A. Knowledge is discovered
B. Both / I can’t decide
C. Knowledge is created
Q4 Can we have knowledge of
a single reality that is
independent of the knower? A. Yes
B. No
C. Sometimes
Scoring yourself (in our totally unscientific study)
1-6 = heading towards positivism
6-11 = couldn’t decide … hovering … or a critical realist
11-15 = heading towards constructivism
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?
Why/what do you want to do?
If you want to:
• test an intervention > positivism
• measure impacts or understandings > positivism
• understand a phenomenon > relativism
• understand perceptions of particular actors > relativism
• act in a situation to improve it > critical framework
Knowledge paradigm
-------------------------------------------------------------------------
Positivism Critical realism Relativism (interpretivism / social constructionism)
Types of questions addressed
Is the policy or intervention (cost)-effective?
What works for whom under which conditions?
How do actors experience and understand different types of interventions or policies?
What are the social processes, including power relations, influencing actors’ understandings and experiences?
Related disciplinary perspectives
EpidemiologyWelfare economicsPolitical science (rational choice
theory)
Policy analysisOrganisational studies
AnthropologySociologyPolitical science (sociological
institutionalism)
Key research approaches and methods
Deductive: Hypothesis drivenMeasurement through surveys,
use of archival and other data records
Statistical analysis,Qualitative data collected
through, for example, semi-structured interviews and interviewing procedures
Deductive and inductive (theory testing and building)
Multiple data collection methods including review of documents, range of interviewing methods, observation
Inductive (maybe theory building and/or testing)Multiple data collection methods
including in-depth interviewing (individuals and groups), documentary review but also participant observation or life histories, for example.
Gilson et al. 2011
Relevance for HPSR?• Such understandings influence the questions you
ask and the role you think researchers can and should play
• Spelling out your assumptions and intuitions allows appropriate critique and comparisons with others (reflexivity)
• HPSR as an emerging multidisciplinary ‘field’
– have to work to understand each other, to develop shared approaches
– BUT can work together to generate different and valuable ideas about same phenomenon, so supporting usefulness of research
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
Copyright
Funding
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Citation of this work must follow normal academic conventions. Suggested citation:
Introduction to Health Policy and Systems Research, course presentation, Presentation 5. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014, www.hpsa-africa.org www.slideshare.net/hpsa_africa
This document is an output from a project funded by the European Commission (EC) FP7-Africa (Grant no. 265482). The views expressed are not necessarily those of the EC.
The CHEPSAA partners
University of Dar Es SalaamInstitute of Development Studies
University of the WitwatersrandCentre for Health Policy
University of GhanaSchool of Public Health, Department of Health Policy, Planning and Management
University of LeedsNuffield Centre for International Health and Development
University of Nigeria Enugu Health Policy Research Group & the Department of Health Administration and Management
London School of Hygiene and Tropical MedicineHealth Economics and Systems Analysis Group, Depart of Global Health & Dev.
Great Lakes University of KisumuTropical Institute of Community Health and Development
Karolinska InstitutetHealth Systems and Policy Group, Department of Public Health Sciences
University of Cape TownHealth Policy and Systems Programme, Health Economics Unit
Swiss Tropical and Public Health InstituteHealth Systems Research Group
University of the Western CapeSchool of Public Health