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 recent 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.
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.
Sriram V., Topp S.M., Schaaf M., Mishra A. Flores W., Rajasulochana S.R. and Scott K. (2018) 10 best resources on power in health policy and systems in low- and middle-income countries Health Policy and Planning, Volume 33, Issue 4, 1 May 2018, Pages 611–621 Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels—local, national and […]
Sheikh, K., Bennett, S.C., el Jardali, F., Gotsadze, G. (2016) Privilege and inclusivity in shaping Global Health agendas, Health Policy Plan (2017) 32 (3) Northern voices dominate Global Health discussions. How can it be acceptable that these groups continue to dominate in deciding what problems we think about in Global Health and how we approach them? The most […]
Benatar S. (2016) Politics, power, poverty and global health: systems and frames. Int J Health Policy Manag. 2016;5(10):599–604 Striking disparities in access to healthcare and in health outcomes are major characteristics of health across the globe. This inequitable state of global health and how it could be improved has become a highly popularized field of academic […]
Molyneux S. and Theobald S. (2018) The vulnerability and health research paradox: Ethics, gender, trust and power, RinGs blog This blog summarises a set of discussions on vulnerability, agency and resilience in a meeting organised by REACH it is framed around the paradox that: on the one hand research can be powerful tool for social justice […]
Nordling L. (2017) Africa: Women’s invisible power, Nature 550, S4–S5 (05 October 2017) Carrying out research on the mechanisms and treatments of disease in sub-Saharan Africa is often conducted in the most traditional and patriarchal communities. These social structures complicate such processes as gaining consent and giving participants feedback on the findings. But researchers have begun to […]
Blog: Morgan, R. (2016) Power and privilege within health policy and systems research teaching, Health Systems Global In this blog Morgan outlines the ways in which power and privilege can be manifested within the teaching of health systems research. This includes in teaching processes as well as institutions. It touches on efforts to decolonise curricula and […]
Guidelines: CCGHR Principles for Global Health Research, Canadian Coalition for Global Health Research Health inequities are often avoidable consequences of actions and contexts that disproportionately advantage some groups over others. These negatively affect human rights, including the right to health. Global health research aims to promote greater equity worldwide. The principles of Authentic Partnering, Inclusion, Shared […]
Shiffman J. (2014) Knowledge, moral claims and the exercise of power in global health, Int J Health Policy Manag. 2014 Nov; 3(6): 297–299 A number of individuals and organizations have considerable influence over the selection of global health priorities and strategies. For some that influence derives from control over financial resources. For others it comes from expertise and […]
Larson E., George A., Morgan R. and Poteat T. (2016) 10 Best resources on… intersectionality with an emphasis on low- and middle-income countries, Health Policy and Planning, Volume 31, Issue 8, 1 October 2016, Pages 964–969 Intersectionality has emerged as an important framework for understanding and responding to health inequities by making visible the fluid and interconnected structures of power […]
Wolfe R., Molyneux S., Morgan R. and Gilson L. (2017) Using Intersectionality to better understand health system resilience, Resyst In dealing with complex systems and multiple actors, operating at different levels of the health system and influenced by power relations, the research lends itself to intersectionality analysis – an approach that focuses attention on studying the interaction […]
Commentary: Beran D, Byass P, Gbakima A, Kahn K, Sankoh O, Tollman S, Witham M and Davies J (2017) Research capacity building—obligations for global health partners, The Lancet, Volume 5, No. 6, e567–e568, June 2017 This commentary argues that, “addressing the gap in research capacity in low- and middle-income countries is pivotal in ensuring broad-based systems improvement, […]
Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems
Pratt, B and Hyder A (2017) Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems, Social Science and Medicine, Volume 174, February 2017, Pages 113–121 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 […]
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 and Planning, 2016, 1–10 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, […]