What is HPSR?
Health policy and systems research (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. By nature, it is inter-disciplinary, a blend of economics, sociology, anthropology, political science, public health and epidemiology that together 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.
Health policy and systems research can be employed at several points in the policy cycle, from getting an issue onto the policy agenda to evaluating and learning from implemented policies. In this way, HPSR is characterized not by any particular methodology, but the types of questions it addresses. It focuses primarily upon the more upstream aspects of health, organizations and policies, rather than clinical or preventive services or basic scientific research (for example into cell or molecular structures). It covers a wide range of questions − from financing to governance − and issues surrounding implementation of services and delivery of care in both the public and private sectors. It is a crucial policy analysis tool − of both policies and processes − including the role, interests and values of key actors at local, national and global levels.
The appropriate mix of disciplines to be used in HPSR depends largely on the nature of the research question being addressed. An evaluation of a health insurance scheme might draw upon economics to understand the financial consequences of the scheme and its impact upon demand for services, anthropology to understand various socio-cultural and organizational aspects as well as patterns of consumption, and epidemiology to understand its health consequences.
HPSR and the building blocks of a health system
HPSR can address any or several of the health systems building blocks (see graphic) and their ultimate objective to promote the coverage, quality, efficiency and equity of health systems. In doing so, it acknowledges the inherent connections and dynamics among the different building blocks in assessing and understanding how interventions might play out across them. It also seeks to unpack the behaviour, reactions, and interconnectedness of health systems and the people within those systems. The way HPSR conceptualizes and analyzes these interactions helps to illuminate not only what works, but for whom, and under what circumstances.
Linking health policy with health systems research
Why health policy and health systems research? Why are these two different domains fused into one? While seemingly separate − with health policy research principally studying how different actors interact in the policy and implementation processes and contribute to policy outcomes, and health systems research addressing questions such as the coverage, quality, efficiency and equity of health systems − the two have clear and multiple synergies:
- Health policies are subject to political processes that govern health systems. Understanding these processes is not only critical in the design of effective policies, but in the creation of evidence to inform those policies. Health policies and health systems are not separate entities: HPSR is a recognition that everything is connected.
- Understanding the processes and dynamics of health systems can directly inform policy- and decision-making.
- Active linkage and exchange between health system researchers, decision-makers and other research-users promotes evidence-informed policy and policy-informed research.
- A systems perspective is critical in evaluating and learning from implemented policies
- Removing both from their silos builds the capacities of key actors in health policy, in health systems research, and creates actors versed and able in both.