Friday, February 24, 2012

[EQ] Health Policy and Systems Research: A Methodology Reader

Health Policy and Systems Research: A Methodology Reader

Edited by Lucy Gilson

Alliance for Health Policy and Systems Research
World Health Organization 2012

Available online as PDF file [474p.] at:

“……..This Reader aims to support the development of the field of Health Policy and Systems Research HPSR, particularly in LMICs. It complements the range of relevant texts that are already available by providing a particular focus on methodological issues for primary empirical health policy and systems research.

There are four main sections in the Reader:

Part 1 provides an overview of the field of Health Policy and Systems Research HPSR  in LMICs and some of the key challenges of this kind of research.

Part 2 outlines key steps to follow when conducting HPSR studies.

Part 3 presents some key references of papers which provide overarching conceptual frameworks for understanding health policy and health systems.

Part 4 is the main body of the Reader and presents a set of empirical papers drawn exclusively from LMICs.
          The papers were selected because they:
          - together demonstrate the breadth and scope of Health Policy and Systems Research HPSR work

          - provide good examples of different forms of research strategy relevant to HPSR
          - are high quality and innovative.

Part 5 presents a set of references for papers that reflect on specific concepts or methods relevant to Health Policy and Systems Research HPSR as well as some of the particular challenges of working in this field.

…..The defining feature of primary Health Policy and Systems Research HPSR is that it is problem- or question-driven, rather than, as with epidemiology, method driven. Therefore, as outlined in Part 2, the first step in doing rigorous and good quality research is to clarify the purpose of the research, what the study is trying to achieve, and to identify and develop relevant and well-framed research questions.

Good quality work then demands an understanding of the research strategy that is appropriate to the questions of focus. The strategy is neither primarily a study design nor a method, but instead represents an overarching approach to conducting the research; it considers the most appropriate methods of data collection and sampling procedure in terms of the research purpose and questions.


The art of study design in Health Policy and Systems Research HPSR, as with all ‘real world research’, is about turning research questions into valid, feasible and useful projects….”




Part 1

Introduction to Health Policy and Systems Research

1. What is Health Policy and Systems Research?

2. Health systems


Elements and characteristics

Multi-levels of operation

Interactions and interrelationships

3. Health system development or strengthening

4. Health policy

5. Health policy analysis

Policy actors

The focus and forms of policy analysis

6. The boundaries of Health Policy and Systems Research  HPSR

7. Understanding the nature of social and political reality



Critical realism

Health Policy and Systems Research HPSR perspectives on causality, generalizability and learning


Part 2

Doing HPSR: Key steps in the process Understanding Health Policy and Systems .

Step 1: Identify the research focus and questions

Networking and creative thinking

Literature search

Key challenges

Identifying the purpose of the research

Taking account of multidisciplinarity

Finalizing research questions

Step 2: Design the study

Using theory and conceptual frameworks to inform the study

Step 3: Ensure research quality and rigour

Step 4: Apply ethical principles


Part 3

Health system frameworks

Bloom G, Standing H, Lloyd R (2008). Markets, information asymmetry and health care: Towards new social contracts.

de Savigny D et al. (2009). Systems thinking: What it is and what it means for health systems. In: de Savigny D, Adam T, eds. Systems thinking for health systems strengthening.


Conceptual frameworks for HPSR

Atun R et al. (2010). Integration of targeted health interventions into health systems: a conceptual framework for analysis.

Bossert T (1998). Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance.

Brinkerhoff D (2004). Accountability and health systems: toward conceptual clarity and policy relevance.

Franco LM, Bennett S, Kanfer R (2002). Health sector reform and public sector health worker motivation: a conceptual framework.

Gilson L (2003). Trust and health care as a social institution.

Kutzin J (2001). A descriptive framework for country-level analysis of health care financing arrangements.

Vian T (2007). Review of corruption in the health sector: theory, methods and interventions.

Walt G, Gilson L (1994). Reforming the health sector in developing countries: the central role of policy analysis.


Part 4

Empirical papers

Overview: research strategies and papers

1.       Cross-sectional perspectives

2.       The case study approach

3.       The ethnographic lens

4.       Advances in impact evaluation

5.       Investigating policy and system change over time

6.       Cross-national analysis

7.       Action research

Part 5

Reflections on Health Policy and Systems Research


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