This document provides an introduction to a course on health policy and systems research (HPSR). It outlines the importance of studying health systems and how they can be improved through research. The course aims to help students identify relevant research questions in health policy and systems, select appropriate research strategies, and understand how to support the use of research evidence in decision-making. Key topics that will be addressed include different research purposes, study designs, ensuring rigor, and engaging with policymakers. The overall goal is for participants to gain skills in conducting and applying HPSR to strengthen health systems.

1. Why are we running
this course?
IHPSR Presentation 1
www.hpsa-africa.org
@hpsa_africa
www.slideshare.net/hpsa_africa
Introduction to Health Policy and
Systems Research

2. Health systems matter
• To individuals
– care and support when sick and vulnerable
– treatment and cure for sickness
• To societies
– part of ‘fabric of society’, not just about
sickness/death

3. Those working in public health
• Need to:
– think about health systems and how to
improve them
– do research on these issues to support
health system development

4. Discussion of importance of
studying health systems
• WHO Report 2000
• 2004 Mexico Ministerial Summit on Health Research
• 2008 Bamako call to action on research for health
• 2010 HSR Symposium
• 2012 HSR Symposium
– Health Systems Global formed
• 2014 HSR Symposium: Cape Town
http://hsr2014.healthsystemsresearch.org/

5. ‘At its best, HPSR should
function as the GPS of
health decision-making,
providing navigational
support to the decision-
maker, locating the
starting point for the
journey (the health
problem), the desired
destination (the health
outcome) and options for
getting there (health
solutions)’.
WHO 2012

6. Course aim
By the end of the course we expect students to be
able, confidently, to identify substantively relevant
health systems and policy research questions,
select appropriate research strategies for
answering these questions in their own contexts
and think through approaches bringing the research
and policy/management worlds to support the use
of research evidence in decision-making. …

7. Learning outcomes
By the end of the course we expect participants to be able to:
1. Identify researchable health policy and systems issues, including those
focused on action to strengthen health systems and the processes of
policy change.
2. Formulate substantively relevant health policy or health systems
research questions, by drawing on relevant empirical work, practice
knowledge, and theoretical insights.
3. Be familiar with the range of research purposes, questions and
strategies used within HPSR.
4. Identify appropriate research strategies and study designs for different
HPSR issues, purposes and question types.
5. Show awareness of critical issues in, and approaches to, ensuring
rigour in HPSR.
6. Be aware of critical ethical issues for HPSR.

8. Course learning outcomes (continued)
7. Be able to source HPSR materials and critically appraise HPSR
empirical papers.
8. Appreciate the value of multiple perspectives (positional and
disciplinary) in conducting HPSR.
9. Have some understanding of how the complex and socially
constructed nature of health policy and health systems is addressed in
HPSR methodology.
10. Plan activities that support the use of research evidence for and in
decision-making, through researcher–policy maker/practitioner
engagement.
11. Recognise that personal skills, such as reflexivity, listening and
facilitation, are critical to being a health policy and systems researcher.

9. Threshold concepts
Health policies and systems
A. Health policies and systems are socially constructed; they exist within
contexts and histories.
B. Health policy and policy processes are always political.
C. Health systems consist of ‘hardware’ and ‘software’.
D. Actors (and their interests, values and power) are key to
understanding policy.
E. People are at the centre of the health system, driven by values and
contexts.
F. Policy comes alive through practice.
G. The health system is knowable and changeable.
H. Managing policy processes requires political awareness.

10. Threshold concepts (continued)
HPSR
A. HPSR is intentionally multidisciplinary and embraces multiple
perspectives.
B. Substantive relevance is critical for the development of sound and
ethical HPSR questions.
C. Phenomena that cannot be quantitatively measured are important to
health policy and systems and can be researched.
D. The precise wording of HPSR questions is important.
E. Health care services/interventions/programmes provide a lens through
which to investigate policy and systems issues in HPSR (i.e. they are
not the primary focus of the research).
F. Exploratory and explanatory research (that deepens our understanding
of health policy and system phenomena) offers policy-relevant insight.

11. Threshold concepts, HPSR (continued)
G. Flexible study designs are the most appropriate design for some HPSR
phenomena.
H. Good (i.e. sound) research design requires that the study design fits
the question, issues and purpose.
I. There is no hierarchy of study design in terms of quality and rigour in
HPSR; and quality and rigour are always important.
J. Researcher curiosity, attentiveness and reflexivity are the basis of
rigorous HPSR.
K. Analytic generalisability is legitimate.
L. Theoretical ideas and concepts have value (as a guide for study design
and analysis in HPSR).
M. The researcher is the primary research instrument.
N. Ethical HPSR requires the responsible use of power and accountability.
O. The HPSR researcher is a policy activist.

12. Threshold skills for HPSR
(that are addressed in this course)
1. Recognising where the boundaries of HPSR lie and the types of
issues that are addressed (what is HPSR).
2. Conducting a literature review (becoming familiar with the field).
3. Framing various types of HPSR research questions.
4. The ability to identify a range of research strategies and study
designs.
5. Knowing ‘the’ appropriate research strategy and study designs to use
to address different types of HPSR issues and questions.
6. Critical analysis (knowing what is rigorous and relevant).
7. Being familiar/comfortable with different perspectives, and able to
work with and across them.
8. Facilitation of small groups.

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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 1. 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.

14. The CHEPSAA partners
University of Dar Es Salaam
Institute of Development Studies
University of the Witwatersrand
Centre for Health Policy
University of Ghana
School of Public Health, Department of
Health Policy, Planning and Management
University of Leeds
Nuffield 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 Medicine
Health Economics and Systems Analysis
Group, Depart of Global Health & Dev.
Great Lakes University of Kisumu
Tropical Institute of Community Health and
Development
Karolinska Institutet
Health Systems and Policy Group,
Department of Public Health Sciences
University of Cape Town
Health Policy and Systems Programme,
Health Economics Unit
Swiss Tropical and Public Health
Institute
Health Systems Research Group
University of the Western Cape
School of Public Health