Pratt B and Hyder AA (2017) Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems, Social Science and Medicine, Volume 174, Pages 113–121, DOI: 10.1016/j.socscimed.2016.11.039
Global health research partnerships are increasingly taking the form of consortia that conduct programs of research in low and middle-income countries (LMICs). An ethical framework has been developed that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda.
Pratt B and Hyder AA (2016) Designing research funding schemes to promote global health equity: An exploration of current practice in health systems research, Developing World Bioethics, DOI: 10.1111/dewb.12136
International research is an essential means of reducing health disparities between and within countries and should do so as a matter of global justice. Research funders from high-income countries have an obligation of justice to support health research in low and middle-income countries (LMICs) that furthers such objectives. This paper investigates how their current funding schemes are designed to incentivise health systems research in LMICs that promotes health equity.
Pratt B and Hyder AA (2016) How can health systems research reach the worst-off? A conceptual exploration, BMC Health Services Research 16:1868, DOI: 10.1186/s12913-016-1868-6
Health systems research is increasingly being conducted in low and middle-income countries (LMICs). Such research should aim to reduce health disparities between and within countries as a matter of global justice. For such research to do so, ethical guidance that is consistent with egalitarian theories of social justice proposes it ought to (amongst other things) focus on worst-off countries and research populations. Yet who constitutes the worst-off is not well-defined.
George AS, Scott K, Mehra V and Sriram V (2016) Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review, BMC Health Services Research, 16:1860, DOI: 10.1186/s12913-016-1860-1
Community capability is the combined influence of a community’s social systems and collective resources that can address community problems and broaden community opportunities. We frame it as consisting of three domains that together support community empowerment: what communities have; how communities act; and for whom communities act. We sought to further understand these domains through a secondary analysis of a previous systematic review on community participation in health systems interventions in low and middle income countries (LMICs).
Systems thinking represents a unique theoretical and practical contribution. It facilitates ways to cross disciplines, and brings previously unused tools and approaches to tackle global health implementation differently. Future Health Systems (FHS) has played a major role in applying and advocating for the approach as a means to holistically understand health systems in low- and middle-income countries, as well as adaptation and scale-up of the project’s interventions.
Pratt B, Merritt M and Hyder AA (2016) Towards deep inclusion for equity-oriented health research priority-setting: A working model, Social Science and Medicine, vol 151, pp 215-224, doi:10.1016/j.socscimed.2016.01.018
Growing consensus that health research funders should align their investments with national research priorities presupposes that such national priorities exist and are just. Arguably, justice requires national health research priority-setting to promote health equity. Such a position is consistent with recommendations made by the World Health Organization and at global ministerial summits that health research should serve to reduce health inequalities between and within countries. Thus far, no specific requirements for equity-oriented research priority-setting have been described to guide policymakers. As a step towards the explication and defence of such requirements, we propose that deep inclusion is a key procedural component of equity-oriented research priority-setting.
Pratt B, Allen KA and Hyder AA (2016) Health Systems Research Consortia and the Promotion of Health Equity in Low and Middle-Income Countries, Developing World Bioethics, doi: 10.1111/dewb.12116
Recent conceptual work has explored what features might be necessary for health systems research consortia and their research programs to promote health equity. Identified features include selecting research priorities that focus on improving access to high-quality health services and/or financial protection for disadvantaged populations in LMICs and conducting research capacity strengthening that promotes the independent conduct of health systems research in LMICs. Yet, there has been no attempt to investigate whether existing consortia have such characteristics. This paper describes the results of a survey undertaken with health systems research consortia leaders worldwide to assess how consistent current practice is with the proposed ethical guidance.
Morgan, R; George, A; Ssali, S; Hawkins, K; Molyneux, S and Theobald, S (2016) How to do (or not to do)… gender analysis in health systems research, Health Policy & Planning, doi: 10.1093/heapol/czw037
Gender — the socially constructed roles, behaviours, activities and attributes that a given society considers appropriate for males, females and other genders — affects how people live, work and relate to each other at all levels, including in relation to the health system. Health systems research (HSR) aims to inform more strategic, effective and equitable health systems interventions, programs and policies; and the inclusion of gender analysis into HSR is a core part of that endeavour. The authors outline what gender analysis is and how gender analysis can be incorporated into HSR content, process and outcomes.
Bennett S and Peters D, (2015) Assessing National Health Systems: Why and How, Health Systems & Reform 1(1):9-17, DOI:10.1080/23288604.2014.997107
In reviewing national health systems assessments (HSAs), the authors identify four primary rationales for doing HSAs: (i) to motivate health systems reform, (ii) to promote harmonization and alignment across actors in the health system, (iii) to help translate health systems reforms into meaningful ways to track performance, and (iv) to facilitate learning through cross-country comparisons. The authors propose a set of principles to guide HSAs.
Pratt B, Allen K A, Hyder A A (2015) Promoting equity through health systems research in low and middle-income countries: Practices of researchers, AJOB Empirical Bioethics, doi:10.1080/23294515.2015.1122669
Health systems research is increasingly identified as an indispensable means to achieve the goal of health equity between and within countries. While conceptual work has explored what form of health systems research in low and middle-income countries (LMICs) is needed to promote health equity, there have been few attempts to investigate whether it is being performed in practice. This paper describes the results of a survey undertaken with health systems researchers worldwide to assess how equity-oriented current practice is in LMICs.
George AS, Mehra V, Scott K, Sriram V (2015) Community Participation in Health Systems Research: A Systematic Review Assessing the State of Research, the Nature of Interventions Involved and the Features of Engagement with Communities. PLoS ONE 10(10): e0141091. doi:10.1371/journal.pone.0141091
Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance. Existing reviews largely focus on the effectiveness of community participation with less attention to how community participation is supported in health systems intervention research.
This systematic review explores the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.
It concludes that despite positive examples, community participation in health systems interventions was variable, with few being truly community directed. Future research should more thoroughly engage with community participation theory, recognize the power relations inherent in community participation, and be more realistic as to how much communities can participate and cognisant of who decides that.