What is health policy & systems research (HPSR)?

What is the broad goal of health policy and systems research (HPSR)?

HPSR is an emerging field that seeks to understand and improve 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. It seeks to draw a comprehensive picture of how health systems respond and adapt to health policies, and how health policies can shape − and be shaped by − health systems and the broader determinants of health. It is founded on concern for collective health goals and, more specifically, health equity, and focuses on the upstream aspects of health, organizations and policies, rather than clinical or preventive services or basic scientific research. 

What does HPSR aim to achieve in policy?

HPSR always seeks to be policy-relevant and to be useful in supporting health system development. This means it always seeks to be useful for policy and practice - and so must always engage with, and negotiate, the information needs of policy actors, including community organisations.

Who conducts HPSR?

HPSR is not the sole preserve of full-time researchers based in universities or independent research organisations. Managers and analyts working within government or in specific health organisations also conduct a range of analytic and research work that addresses the broad goal of HPSR, as do community and civil society organisations. Routine analysis might include, for example, producing and understanding national health accounts data, describing a key component of the health system and, allowing analysis over time of one country’s experience and comparison with other countries’ experiences. Participatory action research at community level, meanwhile, can support improvements in local health services, whilst conceptual research can promote new understandings and provide a basis for new action to strengthen health systems. 

Why are the phrases ‘health policy’ and ‘health systems’ used together? Are these areas of work linked?

HPSR is comprised of two elements: research on policy change, which means that it is concerned with how policies are developed and implemented and the influence that policy actors have over policy outcomes; and research that focuses on health systems – covering work addressing health services as well as wider activities to promote health. HPSR brings together health policy and systems work in one research field and reflects the integral linkages between these apparently separate areas of work:

  • First, health policies can be seen as the purposeful and deliberate actions through which efforts are made to strengthen health systems to promote population health.
  • Second, such deliberate actions must both be informed by an understanding of the current dynamics of health system functioning and performance and are brought alive, or undermined, in the way they find expression in the health system.
  • Third, better understanding of the politics of health policy change, the actors and interests driving which and how policies are developed and implemented, is part of the knowledge base required in taking action to strengthen health systems.
  • Fourth, a focus on policy implementation, specifically, also allows, and indeed requires, better understanding of the organisational dynamics of health systems, a critical, and often overlooked, element of health system functioning.

In practice, therefore, these apparently different areas of work overlap and together provide the knowledge base needed to support health system strengthening, as well as emphasising the need to bring knowledge and power together in order to take appropriate decisions.

Which academic disciplines underpin HPSR?

By nature, HPSR is inter-disciplinary: a blend of economics, sociology, anthropology, political science, public health and epidemiology. HPSR is characterized not by any particular methodology, but the types of questions it addresses. The appropriate mix of disciplines to be used in HPSR depends largely on the nature of the research question being addressed.

What does HPSR seek to understand?

Broadly, HPSR seeks to understand what health systems are and how they operate; what needs to be done to strengthen health systems in order to improve performance in terms of health gain and wider social value; how to influence policy agendas to embrace actions to strengthen health systems; how to develop and implement such actions in ways that enhance their chances of achieving performance gains. More specific interests include:

  • Issues surrounding implementation of services and delivery of care in both the public and private sectors.
  • The role, interests and values of key actors at local, national and global levels as they influence health policy change and health system development.
  • Assessing new organisational models of care or new roles for different types of providers within the provision of health services and programmes.
  • The health system and policy context of particular health services or programmes, as this context has critical influence over sustained action to tackle particular health conditions.
  • The interrelationships among health programmes dedicated to specific conditions or diseases and how health system building blocks (such as human resources, or financing) impact on them, as well as how they impact on those building blocks.

Which level of the health system is addressed by HPSR?

HPSR includes concern for global and international issues as well as national, sub-national and local, community issues. It might involve considering one or more of the following aspects:

  • The wider context (global and national) in which policy is made (macro-level analysis).
  • The processes and institutional arrangements within which policy change is developed and implemented (meso-level analysis).
  • The impact of particular people on policy change and its impacts (micro-level analysis).

This content is either adapted or paraphrased from the following sources: 
AHPSR /WHO website. n.d. What is HPSR? An overview. [Accessed: March 2012].
Gilson, L. Ed (2012). Health Policy and Systems Research: A Methodology Reader. Geneva, World Health Organisation.

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