https://twitter.com/KeystoneHPSR
Building the HPSR Community Building HPSR Capacity
KEYSTONE
Inaugural KEYSTONE Course on Health Policy and Systems Research 2015
Keystone Course: Getting Oriented
KEYSTONE
Because 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
(Courtesy CHEPSAA)
KEYSTONE
Because Health Systems are researchable…
• “We use the extended term Health Policy and Systems Research for a field that is often referred to simply as Health Systems Research.”
• “For us, the broader term better captures the terrain of work it encompasses because it explicitly identifies the interconnections between policy and systems, and highlights the social and political nature of the field.”
Note: focus is mainly on LMIC
(Sheikh et al. 2011)
KEYSTONE
Eclectic History
Social scientists seeking to support change in systems
• Health economics
• Sociology
• Political science
• Anthropology
Public health specialists trying to resolve practical concerns
Brian Abel Smith, Anne Mills, Gill Walt, Michael Reich, Eliot Freidson, TN Madan, Roger Jeffery, Charles Leslie, Mark Nichter, etc.
Milton Roemer, Patrick Vaughan, Carl Taylor, Corlien Varkevisser
H(P)SR: A multidisciplinary and
interdiscipinary field
KEYSTONE
Caveats
• Narrow interpretations: HPSR is being interpreted narrowly –in terms of its utility for addressing the constraints of specific health interventions, focusing on hardware more than software, operational over fundamental societal questions
• “Disciplinary capture”: Quantitative and deductive methods, and their corresponding criteria of quality (“E.g. does this study have a randomised design?”), are often applied where qualitative or inductive methods could be more appropriate.
(Sheikh et al. 2011)
KEYSTONE
Because we need to strengthen the field and build capacities…
Recommendations from PLoS Med series (Sheikh et al. 2011, Gilson et al
2011, Bennett et al 2011)
• Focus on HPSR’s role in supporting societal development and self-sufficiency of LMI nations and communities
• More exploratory and fundamental research
• More literacy of and application of rigorous social science
• More institutional capacity building for HPSR in LMIC
KEYSTONE
What is KEYSTONE?
• KEYSTONE is a national initiative to develop new capacities, and channelize latent capacities in multiple disciplines, towards addressing critical needs of health systems and policy development in India
• A collective endeavour of several Indian research organizations, KEYSTONE is convened by the Public Health Foundation of India in its role as a Nodal Institute of the Alliance for Health Policy & Systems Research, WHO.
• Tagline: Building HPSR Capacity. Building the HPSR Community
KEYSTONE
VALUES• Strive for highest attainable quality of research training and research
• Cross-disciplinarity: promote research that addresses pressing health system priorities through application of a range of disciplinary approaches and cross-disciplinary frameworks
• Emphasize the relevance of the training and research for people involved in positive change in systems, through greater interconnectedness and embeddedness in systems
• Community orientation: building relationships, collegiality, cooperation and mutual support across researchers and research organizations
• Place principles of health equity and health justice at the heart of the initiative
• Be attentive to accepted principles of research ethics at all times, while recognizing that the ethics of HPSR is an evolving field
KEYSTONE
Course Objective
• Course aims and objectives: The KEYSTONE course aims to develop individual capacities and channelize latent capacities of participants, for investigating and addressing real-world problems of health systems and policy, through rigorous immersion in current HPSR approaches, frameworks and methodologies
KEYSTONE
Learning Outcomes
By the end of the course participants should be able to
• Formulate relevant health policy and systems research questions,
• Select the appropriate research strategies and approaches for answering these questions
• Think through strategies to support the use of research knowledge in health system decision-making
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
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
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 effectse.g. antiretroviral therapy
• Must think BEYOND the programme/service!
Courtesy CHEPSAA
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 programmesCourtesy CHEPSAA
KEYSTONE
Threshold Concepts - 1
• The health system is knowable and changeable
• People are at the centre of the health system, driven by values and contexts
• The health policy and systems researcher is also part of the health system – and their perspectives influence how issues and research is shaped, and how evidence is utilized
• Health systems are socially constructed; they exist within contexts and histories.
• Health systems are integrative by nature, and consist of complex inter-relationships; we all have a role in the system.
• Health systems consist of ‘hardware’ and ‘software’.
(Courtesy CHEPSAA)
KEYSTONE
Threshold Concepts - 2
• HPSR is multi-disciplinary, embracing and valuing science and practice perspectives, as well as different research perspectives
• The substantive relevance of a research study is informed by existing work in the field and in a specific setting, and it is critical to consider in identifying the research purpose and conducting ethical research
• The research purpose may be normative, exploratory, descriptive, explanatory or emancipatory, or some combination of these
• The HPS research question reflects the study’s research purpose and drives the selection of an appropriate research strategy/study design
• HPSR embraces both fixed and flexible research strategies/study designs (including quasi-experimental studies, cross-sectional structured surveys, case study work, mixed method studies, ethnography, cross-sectional qualitative studies, and different forms of longitudinal work)
• There is a flat hierarchy among research strategies within HPSR (no gold standard)• HPSR embraces both statistical and analytical generalizability
(Courtesy CHEPSAA)
KEYSTONE
Threshold skills/competencies for the HPS researcher
• Recognizing where the boundaries are (what is HPSR)
• Literature review (becoming familiar with the field)
• Framing various types of HPSR research questions
• Knowing what research strategy to use to answer different types of HPSR questions
• Recognizing the strengths and weaknesses of different research approaches and tools
• Critical analysis (knowing what is rigorous and relevant)
• Being familiar/comfortable with different perspectives
(Courtesy CHEPSAA)
KEYSTONE
“Horizontals”
“Horizontals” are topic areas of instruction on HPSR, including foundational concepts and common HPSR approaches
1. Foundations
• Health Systems & Health Policy Frameworks
• Social justice, Equity & Gender
• System complexity
• Health Policy & Systems Research (HPSR) Frameworks
• Knowledge translation
KEYSTONE
2. Approaches or Lenses
Different and complementary methodological approaches and lenses in health policy & systems research
• Economic Analysis
• Policy Analysis
• Realist Evaluation
• System Thinking
• Ethnography
• Implementation Research
• Participatory Action Research
KEYSTONE
“Verticals”
Cross-cutting components represent strands of engagement and activity that run through the course
• KEYSTONE Vertical
• Problem Vertical
• Reading Vertical
KEYSTONE
DAY Date 09.00-10.00 10.00-11.30 11.45-13.15 14.00-15.30 15.45-17.15
1 23 Feb Health Systems & Health Policy (HSHP)
Social justice, equity and gender (JEG)
Introduction,
icebreakerHSHP JEG
2 24 Feb Complexity, systems thinking (COM)
Health Policy & Systems Research
frameworks (RF)
Finalize researchable problem
Recap/quiz,
discussion of readings COM RF
3 25 Feb Economic analysis (ECO) Recap/quiz,
discussion of readingsECO
4 26 Feb Policy analysis (POL) Recap/quiz,
discussion of readingsPOL
5 27 Feb Realist evaluation (REAL)
Systems thinking (ST)Recap/quiz,
discussion of readingsREAL ST
28 Feb OFF DAY
6 1 Mar Ethnography (ETH) Recap/quiz,
discussion of readingsETH
7 2 Mar Implementation research (IMP)
Participatory action research (PAR)
Finalize research question & approach
Recap/quiz,
discussion of readingsIMP PAR
8 3 Mar Knowledge translation (KT)
Research plan writingRecap/quiz,
discussion of readingsKT Research plan workshop
9 4 Mar Private work on research plans
10 5 Mar Research plan presentations Presentations Conclusion
Open Access PolicyKEYSTONE commits itself to the principle of open access to knowledge. In keeping with this, we strongly support open access and use of materialsthat 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 underopen licenses that promote sharing and dissemination. In keeping with this spirit, we hereby provide all our materials (wherever they are already notcopyrighted elsewhere as indicated) under Creative Commons Attribution-NonCommercial 4.0 International License. To view a copy of this licensevisit http://creativecommons.org/licenses/by-nc/4.0/
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