Recognising your starting points

IHPSR Presentation 5

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Introduction to Health Policy and Systems Research

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?

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

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?

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

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/Constructivism)

What is the nature of the social reality being

investigated?

Epidemiology/Clinical

scienceThere 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

Epistemological self-diagnosis

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

Q1 Which do you trust more?

‘hard science’ or ‘soft science’?A. Hard science

B. Both/either/it depends

C. Soft science

Q2 Is there such a thing as ‘truth’?

A. I can’t decide

B. No (no truth or many truths)

C. Yes

Q3 Is knowledge discovered or created?

A. Knowledge is discovered

B. Both / I can’t decide

C. Knowledge is created

Q4 Can we have knowledge of

a single reality that is

independent of the knower? A. Yes

B. No

C. Sometimes

Q5 What is the role of the HPS researcher?

A.Truth gatherer

B.Interpreter

C.Meaning maker

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

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

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?

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

Knowledge paradigm

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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

EpidemiologyWelfare economicsPolitical science (rational choice

theory)

Policy analysisOrganisational studies

AnthropologySociologyPolitical science (sociological

institutionalism)

Key research approaches and methods

Deductive: Hypothesis drivenMeasurement 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

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

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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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.

The CHEPSAA partners

University of Dar Es SalaamInstitute of Development Studies

University of the WitwatersrandCentre for Health Policy

University of GhanaSchool of Public Health, Department of Health Policy, Planning and Management

University of LeedsNuffield 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 MedicineHealth Economics and Systems Analysis Group, Depart of Global Health & Dev.

Great Lakes University of KisumuTropical Institute of Community Health and Development

Karolinska InstitutetHealth Systems and Policy Group, Department of Public Health Sciences

University of Cape TownHealth Policy and Systems Programme, Health Economics Unit

Swiss Tropical and Public Health InstituteHealth Systems Research Group

University of the Western CapeSchool of Public Health