KEYSTONE HPSR Initiative // Module 4: Health Policy & Systems Research frameworks // Slideshow 1: Health Policy & Systems Research Frameworks- 1 This is the first 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 – 1

2. KEYSTONE
Health Policy & Systems Research
Frameworks – 1
(Framing the Field)
Kabir Sheikh
24 Feb 2015

3. KEYSTONE
What is Health Policy and Systems
Research (HPSR)?
• Emerging cross-disciplinary global field with its own
evolving standards for creating, evaluating and utilizing
knowledge, and a particular orientation towards
influencing policy and wider action to strengthen health
systems
• Family of approaches including implementation research,
evaluation science, policy analysis, participatory research,
and drawing from social sciences, public health
• Critical element of action needed to achieve health-
focused Millennium Development Goals, strengthen
primary health care, and advance towards
Universal Health Coverage
Also known as Health Systems Research

4. KEYSTONE
Health policy and systems research (HPSR) is an emerging field that
seeks to understand and improve how societies organize themselves in
achieving collective health goals, and how different actors interact in
the policy and implementation processes to contribute to policy
outcomes.
By nature, it is inter-disciplinary, a blend of economics, sociology,
anthropology, political science, public health and epidemiology that
together draw a comprehensive picture of how health systems
respond and adapt to health policies, and how health policies can
shape − and be shaped by − health systems and the broader
determinants of health.
- AHSPR

5. KEYSTONE
Health Policy and Systems Research:
• is a multidisciplinary research field, distinguished by the issues and
questions addressed through the research rather than by a particular
disciplinary base or set of methods;
• includes research that focuses on health services as well as on the
promotion of health in general;
• includes concern for global and international issues as well as national
and sub-national issues, as global forces and agencies have important
influences over health systems in low- and middle-income countries;
• encompasses research on or of policy, which means that it is concerned
with how policies are developed and implemented and the influence that
policy actors have over policy outcomes – it addresses the politics of
health systems and health system strengthening;
• promotes work that explicitly seeks to influence policy, that is, research
for policy.
- From HPSR reader

6. KEYSTONE
Scope & Nature
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 implemented)
From CHEPSAA

7. KEYSTONE
Scope & Nature
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!
From CHEPSAA

8. KEYSTONE
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
From CHEPSAA

9. KEYSTONE
FRAMING THE FIELD

10. KEYSTONE
Framing the Research Field
• What do we want to investigate?
• Why do we want to investigate it?
• What and how can we know about it?
• How do we investigate it?

11. KEYSTONE
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
knowledg
e?
Which
precise
procedures
can we use
to acquire
it? Which
data can
we
collect?

12. KEYSTONE
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
& what role you think researchers can and should play

13. KEYSTONE
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
From CHEPSAA

14. KEYSTONE
Gilson et al 2011

15. KEYSTONE
Topics of Enquiry
Systems ‘Software’
Ideas and interests,
Relationships and power,
Values and norms
Systems ‘Hardware’
Human Resources, Finance,
Medicines & technology,
Organizational structure,
Service infrastructure,
Information systems
International
National
Subnational
Local
ARENA

16. KEYSTONE
Disciplinary views of behavioural
drivers
Machine Perspective
Economic
Perspective
Socio-cultural
Perspective
View of
organisation
Clearly defined parts
working
efficiently
together in
routinised ways
Atomistic economic
actors engaged in
market relations
Reflective,
responsive people
forming a
complex social
system
View of human
behaviour
Compliant : Humans
simply comply
with
organisational
changes
Calculating : Humans
are individualistic
& motivated by
self-interest
Social : Human
behaviour is
influenced by
social networks
and relationships
Coordinating
mechanisms
Formal rules &
procedures
Authority
Prices
Competition
Financial incentives
Norms
Values
Trust
Shared meanings
From CHEPSAA

17. KEYSTONE
Thinking about levels
• Macro level
– architecture and oversight
• Meso level
– functioning of organisations (interventions or programmes as
tracers for that)
• Micro level
– the individual in the system
• Cross-level
– for example: how global influences shape architecture, so
influencing local systems and individuals’ behaviour
From CHEPSAA

18. KEYSTONE
HPSR Methodological Considerations
Applied:
– Starts with topic or problem rather than method (vs.
epidemiology) or discipline
– ‘Real world’ vs laboratory
– Policy relevant
No single methodological gold standard study design
– Range of study designs or research strategies depending
on purpose and question
Data collection methods:
– Qualitative or quantitative, often mixed methods
From CHEPSAA

19. KEYSTONE
Methodology (cont.)
Must consider complexity:
>> Investigator has little control over events
– Numerous interacting elements, open systems
(complex adaptive systems)
– Different actors with different experiences &
different questions: managers, citizens, patients
– Social phenomena important: culture, interests,
leadership etc.
– Contextual influences
From CHEPSAA

20. KEYSTONE
Methodology (cont.)
No single methodological gold standard e.g. RCT
– Range of study designs or research strategies depending
on purpose and question
• Cross-sectional
• Longitudinal
• Experimental
• Case study
• Ethnographic
• Action-research
Range of “epistemologies” (philosophies of knowledge)
– Different paradigms
– Positivism, relativism, realism
From CHEPSAA

21. KEYSTONE
Being systematic, principled, ethical
• The four steps of HPSR
Step 1: Identify the research focus and questions
Step 2: Design the study
Step 3: Ensure research quality and rigour
Step 4: Apply ethical principles
From CHEPSAA

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