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Health systems research is inherently political. It prompts us to grapple with issues of status and inequality. Issues of power and privilege can be built into the systems and institutions of research and academia which shape researchers’ views, actions, and room for manoeuvre when it comes to ethics. Researchers also need to consider how they relate to different groups with a stake in the outcomes of health systems research for example, health service users, communities, health workers, managers, policy makers and donors. Within these relationships various organisations and individuals wield different levels of power and influence over the research process.

Social science and feminist approaches to research ethics tend to have a strong emphasis on the relational elements of ethical practice, and of producing quality data. They stress the need to be aware of and pay attention to conflicting interpersonal relationships and power imbalances inherent in many research relationships, and there is interest in the political implications of the research endeavour.

At the institutional and structural levels there is a need to consider power imbalances and unearned privileges in the ways in which research partnerships and knowledge economies are conceptualised, financed and managed.

The resources begin with a review of the literature on power and health systems research by Sriram et al. (2018). A commentary by Sheikh et al. (2016) explores how power relations and privilege play out in the ways that global health agendas are set and argues for a more intersectional approach to recognising and tackling power imbalances. The paper by Benatar (2016) prompts us to look at global health framings, priorities and strategies – and how they shape or constrain thinking and action. The blog by Molyneux and Theobald (2018) explores both power and vulnerability in field work and the relationships between research partners.

A number of resources in this section address the issue of gendered power relations and health systems research. Three overview papers look at gender and intersectionality within the process of conceptualising and conducting health systems research. The article by Nordling (2017) explores what patriarchal power relations mean for field work in the Africa region. While the blog by Morgan (2016) asks us to consider power and privilege within our teaching practices.

Also included are articles on research partnerships with a focus on shared sovereignty and capacity development, inequities in global health and the need to decolonise health systems research. These resources cover issues like ‘trickle-down science’, foreign authorship, parachute researchers and donor censorship.  Blogs on decolonising focus on consulting, theorising and activism.

In the book Structural Injustice: Power, Advantage, and Human Rights (2019) Madison Powers and Ruth Faden develop an innovative theory of structural injustice that links human rights and fairness norms. Norms of both kinds are grounded in an account of well-being. They explain the depth of unfairness of systematic patterns of disadvantage, and locate the unfairness of power relations in forms of control some groups have over the well-being of other groups.

Providing practical advice, the framework from the Canadian Coalition for Global Health Research suggests how greater equity might be fostered through applying principles of authentic partnering, inclusion, shared benefits, commitment to the future, responsiveness to causes of inequities, and humility.