Introduction to Health Policy and Systems Research
Facilitator’s Guide
This is a document developed by members of the CHEPSAA project.
CHEPSAA (Consortium for Health Policy and Systems Analysis in Africa) is a project funded by the European Union which aims to extend sustainable African capacity to produce and use high quality health policy and systems research by harnessing synergies among a Consortium of African and European universities with relevant expertise.
/ 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. /Introduction to Health Policy and Systems Researchis licensed under a
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December2014
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Contents
Overview of the course page 5
Introduction
Overall course aim
Logic of the course
Approach to teaching and learning
Managing group work
Presentations
Course readings
Resources
Learning outcomes and threshold concepts page 10
Course outline page 12
Course sessions
1 Introductions page 15
1.1Multiple perspectives within the class and within HPSR
1.2 What is a health system and why is it important?
1.3 Ways of understanding, and strengthening, a health system
2 Starting points: the focus and field of HPSR page 21
2.1 Revisiting: health systems and how to strengthen them
2.2 What is the focus and field of HPSR?
3 HPSR questions and perspectives page 27
3.1 Asking HPSR questions
3.2 Recognising multiple perspectives
4 Introduction to HPSR protocol and design page 32
4.1 Reviewing HPSR protocols
4.2 HPSR study design – an overview
5 HPSR design: turning questions into projects page 36
5.1 Examining protocol designs
5.2 Common HPSR designs
6 Rigour, trustworthiness and generalisable claims page 39
6.1 Ensuring rigour
7 Topic to design: HPSR paper critique page 42
7.1 One HPSR research topic, different design options
8 Developing an HPSR protocol outline page 45
8.1 Framing the issue, developing the question and design
9 Pitching the idea page 47
9.1 Presenting and assessing an HPSR protocol
10 Influencing health policy and practice page 50
10.1 Strengthening evidence-informed health policy-making
10.2 Personal reflection
10.3 Course wrap-up and evaluation
Annex 1:Suggested timetable for a five-dayintroduction to HPSR short course page 54
Annex 2: Course assessment and assignment guide page 55
Annex 3: Reading list page 63
Annex 4: An example of an HPSR protocol for review in Activity 6 (Sessions 4–6)page 73
Annex 5: An example of a table for making a summary of an HPSR protocol (Activity 6, Sessions 4–6) page 82
Complementary resources
The handouts are available as a set of Word files. The PowerPoint slides for the presentations are available for downloadfrom the CHEPSAA website:
Handouts
Handout 1: Course overview
Handout 2: Health systems and services: Alocal TBservice delivery case
Handout 3: HPSR protocol review
Handout 4: HPSR strategies– approaches to rigour
Handout 5: A guide for the HPSR paper critique
Handout 6: Develop an HPSR strategy and design
Handout 7: Building practitioner–researcher engagement
Handout 8: Personal reflection
Handout 9: Course evaluation
Presentations
Presentation 1: Why are we running this course?
Presentation 2: What is a health system? What is health system strengthening?
Presentation 3: HPSR? What is health policy and systems research?
Presentation 4: Generating and framing HPSR questions
Presentation 5: Recognising your starting points
Presentation 6: Study design: from questions to projects
Presentation 7:Planning HPSRstudies: key issues for specific designs
Presentation8: Rigour and ethics
Presentation9: Influencing policy and practice
Presentation10: IHPSR wrap-up
Overview of the course
Introduction
This course provides an introduction to the practice of health policy and systems research (HPSR). It is intended for all those interested in health systems – whether or not they are likely to go on to become full-time researchers, to do research in other positions, to commission research or to seek evidence from research studies to inform decision-making.
The course seeks to sensitise participants to some of the fundamental starting points for HPSR and its conceptual and methodological foundations.
The course is intended primarily as a Master’s level introductory course, offered within a broader Master’s programme, such as an MPH (Master’s in Public Health). Its target audiences are, therefore, varied and include those interested in a future HPSR career,either coming from other research areas or as new researchers, health systems practitioners and managers, and those likely to work in non-governmental organisations. Such participants bring to the course an interesting mix of experiences, disciplinary backgrounds and future aspirations, including diversity in the extent and nature of their experience of health policy and systems.
The course as presented in this guide is structured around ten, three-hour sessions – a total of 30 hours of contact time. However, the length of time given to various activities and sessions can be adapted, whilst retaining the core logic of the course. For example, the course could be run as an intensive short course that is spread over five days (see Annex 1). A longer course could alsoallow for the inclusion of additional sessions on the principles of qualitative and quantitative data collection and analysis. Alternatively, it could be complemented by other courses focused on these principles.
Overall course aim
By the end of the course participants are expected to be able, confidently, to identify substantively relevant HPSR questions, to select appropriate research strategies for addressing these questions in specific contexts and to think through approaches that support the use of research evidence in decision-making. The course is framed within the understanding that HPSR is rooted in real-world problems, and requires constant consideration of the ties between policy-making and research.
Logic of the course
Each of the 10 contact sessions in the course is designed to take 3 hours (allowing for a 15 minute break within each). You will have to adjust the sessions if your timetable does not allow this amount of contact time.However, you would ideally keep the core logic of the course intact. This logic is shown in the sequence of core themes given below.
Introductions: Why HPSR?
Starting points
What is a health system? What is health system strengthening?
What is health policy? What are the boundaries of HPSR?
What is HPSR?
Identifying HPSR issues and framing HPSR questions
From question to research strategy and study design
Understanding HPSR (critique and rigour)
Using research to influence policy and practice
Approach to teaching and learning
This course takes an outcomes-based approach to education that involves identifying clear learning outcomes that can be shown and assessed at the end of the learning programme. Participants need to know what they are expected to work towards at the beginning of the course. The key learning outcomes and threshold concepts (key underpinning ideas) for the course are listed at the end of this section of the guide.
See Annex 2 for suggested assessmenttasks that build on course activities and that are designed to show evidence of learners’ achievment of learning outcomes. It is useful to construct these tasks to allow iterative learning.
This module also follows a constructivist approach to learning which is based on the understanding that learners are not ‘empty vessels’ to be filled with ‘knowledge’, but that their understanding of new information is built upon and shaped by their existing knowledge, skills, values and attitudes. Therefore, many of the activities in the module have been designed to encourage participants to think through issues for themselves before providing them with new information or theory. In this way learning can be more effective as participants relate the ideas and concepts to their own experience and existing knowledge. This also means that input needs to be adapted by the facilitator to suit the needs of particular learning groups.
In addition, the course follows an active-learning approach as the individual or group activities allow participants to apply what they have learnt and grapple with some of the complexities of HPSR.
It is worth emphasising to participants that the activities provide valuable learning opportunities and the more time and effort they put into them the more they will gain from the learning experience.
Active participation
This course is primarily for people who may go on to be health researchers, managers or advocates, premised on the notion that all health system actors can conduct research and have critical insights on the issues of focus in HPSR. Therefore, active participation in all course activities is central to the learning experience, and this includes opportunities for students to listen to each other and to participate in, and facilitate, small group activities. Through these activities participants engage with each other’s different experiences and perspectives and so directly confront the multi-disciplinary challenges of HPSR and experience the value of considering multiple perspectives.
Managing group work
If possible choose a venue that allows participants to move into, and work in, small groups around separate tables. A presentation theatre setting is not conducive to group work, participation or discussion, and does not allow you to move around the groups to give guidance.
The ideal size for most group activities is four to six participants. For some activities, such as thinking pairs, groups of two to threeparticipants are more appropriate.
Some of the group activities require leadership to encourage participation from all group members and to ensure that tasks are completed in time. Create opportunities for as many participants as possible to lead such processes. Provide some guidance and ideas for small group facilitation to support this. A rich array of material is available on the Internet that can be used, and it might also be possible to include some informal or formal peer review of facilitation skills within the course.
Some useful strategies for the group work activities within the course are suggested below.
- Where appropriate, reform the groups during the course to allow participants to engage with different individuals, and to give different group leaders an opportunity to practise their facilitation skills.
- In every group activity, suggest that roles are clearly identified beforehand (e.g. group facilitator/chair, group scribe, presenters).
- Provide a brief guideline on effective group facilitation at the beginning of the course (e.g. ensuring everyone is heard, how to manage strong voices, dealing with different disciplinary perspectives).
- If the timing allows, group leaders can be prepared/given warning of the work required in advance (e.g. given an outline of the activity, and time to read the resource materials carefully beforehand).
- Observe the groups as they work, and provide guidance as needed, for example:
- If one person dominates the group: ask questions to encourage other participants to contribute.
- If the group gets ‘stuck’ on one issue: ask questions to encourage them to think of other issues, prompt them to move on.
- Remind participants to record their ideas or the consensus reached.
- Remind the groups of the time and help them to pace themselves, for example: ‘Use the last 10 minutes to focus on question X or plan your presentation’.
Note: The development of a research strategy and funders’ pitch (Activities 8 and 9, Sessions 8 and 9) needs particularly careful group facilitation. We suggest that participants who show an ability to manage group work are selected to lead the groups for these activities.
Presentations
During the power point presentations (PPTs), asking relevant questions can help to draw out what participants already think about certain issues or terms. In this way new information can be provided in a way that helps to either reinforce participants’ understanding or correct any misunderstandings they may have. Questions can also be used to encourage participants to apply their knowledge and to assess their understanding of new concepts and theories.
However, if time is short it is easy to let a lecture-mode of imparting knowledge dominate. To avoid this, use the activities to guide discussion and draw out key themes or concepts, and be flexible in when, and how, theoretical input is given.
A key challenge of this style of teaching is time-management, which involves the ability to keep the discussions to the point and manage the group dynamics (i.e. encouraging contributions from quieter participants and avoiding discussions being
dominated by the more vocal participants).
Course readings
This course is designed to be taught utilising the Alliance Reader(reference below)as its core reading. Course facilitators should be familiar with this document, particularly Parts 1 and 2 (pp.1–60), before organising the course.
Gilson L, ed. (2012). Health policy and systems research: a methodology reader. Alliance for Health Policy and Systems Research, World Health Organization. (Entire reader available for download at:
Other textbooks of particular value for this course
Fulop N et al., eds (2001).Studying the organisation and delivery of health services: research methods. London, Routledge.
Robson C (2002). Real world research: a resource for social scientists and practitioner–researchers,2nd ed. Oxford, Blackwell Publishing.
Thomas A, Chataway J, Wuyts M, eds(1998).Finding outfast: investigative skills for policy and development. London, Thousand Oaks, New Dehli, Sage Publications (pp. 307–332).
See also the reading list given in Annex 3, from which facilitators can select readings for participants’ self-study sessions or to use as examples in specific activities, as appropriate.
Resources
In addition to this facilitator’s guide, the materials for this course include:
- Handouts, available as separate Word files. The handouts are numbered in the order in which they are given to participants during the course.
- Suggestions for assessment (Annex 2)
- A list of readings (Annex 3)
- PowerPoint slides for input sessions, available electronically.
You may need to adapt these resources as appropriate to suit the needs of your participants.
For each session you will also need flip-chart (or newsprint/large sheets of paper) and marker pens to record key points during discussions. It is helpful if these are displayed on the walls and left for participants to refer to as needed during the course.
Learning outcomes and threshold concepts
Course learning outcomes
This course has 11 learning outcomes. While not all sessions address all of the outcomes, most of them weave through the majority of the sessions, albeit with different weightings in each session.
By the end of the course participants are expected to be able to:
- Identify researchable health policy and systems issues, including those focused on action to strengthen health systems and the processes of policy change.
- Formulate substantively relevant health policy or health systems research questions, by drawing on relevant empirical work, practice knowledge, and theoretical insights.
- Be familiar with the range of research purposes, questions and strategies used within HPSR.
- Identify appropriate research strategies and study designs for different HPSR issues, purposes and question types.
- Show awareness of critical issues in, and approaches to, ensuring rigour in HPSR.
- Be aware of critical ethical issues for HPSR.
- Be able to source HPSR materials and critically appraise HPSR empirical papers.
- Appreciate the value of multiple perspectives (positional and disciplinary) in conducting HPSR.
- Have some understanding of how the complex and socially constructed nature of health policy and health systems is addressed in HPSR methodology.
- Plan activities that support the use of research evidence for and in decision-making, through researcher–policy maker/practitioner engagement.
- Recognise that personal skills, such as reflexivity, listening and facilitation, are critical to being a health policy and systems researcher.
Threshold concepts
A number of threshold concepts (key underpinning ideas) have been identified for this course, as listed below.