KEYSTONE HPSR Initiative // Module 1: Introducing Health Systems & Health Policy // Slideshow 4: Health Systems and Health Policy: Wrap Up This is the fourth slideshow of Module 1: Introducing Health Systems & Health Policy, of the KEYSTONE Teaching and Learning Resources for Health Policy and Systems Research To access video sessions and slides for all modules copy and past the following link in your browser: http://bit.ly/25vVVp1 Module 1: Introducing Health Systems & Health Policy This module introduces students to the KEYSTONE initiative, the objectives and design of the inaugural course, and the field of Health Policy and Systems Research. Common frameworks used to understand health systems and health policy are delineated, including the WHO building blocks framework, health systems hardware and software, systems thinking, social construction, and people-centred health systems. There are 5 slideshows in this module. Module 1: Introducing Health Systems & Health Policy -Module 1 Slideshow 1: KEYSTONE Course: Getting Oriented -Module 1 Slideshow 2: Health Systems and Health Policy Frameworks - 1 -Module 1 Slideshow 3: Health Systems and Health Policy Frameworks - 2 -Module 1 Slideshow 4: Health Systems and Health Policy: Wrap Up -Module 1 Slideshow 5: Epistemological self-diagnosis The other modules in this series are: Module 2: Social justice, equity & gender Module 3: System complexity Module 4: Health Policy & Systems Research frameworks Module 5: Economic analysis Module 6: Policy analysis Module 7: Realist evaluation Module 8: Systems thinking Module 9: Ethnography Module 10: Implementation research Module 11: Participatory action research Module 12: Knowledge translation Module 13: Research Plan Writing KEYSTONE is a collective initiative of several Indian health policy and systems research (HPSR) organizations to strengthen national capacity in HPSR towards addressing critical needs of health systems and policy development. KEYSTONE is convened by the Public Health Foundation of India in its role as Nodal Institute of the Alliance for Health Policy and Systems Research (AHPSR). The inaugural KEYSTONE short course was conducted in New Delhi from 23 February – 5 March 2015. In the process of delivering the inaugural course, a suite of teaching and learning materials were developed under Creative Commons license, and are being made available as open access resources. The KEYSTONE teaching and learning resources include 38 videos and 32 slide presentations organized into 13 modules. These materials cover foundational concepts, common approaches used in HPSR, and guidance for preparing a research plan. These resources were created and are made available through support and funding from the Alliance for Health Policy & Systems Research (AHPSR), WHO for the KEYSTONE initiative.

1. https://twitter.com/KeystoneHPSR
Building the HPSR CommunityBuilding HPSR Capacity
KEYSTONE
Inaugural KEYSTONE Course on Health Policy and Systems Research 2015
Health Systems and Health Policy (HSHP)
Wrap up

2. KEYSTONE
HSHP - Wrap up
Kabir Sheikh
23 February 2015

3. KEYSTONE
Scope of HPSR
• Distinguished by issues and questions considered,
not by a disciplinary base, and includes:
– research focused on health services as well as
promotion of health
– concern for global and international issues as well as
national and sub-national issues
– research on or of policy – addresses politics of health
systems and health systems services
• Promotes work that explicitly seeks to influence
policy
Courtesy CHEPSAA

4. KEYSTONE
Scope & nature of HPSR (continued)
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 are implemented)
Courtesy CHEPSAA

5. KEYSTONE
Scope & nature (continued)
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!
Courtesy CHEPSAA

6. KEYSTONE
Programmatic and health systems perspectives on tuberculosis (TB) research
Systems goal Disease programme
perspective
Health systems
perspective
Thinking broad (beyond the
disease)
Izoniazid (INH) prophylaxis
for prevention
Secondary prevention for
TB and other common
diseases
Thinking cross-cutting
(underlying functions)
Implementing a TB patient
register
Improvement in information
systems
Thinking scale (e.g. facility
to district, province)
Strengthening facility
Directly Observed
Treatment, Short Course
(DOTS) support systems
Strengthening district
community-based services
Thinking comprehensive
delivery platforms
Running a TB service Building a primary health
care system that is
available, affordable and
acceptable/responsive
Thinking about systems not programmes
Courtesy CHEPSAA

7. KEYSTONE
Considerations while identifying your
researchable health system issue / rationale..
• Is it acceptable and recognizable as a health system problem?
• Is it associable with at least one of the "building blocks”?
• If it relates to a particular disease, health programme or
service, is it because it is a tracer for understanding broader
system issues / because it has system wide effects? If so,
how?
KEYSTONE VERTICAL MILESTONE: DAY 2

8. KEYSTONE
Research plan template
• Background and rationale (1 page)
• Brief review of literature (2 pages)
• Research question(s)
• Approach(es) and design (2 pages)
– Choice of approach and reasons
– Study design and conceptual framework
• Methodology (2 pages)
• Ensuring research quality (< 1 page)
• Ethical considerations (< 1 page)
• Outcomes (2 pages)
– Audience and beneficiaries
– Impact pathways
• Timeline
• Financial plan

9. KEYSTONE
Reading for tomorrow
• Sheikh, K. et al., 2011. Building the Field of Health Policy and
Systems Research: Framing the Questions. PLoS Med, 8(8)
• World Health Organization, 2007. Everybody’s business–
strengthening health systems to improve health outcomes: WHO’s
framework for action (esp. pages 1-27)
• Roberts, M.J. et al., 2003. Getting health reform right. a guide to
improving performance and equity, New York. Oxford.: Oxford
University Press. (esp. Chapter 1)
• Frenk, J., 1994. Dimensions of health system reform. Health Policy
(Amsterdam, Netherlands), 27(1), pp.19–34.
• Sheikh, K., Ranson, M.K. & Gilson, L., 2014. Explorations on people
centredness in health systems. Health Policy and Planning, 29 Suppl
2, pp.ii1–5.

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