Health policy and systems research

Health policy and systems research (HPSR) is a field of inquiry that studies "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".[1] HPSR is interdisciplinary and brings together expertise in biomedical and social sciences such as economics, sociology, anthropology, political science, public health and epidemiology.

History and development

The Commission on Health Research for Development[2] and the Ad Hoc Committee on Health Research[3] (1996) both highlighted the urgent need for focusing research methods, funding and practice towards addressing health inequities and embracing inter-disciplinary and intersectoral thinking. These reports and other academic and activist voices linked to them argued for greater voice and participation of developing countries in defining research priorities.[4] In 1997, at the Lejondal Meeting in Stockholm with senior scientists including Göran Tomson, policymakers and representatives of various agencies with a stake in HPSR, an Interim Board for an Alliance was proposed.[2] Since then, the creation of the Alliance for Health Policy and Systems Research in 2000 and of Health Systems Global in 2012 have consolidated the practice community of HPSR. In 2010, the first global symposium on health systems research was held in Montreux. PLoS Medicine commissioned three articles on the state-of-the-art in HPSR authored by a diverse group of global health academics. These articles critically examined the status of HPSR, current challenges and mapped the need to build capacity in HPSR and support local policy development and health systems strengthening, especially in LMICs.[5] The series positioned HPSR as a field of inquiry that is driven by the nature of research question as opposed to being guided by the research methods.[5]

Key concepts and themes

HPSR can be distinguished from related fields of inquiry such as health services research from particular focus on wider systemic, structural and societal phenomena. The key concepts and themes in HPSR include[1] the treatment of health systems as Complex adaptive system[6], a focus on governance and stewardship of health systems[7] (as opposed to focusing on individual health behaviours), an intent to create knowledge for health equity and social justice,[8] pursuing people-centred and community-oriented healthcare[9], focusing on Implementation research[10], exploring the role of power using political economy approaches[11][12], studying systems phenomena such as resilience[13] and responsiveness, using participatory action research to co-produce research and action[14] and adopting a learning health systems approach.[15]

Methods and approaches

Health Policy and Systems Research (HPSR) is defined by the questions it asks (typically on functioning, reform, and governance of health policy and systems) than by specific methodologies (it is methods agnostic).[1][8] Researchers and practitioners use biomedical or social science research or practice approaches that are best fit for a given question including realist and theory-driven approaches, participatory action research, policy analysis, implementation research or any methodological approach that is best fit for the given HPSR question. The Alliance for Health Policy and Systems Research has produced methods readers and evidence synthesis guidelines for HPSR.[16]

Importance and impact

Challenges and criticism

Future directions

Key organisations and initiatives

References

  1. 1 2 3 "What is Health Policy and Systems Research". WHO Alliance for Health Policy & Systems Research. Retrieved 2024-01-17.
  2. 1 2 Bennett, Sara; Adam, Taghreed; Zarowsky, Christina; Tangcharoensathien, Viroj; Ranson, Kent; Evans, Tim; Mills, Anne (November 2008). "From Mexico to Mali: progress in health policy and systems research". The Lancet. 372 (9649): 1571–1578. doi:10.1016/S0140-6736(08)61658-X. PMID 18984191. S2CID 21065572.
  3. ↑ Lin, V (1997-12-01). "Resource review. Investing in health research and development: report of the ad hoc committee on health research relating to future intervention options. World Health Organization, Geneva, 1996". Health Promotion International. 12 (4): 331–332. doi:10.1093/heapro/12.4.331.
  4. ↑ Weisz, George (2020-08-02). "What Happened to the Global Forum for Health Research?". Global Public Health. 15 (8): 1212–1224. doi:10.1080/17441692.2020.1752767. ISSN 1744-1692. PMID 32295489. S2CID 215793442.
  5. 1 2 Sheikh, Kabir; Gilson, Lucy; Agyepong, Irene Akua; Hanson, Kara; Ssengooba, Freddie; Bennett, Sara (2011-08-16). "Building the Field of Health Policy and Systems Research: Framing the Questions". PLOS Medicine. 8 (8) e1001073. doi:10.1371/journal.pmed.1001073. ISSN 1549-1676. PMC 3156683. PMID 21857809.
  6. ↑ Savigny, Donald de; Adam, Taghreed (2009). Systems thinking for health systems strengthening. Alliance for Health Policy and Systems Research. ISBN 978-92-4-156389-5.
  7. ↑ Siddiqi, Sameen; Masud, Tayyeb I.; Nishtar, Sania; Peters, David H.; Sabri, Belgacem; Bile, Khalif M.; Jama, Mohamed A. (April 2009). "Framework for assessing governance of the health system in developing countries: gateway to good governance". Health Policy (Amsterdam, Netherlands). 90 (1): 13–25. doi:10.1016/j.healthpol.2008.08.005. ISSN 0168-8510. PMID 18838188.
  8. 1 2 Gilson, Lucy; AHPSR, WHO (2012). Health policy and systems research: a methodology reader. Alliance for Health Policy and Systems Research. ISBN 978-92-4-150384-6.
  9. ↑ Sheikh, Kabir; George, Asha; Gilson, Lucy (2014-04-17). "People-centred science: strengthening the practice of health policy and systems research". Health Research Policy and Systems. 12 (1): 19. doi:10.1186/1478-4505-12-19. ISSN 1478-4505. PMC 4018943. PMID 24739525.
  10. ↑ Peters, David; Tran, Nhan; Adam, Taghreed; Research, Alliance for Health Policy and Systems; Organization, World Health (2013). Implementation research in health: a practical guide. World Health Organization. ISBN 978-92-4-150621-2. {{cite book}}: |first4= has generic name (help)
  11. ↑ Gilson, Lucy; Hanson, Kara; Sheikh, Kabir; Agyepong, Irene Akua; Ssengooba, Freddie; Bennett, Sara (2011-08-23). "Building the Field of Health Policy and Systems Research: Social Science Matters". PLOS Medicine. 8 (8) e1001079. doi:10.1371/journal.pmed.1001079. ISSN 1549-1676. PMC 3160340. PMID 21886488.
  12. ↑ Topp, Stephanie M.; Schaaf, Marta; Sriram, Veena; Scott, Kerry; Dalglish, Sarah L.; Nelson, Erica Marie; SR, Rajasulochana; Mishra, Arima; Asthana, Sumegha; Parashar, Rakesh; Marten, Robert; Costa, João Gutemberg Quintas; Sacks, Emma; BR, Rajeev; Reyes, Katherine Ann V. (2021-11-05). "Power analysis in health policy and systems research: a guide to research conceptualisation". BMJ Global Health. 6 (11) e007268. doi:10.1136/bmjgh-2021-007268. ISSN 2059-7908. PMC 8573637. PMID 34740915.
  13. ↑ Kruk, Margaret E.; Myers, Michael; Varpilah, S. Tornorlah; Dahn, Bernice T. (2015-05-09). "What is a resilient health system? Lessons from Ebola". The Lancet. 385 (9980): 1910–1912. doi:10.1016/S0140-6736(15)60755-3. ISSN 0140-6736. PMID 25987159.
  14. ↑ Swaminathan, Soumya; Sheikh, Kabir; Marten, Robert; Taylor, Martin; Jhalani, Manoj; Chukwujekwu, Ogochukwu; Pearson, Luwei; Allotey, Pascale; Gough, Jean; Scherpbier, Robert W.; Gupta, Anuradha; Wijnroks, Marijke; Pate, Muhammad Ali; Sorgho, Gaston; Levine, Orin (December 2020). "Embedded research to advance primary health care". BMJ Global Health. 5 (12) e004684. doi:10.1136/bmjgh-2020-004684. ISSN 2059-7908. PMC 7751205. PMID 33355263.
  15. ↑ Sheikh, Kabir; Abimbola, Seye (2022-03-16). "Strong health systems are learning health systems". PLOS Global Public Health. 2 (3) e0000229. doi:10.1371/journal.pgph.0000229. ISSN 2767-3375. PMC 10021419. PMID 36962387.
  16. ↑ "Evidence synthesis for health policy and systems: a methods guide". AHPSR. Retrieved 2026-08-03.
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