What are the key ethics issues in health systems research?
Health systems research is a field that draws on different disciplinary traditions and methodological approaches. Its overall aim is to influence policy and wider action to improve health system performance.
Health policy and systems research focuses on:
- The performance of health systems and their sub components (resources, organisations, and services)
- How links between the sub components shape performance, and what forces influence those links
- How to strengthen health system performance over time
Existing guidelines and research ethics committee members’ training tends to focus predominantly on the ethics of biomedical research. This is challenging for health systems research, which often operates at system or population as opposed to individual level. Also, in some health systems research (for example some embedded or participatory research) the distinction between research and practice that is central to much biomedical research ethics guidance is deliberately blurred.
There are very few guidelines and papers which deal directly with the ethics of health systems research. We have gathered together the ones that do in the Useful Resources section below. Many of these papers were led by Bridget Pratt and Adnan Hyder who have put considerable effort into synthesising existing literature and adding analysis based on their work within health systems consortia, for example, Future Health Systems.
The resources begin with a 2019 paper from the Alliance for Health Policy and Systems Research. It outlines a series of “points to consider” for the identification, consideration and communication of ethical issues.
This is followed by a recording of a webinar organised by the Health Systems Global Thematic Working Group on the Ethics of Health Systems Research. The Group is a great community of practice for those who want to share and learn on the topic. The webinar tackles issues such as how we conceptualise ethics in relation to non-human subjects (such as hospitals or communities), consent, and ensuring that risks are minimised and benefits maximised.
We have included a blog by Molyneux et al (2017) because it gives a quick round-up of what ethical issues were discussed at the Fourth Global Symposium on Health Systems Research raising issues such as social justice, micro-level ethics questions, and obligations and responsibilities in the face of multiple needs and inequities.
Having provided this overview, a series of papers provides more detailed insights. Krubiner and Hyder (2014) provide overarching domains in which we could consider health systems ethics: holism, sustainability, evidence and effectiveness, efficiency, public engagement and transparency, accountability and feedback, equity and empowerment, justice and fairness, responsiveness, collaboration, and quality.
Pratt et al. (2016) call upon the field of bioethics to move their focus beyond clinical trials to look at issues such as operations research, implementation research, health systems research, and research on the social determinants of health. The paper by Wassenaar and Rattani (2016) applies the Emanuel Framework for Clinical Research to health systems research to see how this might further Hyder’s call for more contemplation of ethics. The paper by Luyckx et al. (2017) draws on an expert meeting and calls for greater understanding and exploration of these issues within Ethics Review Boards.
Pratt et al. (2017) lead us through a scoping review of the literature related to health systems research, a conceptual exploration of the issue, how systems thinking might be applied to the topic, a review of field experiences and a call to action.
Abstract Fieldwork – “going there” – is the presumed norm and baseline of geographical research. In this commentary, I propose a framework for challenging the normative framing of fieldwork in geography and other fields (including those beyond academia): an ethic of not going there. I argue that fieldwork, rather than a neutral rite of passage, is deeply […]
Respected global medical journal The Lancet will continue to reject papers with data from Africa that fail to acknowledge African collaborators, in the interest of building African research and of promoting integrity, equity and fairness in research collaboration, according to senior executive editor Sabine Kleinert. The journal made the decision after coming across manuscripts submitted by researchers […]
This piece was published on the Collective blog and the original can be found here. Research priorities set by funding institutions are steeped in ideology. In this piece, Collective member Ramya Kumar reflects on what these ideologies mean for knowledge production in global health. Research requires funds, which are of limited availability in low- and lower-middle […]
New framework aims to improve inclusion and ethics in global research collaborations amid wider efforts to end exploitative practices. Exploitative research practices, sadly, come in all shapes and sizes. ‘Helicopter research’ occurs when researchers from high-income settings, or who are otherwise privileged, conduct studies in lower-income settings or with groups who are historically marginalized, with […]
An emerging movement aims to push researchers to pay more heed to inequities in scholarly citations. Christen Smith was at a conference in October 2017 when she felt a familiar jolt of frustration. A presenter showed a slide with passages that had been paraphrased from one of her books — and, to her dismay, had […]
Pandemic publishing: rethinking editorial ethics during COVID Researchers need to observe ethical standards during a pandemic, say Ben Kasstan (University of Bristol), Rishita Nandagiri (LSE) and Siyane Aniley (Addis Ababa University), and journals should hold them to these standards. The pandemic has changed academic research. It has led to gender gaps in authorship, questions about the quality of scientific publishing, and shifts in peer review […]
“Fake” Journals and the Fragility of Authenticity: Citation Indexes, “Predatory” Publishing, and the African Research Ecosystem
Abstract This article explores the contested politics of academic authenticity within the African research ecosystem, with particular reference to Nigeria. We show how a fear of “fake” journals is cultivated amongst African academics, with international journal citation indexes being used to adjudicate the credibility of African journals and publishers. The article juxtaposes an ethnographic vignette […]
Summary The scientific constructs, standards and findings used to guide parenting interventions are overwhelmingly based on research in Euro-American settings, resulting in a Western bias when applied to communities in low/middle-income countries. Ignoring this Western bias and overstating scientific evidence is a major obstacle to the fulfilment of ethical principles in parenting interventions because it […]
Africa is not a museum: the ethics of encouraging new parenting practices in rural communities in low-income and middle-income countries
The Nurturing Care Framework for Early Childhood Development urges stakeholders to implement strategies that help children worldwide achieve their developmental potential. Related programmes range from the WHO’s and UNICEF’s Care for Child Development intervention, implemented in 19 countries, to locally developed programmes, such as non-governmental organisation Tostan’s Reinforcement of Parental Practices in Senegal. However, some […]
The NIHR global health research portfolio held a webinar for applicants about ethical dimensions of community engagement and involvement in global health research, in partnership with the Institute of Development Studies. The the speakers for this session are: Dr Bridget Pratt, Senior Research Fellow in the School of Population and Global Health at the University […]