Health Policy And Systems Research - WHO

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Health Policy andSystems ResearchA Methodology ReaderEdited by Lucy Gilson

Health Policy andSystems ResearchA Methodology ReaderEdited by Lucy Gilson

WHO Library Cataloguing-in-Publication DataHealth policy and systems research: a methodology reader / edited by Lucy Gilson.1.Health policy. 2.Health services research. 3.Delivery of health care. 4.Research. 5.Review literature. I.Gilson, Lucy.II.Alliance for Health Policy and Systems Research. III.World Health Organization.ISBN 978 92 4 150313 6(NLM classification: W 84.3) World Health Organization 2012All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchasedfrom WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: 41 22 791 3264; fax: 41 22 791 4857;e-mail: bookorders@who.int).Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed toWHO Press through the WHO web site (http://www.who.int/about/licensing/copyright form/en/index.html).The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the partof the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation ofits frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World HealthOrganization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products aredistinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, thepublished material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use ofthe material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.The named authors alone are responsible for the views expressed in this publication.Printed by the WHO Document Production Services, Geneva, SwitzerlandDesigned by Capria

Contents

ContentsAbout this Reader . 11Part 1Introduction to Health Policy and Systems Research . 191. What is Health Policy and Systems Research? . 21Key characteristics . 21Key areas of HPSR . 222. Health systems . 23Goals . 23Elements and characteristics . 23Multi-levels of operation . 24Interactions and interrelationships . 253. Health system development or strengthening . 264. Health policy . 285. Health policy analysis . 28Policy actors . 29The focus and forms of policy analysis . 296. The boundaries of HPSR . 30What HPSR is . 31What HPSR is not . 32The distinction between HPSR and service delivery/disease programme research . 32Fuzzy boundaries . 337. Understanding the nature of social and political reality . 34Positivism . 35Relativism . 35Critical realism . 36HPSR perspectives on causality, generalizability and learning . 36References .38Contents5

Part 2Doing HPSR: Key steps in the process . 41Step 1: Identify the research focus and questions . 43Networking and creative thinking . 44Literature search . 45Key challenges . 46Identifying the purpose of the research . 47Taking account of multidisciplinarity . 51Finalizing research questions . 51Step 2: Design the study . 52Using theory and conceptual frameworks to inform the study . 54Step 3: Ensure research quality and rigour . 55Step 4: Apply ethical principles . 58References .59Part 3Understanding Health Policy and Systems . 61Health system frameworks . 63Bloom G, Standing H, Lloyd R (2008). Markets, information asymmetry and health care: Towards newsocial contracts. . 63de 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. . 63Conceptual frameworks for HPSR . 64Atun R et al. (2010). Integration of targeted health interventions into health systems: a conceptualframework for analysis. . 64Bossert T (1998). Analyzing the decentralization of health systems in developing countries: decisionspace, innovation and performance. . 64Brinkerhoff D (2004). Accountability and health systems: toward conceptual clarity and policy relevance. . 64Franco LM, Bennett S, Kanfer R (2002). Health sector reform and public sector health workermotivation: a conceptual framework. . 64Gilson L (2003). Trust and health care as a social institution. . 64Kutzin J (2001). A descriptive framework for country-level analysis of health care financing arrangements. . 64Vian T (2007). Review of corruption in the health sector: theory, methods and interventions. . 64Walt G, Gilson L (1994). Reforming the health sector in developing countries: the central roleof policy analysis. . 646Gilson L, ed. (2012). Health Policy and Systems Research: A Methodology ReaderAlliance for Health Policy and Systems Research, World Health Organization

Part 4Empirical papers . 65Overview: research strategies and papers . 671. Cross-sectional perspectives . 72Blaauw D et al. (2010). Policy interventions that attract nurses to rural areas: a multicountrydiscrete choice experiment. . 75Glassman A et al. (1999). Political analysis of health reform in the Dominican Republic. . 83Morrow M et al. (2009) Pathways to malaria persistence in remote central Vietnam: a mixed-methodstudy of health care and the community. . 95Ramanadhan et al. (2010). Network-based social capital and capacity-building programs: an examplefrom Ethiopia . 105Ranson MK, Jayaswal R, Mills AJ (2011). Strategies for coping with the costs of inpatient care: a mixedmethods study of urban and rural poor in Vadodara District, Gujarat, India. . 116Riewpaiboon et al. (2005). Private obstetric practice in a public hospital: mythical trust in obstetric care. . 129Rwashana AS, Williams DW, Neema S (2009). System dynamics approach to immunization healthcareissues in developing countries: a case study of Uganda. . 139Sheikh K, Porter J (2010). Discursive gaps in the implementation of public health policy guidelinesin India: The case of HIV testing. . 1522. The case study approach . 161Atkinson S et al. (2000). Going down to local: incorporating social organisation and political cultureinto assessments of decentralised health care. . 166Murray SF, Elston MA (2005). The promotion of private health insurance and its implications for the socialorganisation of health care: a case study of private sector obstetric practice in Chile. (Reproduced in the print version only)Mutemwa RI (2005). HMIS and decision-making in Zambia: re-thinking information solutions fordistrict health management in decentralised health systems. . 184Rolfe B et al. (2008). The crisis in human resources for health care and the potential of a ‘retired’workforce: case study of the independent midwifery sector in Tanzania. . 197Russell S, Gilson L (2006). Are health services protecting the livelihoods of the urban poor in Sri Lanka?Findings from two low-income areas of Colombo. . 210Shiffman J et al. (2004). The emergence of political priority for safe motherhood in Honduras. . 2233. The ethnographic lens . 235Aitken JM (1994). Voices from the inside: Managing district health services in Nepal. (Reproduced in the print version only)Behague DT, Storeng KT (2008). Collapsing the vertical-horizontal divide: an ethnographic studyof evidence-based policymaking in maternal health. . 239George A (2009). By papers and pens, you can only do so much: views about accountability and humanresource management from Indian government health administrators and workers. (Reproduced in the print version only)Lewin S, Green J (2009). Ritual and the organisation of care in primary care clinics in Cape Town,South Africa. . 245Contents7

Part 4 (continued)4. Advances in impact evaluation . 253Björkman M, Svensson J (2009). Power to the people: evidence from a randomized field experimenton community-based monitoring in Uganda. . 257Macinko J et al. (2007). Going to scale with community-based primary care: an analysis of the familyhealth programme and infant mortality in Brazil. . 292Marchal B, Dedzo M, Kegels G (2010). A realist evaluation of the management of a well-performingregional hospital in Ghana. . 303Wang H et al. (2009). The impact of rural mutual health care on health status: evaluation of a socialexperiment in rural China. (Reproduced in the print version only)5. Investigating policy and system change over time . 317Brown TM, Cueto M, Fee E (2006). The World Health Organization and the transition from‘international’ to ‘global’ public health. . 320Crichton J (2008). Changing fortunes: analysis of fluctuating policy space for family planning in Kenya. . 331Masanja H et al. (2008).Child survival gains in Tanzania: analysis of data from demographic andhealth surveys. . 343Van Ginneken N, Lewin S, Berridge S. (2010). The emergence of community health workerprogrammes in the late apartheid era in South Africa: an historical analysis. . 3516. Cross-national analysis . 361Bryce J et al. (2005). Programmatic pathways to child survival: results of a multi-country evaluationof Integrated Management of Childhood Illness. . 363Gilson L et al. (2001). Strategies for promoting equity: experience with community financingin three African countries. . 369Lee K et al. (1998). Family planning policies and programmes in eight low-income countries:A comparative policy analysis. . 400O’Donnell O et al. (2007). The incidence of public spending on healthcare: comparative evidencefrom Asia. . 4117. Action research . 443Khresheh R, Barclay L (2007). Practice-research engagement (PRE): Jordanian experiencein three Ministry of Health hospitals. . 445Khresheh R, Barclay L (2008). Implementation of a new birth record in three hospitals in Jordan:a study of health system improvement. . 4618Gilson L, ed. (2012). Health Policy and Systems Research: A Methodology ReaderAlliance for Health Policy and Systems Research, World Health Organization

Part 5Reflections on Health Policy and Systems Research .

Reflections on Health Policy and Systems Research. 469 de Savigny D et al. (2009). Systems thinking: Applying a systems perspective to design and evaluate health systems interventions. In: de Savigny D, Adam T, eds. Systems thinking for health systems

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