This document discusses the multidisciplinary nature of health policy and systems research (HPSR) and the importance of understanding different perspectives within research. It addresses how a researcher's lenses and disciplinary background can influence their view. It also explores understandings of knowledge, including whether knowledge is discovered or constructed, and what role researchers play. The document emphasizes that HPSR embraces complexity and knowledge generation through engagement between researchers and policy actors. It stresses the need for researchers from different disciplines to work together to understand each other and generate new ideas about phenomena.

1. 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

2. 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?

3. 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

4. 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?

5. 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

6. 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/C
onstructivism)

7. 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

8. Epistemological self-diagnosis
A totally unscientific self-diagnosis …
this is not a test – try to be honest with yourself

9. Q1 Which do you trust more?
‘hard science’ or ‘soft science’?
A. Hard science
B. Both/either/it depends
C. Soft science

10. Q2 Is there such a thing as ‘truth’?
A. I can’t decide
B. No (no truth or many truths)
C. Yes

11. Q3 Is knowledge discovered or
created?
A. Knowledge is discovered
B. Both / I can’t decide
C. Knowledge is created

12. Q4 Can we have knowledge of
a single reality that is independent
of the knower?
A. Yes
B. No
C. Sometimes

13. Q5 What is the role of the HPS
researcher?
A. Truth gatherer
B. Interpreter
C. Meaning maker

14. Scoring yourself
Q1 A= 1 B=2 C=3
Q2 A= 2 B=3 C=1
Q3 A=1 B=2 C=3
Q4 A=1 B=3 C=2
Q5 A=1 B=2 C=3

15. 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

16. 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?

17. 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

18. 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
Epidemiology
Welfare economics
Political science (rational choice
theory)
Policy analysis
Organisational studies
Anthropology
Sociology
Political science (sociological
institutionalism)
Key research
approaches
and methods
Deductive: Hypothesis driven
Measurement 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

19. 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

20. 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

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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.

22. 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