KEYSTONE HPSR Initiative // Module 4: Health Policy & Systems Research frameworks // Slideshow 3: Health Policy & Systems Research Frameworks- 3 This is the third slideshow of Module 4: Health Policy and Systems Research Frameworks, 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 4: Health Policy & Systems Research frameworks Health systems are knowable and researchable and their study calls for a range of inputs from different disciplines. Different questions and different understandings of health system problems lend themselves to different and complementary research approaches under the HPSR umbrella. Evolving concepts of ethics and rigour in HPSR are also delineated and knowledge translation as being integrated and continuous with the production of knowledge in HPSR is also considered. There are 3 slideshow in this module. Module 4: Health Policy & Systems Research frameworks -Module 4 Slideshow 1: Health Policy and Systems Research Frameworks -1 -Module 4 Slideshow 2: Health Policy and Systems Research Frameworks - 2 -Module 4 Slideshow 3: Health Policy and Systems Research Frameworks - 3 The other modules in this series are: Module 1: Introducing Health Systems & Health Policy Module 2: Social justice, equity & gender Module 3: System complexity 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: Preparing a Research Plan 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 Policy & Systems Research Frameworks – 3
(Knowledge translation, rigour and ethics)

2. KEYSTONE
Health Policy & Systems Research
Frameworks – 3
(Knowledge translation, rigour and
ethics)
Kabir Sheikh
24 Feb 2015

3. KEYSTONE
KNOWLEDGE TRANSLATION IN
HPSR

4. KEYSTONE
The change we want to see
Creation of
useful
knowledge
about the
system
Utilization
of that
knowledge for
real world
improvements
Systems ‘Software’
Ideas and interests,
Relationships and power,
Values and norms
Systems ‘Hardware’
Human Resources,
Finance, Medicines &
technology, Organizations,
Services Information
systems
SOCIAL, POLITICAL, ECONOMIC CONTEXT
Policy decisions
THE HEALTH SYSTEM

5. KEYSTONE
But how successful is HPSR in
informing real-world change?
Its hard to say… but there are many gaps
Unfortunately, the current understanding of how research influences change
is flawed
• ‘Research to Policy’ implies schism between knowledge and action
• Our thoughts and actions mimic this and reinforce schism
• But, world of knowledge and world of action cannot be neatly separated

6. KEYSTONE
HPSR can inform health systems change more
effectively, by becoming more people-centred

7. KEYSTONE
Health Systems: people-centred view
1. Health systems are made up of people, ALL of
whom make decisions that shape its performance
2. People in the health system are both sources and
users of knowledge about the health system
3. Researchers are an integral part of the health
system

8. KEYSTONE
People constitute systems
THE HEALTH SYSTEM
(People
who are)
sources of
knowledge
about
system
(People
who are)
users of
knowledge
about
system
PLANNERS
FINANCERS,
ADMINISTRATORS
ADVOCATES
SERVICE USERS
FRONTLINE
PROVIDERS
RESEARCHERSINTERCHANGEABLE CATEGORIES

9. KEYSTONE
A dialogic practice – unlike some other sciences
THE HEALTH SYSTEM
RESEARCHERS
Promote
inclusion of
excluded voices
Promote
reflection
and learning
Stimulate discourse
Inform policy choices
Reframe
debates
Synthesize and
analyze knowledge
KNOWLEDGE UTILIZATION
KNOWLEDGE CREATION
OTHER HEALTH
POLICY / SYSTEM
ACTORS

10. KEYSTONE
NOTES ON RIGOUR AND ETHICS IN
HPSR

11. KEYSTONE
• System: a demonstrable system of collecting, analyzing and interpreting
data (RItchie and Spencer 2004)
• Reflexivity: sensitivity to the role of the researcher and the research
process in influencing the way the data is collected or interpreted (Mays
and Pope 2000)
• Fair dealing: ensuring that views of a particular group or groups are not
presented as the sole truth about a situation (Dingwall 1992).
• Credibility: ensuring “the compatibility of the constructed realities that
exist in the minds of respondents, with those that are attributed to
them” (Fischer 2003)
Rigour and ethics in HPSR

12. KEYSTONE
1Q = Broad View of Quality
• Does my methodology match my question?
• Have I applied parameters appropriate to
methodology?
• Respect for knowledge ecology: What is the existing
knowledge on this issue in the setting? Beyond PUB-
MED? (If poorly explored) Does my research have an
exploratory, open-ended component?
• Policy-mindedness: Have I considered consequences of
application of findings in context? Intended and
unintended? For other priorities / sectors?

13. KEYSTONE
2Q – Qualifying one’s work and position
Have I discussed my interest in and approach in the
topic?
Have I discussed my value and philosophical base?
Audience: Have I considered who my research is for?
Who has influenced my research? How?
Have I discussed my position and power in the health
system?
Do I have autonomy of ideas and action?

14. KEYSTONE
Researcher reflexivity
Robson, 2002
• Identify your personal issues in relation to topic
• Clarify your value system
• Identify areas of possible role conflict
• Identify gatekeepers and how they will influence you
• Identify where you are not neutral

15. KEYSTONE
3Q - Foregrounding Human Qualities
• Does the research advance understanding of specific
human attributes of systems in the setting? Does it
go beyond ‘the machine’?
• Does the research address system complexity?
• Does the research acknowledge, if not address,
equity, justice and power in the system?
• Have I located the subject in its broader social,
political and economic contexts?

16. KEYSTONE
Ethical concerns in real world research
Robson, 2002
• Involving people without consent
• Coercing them to participate
• Withholding information about true nature of research
• Otherwise deceiving participants
• Inducing participants to commit acts diminishing of their self-esteem
• Violating rights of self-determination
• Exposing participants to physical or mental stress
• Invading privacy
• Withholding benefits from some participants
• Not treating participants fairly or with respect

17. KEYSTONE
Readings
• Gilson, L. et al., 2011. Building the Field of Health Policy and Systems
Research: Social Science Matters. PLoS Med, 8(8), p.e1001079.
• Sheikh, K., George, A. & Gilson, L., 2014. People-centred science:
strengthening the practice of health policy and systems research. Health
Research Policy and Systems, 12, p.19.
• Gilson, L. ed., 2012. Health policy and systems research: a methodology
reader, Alliance for Health Policy & Systems Research, WHO.
• Introduction to Health Policy and Systems Research, course presentation,
Presentation 5. Copyright CHEPSAA (Consortium for Health Policy &
Systems Analysis in Africa) 2014
• Introduction to Health Policy and Systems Research, course presentation,
Presentation 6. Copyright CHEPSAA (Consortium for Health Policy &
Systems Analysis in Africa) 2014

18. KEYSTONE
Groupwork
• Facilitated work towards defining health
system problem, and thinking about research
questions
• Collation of finalized health system problems

19. Open Access Policy
KEYSTONE 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: