Be concerned about safeguarding:
1. the scientific validity and trustworthiness of the data – through careful and deliberate training for all research staff, including fieldworkers, to equip them As with all research, it is important to take account of
with the attitudes and communication skills necessary ethical issues in conducting HPSR. Although the focus of
to conduct good quality interviews and get beyond the research differs from other health research, there are
their differences in race, class, nationality, gender or always issues of power at play between those doing the
education with respondents; and treatment of field-research and those being field-researched, and so there is real
workers as true partners in the research inquiry, potential for disrespectful and unfair treatment. Robson
recognizing their essential role in shaping the nature (2002) suggests that all ‘real world researchers’ need to
and quality of data.
watch out for the following ten questionable ethical
2. social value and a favourable risk–benefit ratio of the practices:
study – by careful consideration of the individual involving people without consent
and community-level risks and benefits of participa-coercing them to participate
tion in the study, through engagement with a range withholding information about true nature of the
of stakeholders at the start of the study and constant research
review and reflection during the study.
otherwise deceiving participants
3. informed consent and respect for participants and inducing participants to commit acts diminishing of
communities – by ensuring that all team members their self-esteem
are familiar with the study’s key messages and can violating rights of self-determination
call for assistance when unexpected ethical issues exposing participants to physical or mental stress
arise; are able to, and do, demonstrate respect for invading privacy
participants in all their engagements with commu-withholding benefits from some participants
nities; and re-negotiate relationships as and when not treating participants fairly or with respect.
necessary rather than concentrate efforts only on These are similar to the concerns of all health research. formal consent procedures (which may be infeasible The challenges may be particularly acute in cross-cultural in an HPSR study or impact negatively on the rela-research, such as when HPSR is undertaken in lower- tionships with study participants that are essential to income countries by researchers or others from higher- gathering honest information).
income settings (Molyneux et al., 2009). Thus, one of the 4. independent review – by supporting ethics commit-eight ethical principles proposed by Emanuel et al. (2004) tees to pay particular attention to the proposed for clinical research is collaborative partnership between process of research and interactions among different investigators and research sponsors in higher-income actors within HPSR work, rather than primarily exami-countries and researchers, policy-makers and commu- ning study design and tools.
nities in lower-income countries (see Box 7).
Ultimately, however, “the social relationships established However, as HPSR differs in nature from medical research,
between researchers and field-teams and community there are some particular ethical debates in, and peculiar
members, are critical to fulfilling the moral (as opposed ethical challenges for, this area of work. From reflection
to legal) aspects of ethics guidelines” (Molyneux et al., on the experience of conducting household-level HPSR
2009:324). Such relationships will always be important studies in different countries, for example, Molyneux et
in HPSR, whether the interviewees are community al. (2009) make the following four sets of proposals on
members or policy elites.
how to implement the principles of Box 7 in this form of research.
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References
Alliance for Health Policy and Systems Research (AHPSR) Gilson L, Khumalo G, Erasmus E, Mbatsha S and McIntyre (2009). Priority setting for Health Policy and Systems D (2004). Exploring the influence of workplace trust over Research. AHPSR Briefing Note 3. Geneva, World Health health worker performance: Preliminary national overview
Organization ( , report South Africa. Johannesburg: Centre for Health
accessed 22 August 2011). Policy. Unpublished report.
Bloom G, Standing H, Lloyd R (2008). Markets, informa- Gilson L et al. (2011). Building the field of health policy tion asymmetry and health care: Towards new social and systems research: social science matters. PLoS contracts. Social Science & Medicine, 66 (10):2076-2087. Medicine 8(8):e1001079.
de Savigny D, Adam T, eds (2009). Systems thinking for Green A, Bennett S, eds (2007). Sound choices:
health systems strengthening. Geneva, World Health enhancing capacity for evidence-informed health policy.
Geneva, World Health Organization.
Organization (
, accessed 10 July 2010).
Green J, Thorogood N (2009). Qualitative methods for health research. London, Sage Publications.
Emanuel E et al. (2004). What makes clinical research in developing countries ethical? The benchmarks of clinical
Henning E (2004). Finding your way in qualitative research. Journal of Infectious Diseases, 189:930–937.
research. Pretoria, Van Schaik Publishers.
Gilson L (2003). Trust and the development of health
Klopper H (2008). The qualitative research proposal.
care as a social institution. Social Science & Medicine,
Curationis. 31(4):62–72.
56(7):1453–1468.
Kutzin J (2001). A descriptive framework for country-level Gilson L, Palmer N and Schneider H. (2005) Trust and
analysis of health care financing arrangements. Health health worker performance: exploring a conceptual
Policy, 56:171–204.
framework using South African evidence. Social Science
and Medicine 61(7): 1418-1429 Mackian S, Bedri N, Lovel H (2004). Up the garden path and over the edge: where might health-seeking Gilson L, Raphaely N (2008). The terrain of health policy
behaviour take us? Health Policy and Planning, analysis in low- and middle-income countries: a review
19(3):137–46.
of published literature 1994–2007. Health Policy and
Planning, 23(5):294–307. Marchal B, Dedzo M, Kegels G (2010). A realist evalu-ation of the management of a well-performing regional hospital in Ghana. BMC Health Services Research, 10:24.
http://www.who.int/alliance-hpsr/en/
http://www.who.int/alliance-hpsr/resources /9789241563895/en/index.html
• Collaborative partnership • Social value
• Scientific validity • Fair selection of study population
• Favourable risk-benefit ratio • Independent review
• Informed consent • Respect for recruited participants and study communities
Box 7: Eight ethical principles for clinical research in low- and middle-income countries
Source: Emanuel et al., 2004
Molyneux C et al. (2009). Conducting health-related Thomas A (1998). Introduction. In: Thomas A, Chataway J, social science research in low-income settings: ethical Wuyts M, eds. Finding out fast: investigative skills for dilemmas faced in Kenya and South Africa. Journal of policy and development. London, Sage Publications:1–18.
International Development, 21(2):309–325.
Varkevisser CM, Pathmanathan I, Brownlee A (2003).
Parsons W (1995). Public policy: an introduction to Designing and conducting health systems research the theory and practice of policy analysis. Aldershot, projects: Volume 1: proposal development and fieldwork
Edward Elgar. [e-book]. Amsterdam, KIT Publishers, International
Development Research Centre ( Potter S, Subrahmanian R (1998). Information needs and
, accessed 7 July 2010).
policy change. In: Thomas A, Chataway J, Wuyts M, eds.
Finding out fast: investigative skills for policy and Walker L, Gilson L (2004). We are bitter but we are development. London, Sage Publications:19–40. satisfied: nurses as street level bureaucrats in South Africa. Social Science & Medicine, 59(6):1251–1261.
Riewpaiboon W et al. (2005). Private obstetric practice
in a public hospital: mythical trust in obstetric care. Social Walt G, Lush L, Ogden J (2004). International organ-Science & Medicine, 61(7):1408–1417. izations in transfer of infectious diseases: iterative loops
of adoption, adaptation and marketing. Governance.
Rist RC (1998). Influencing the policy process with
17(2):189–210.
qualitative research. In: Denzin NK, Lincoln YS, eds.
Collecting and interpreting qualitative materials. Walt G et al. (2008). ‘Doing’ health policy analysis:
Thousand Oaks, California, Sage Publications:400–424. methodological and conceptual reflections and challenges.
Health Policy and Planning, 23(5):308-317.
Robson C (2002). Real world research: a resource for
Yin RK (2009). Case study research: design and methods, social scientists and practitioner-researchers, 2nd ed.
Oxford, Blackwell Publishing. 4th ed. Thousand Oaks, California, Sage Publications.
Sandelowski M (2000) Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies. Research in Nursing
& Health, 23:246–255.
Schneider H (2011). Introduction to Health Systems Research and Evaluation. Masters in Public Health course power point slides. Cape Town, University of Cape Town.
Sheikh K, Porter J (2010). Discursive gaps in the imple-mentation of public health policy guidelines in India: the case of HIV testing. Social Science & Medicine, 71(11):
2005–2013.
Sheikh K et al. (2011). Building the field of health policy and systems research: framing the questions.
PLoS Medicine 8(8):e1001073.
Shiffman J (2007). Generating political priority for maternal mortality reduction in 5 developing countries.
American Journal of Public Health, 97(5):796–803.
http://www.idrc.ca/en/ev-33011-201-1-DO_TOPIC.html
Part 3
Understanding Health Policy
and Systems
As indicated in Part 1 of this Reader, a defining charac-teristic of Health Policy and Systems Research (HPSR) is
Atun R, Menabde N (2008). Health systems and that it focuses on issues or problems related to health
systems thinking. In: Coker R, Atun R, McKee M, eds.
policy and health systems rather than, for example,
Health systems and the challenge of communicable exploring particular disciplinary questions or perspectives.
diseases: experiences from Europe and Latin America.
In other words, it is the research question, or issue of
Maidenhead, Open University Press (European Observa-focus, that guides the research.
tory on Health Systems and Policies Series):121–140.
This section of the reader presents key references to two
Available at:
sets of papers that support HPSR by providing concep-tual frameworks that can inform our understanding of
Rationale for selection: Draws on system thinking issues related to health policy and systems.
perspectives.
Frenk J (2010). The Global Health System: strengthening national health systems as the next step for global progress.
These references give insight and understanding about PLoS Medicine, 7(1):1–3. Available at:
the nature of health systems.
Rationale for selection: A succinct statement of Bloom G, Standing H, Lloyd R (2008). Markets, infor- current thinking by a world leader in the field.
mation asymmetry and health care: Towards new social
World Health Organization (2007). Everybody’s business:
contracts. Social Science & Medicine, 66(10): 2076–2087
Strengthening health systems to improve health outcomes:
which recognizes the plurality of health systems
WHO’s framework for action. Geneva, World Health (i.e. the variety of providers that comprise health
Organization:iv–vii, 1–30. Available at:
systems) and the importance of understanding their institutional dynamics.
Rationale for selection: This is the most recent de Savigny D et al. (2009). Systems thinking: What it is statement of the influential World Health and what it means for health systems. In: de Savigny D, Organization framework.
Adam T, eds. Systems thinking for health systems strengthening. Geneva, World Health Organization:
37–48. Available at:
which is the most recent and more nuanced version of the World Health Organization’s building blocks approach to health systems (which focuses on the six functions of service delivery, health workforce, information, medical products, vaccines and technologies, financing, leadership/governance) - this work also seeks to understand health systems from the perspective of systems thinking.
Additional references
Health system frameworks
Two key references
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http://www.euro.who.int/__data/assets/
pdf_file/0005/98393/E91946.pdf
http://www.plosme dicine.org/article/info%3Adoi%2F10.1371%2Fjournal.
pmed.1000089
http://www.who.int/
entity/healthsystems/strategy/everybodys_business.pdf
http://www.who.int/alliance-hpsr/resources/ 9789241563895/en/index.html
Conceptual frameworks for HPSR
References
Gilson L (2003). Trust and health care as a social institution. Social Science & Medicine, 56(67):1452 –1468.
These references provide a range of conceptual
frame-Rationale for selection: highlights the importance works that can be used to guide careful and systematic
of relationships within health systems and the investigation of health policy and health systems’ issues,
institutional influences over them, and specifically and so lead to a deeper understanding of their complexity.
trust; provides concepts for understanding the nature and role of trust in health systems
Atun R et al. (2010). Integration of targeted health Kutzin J (2001). A descriptive framework for country-level interventions into health systems: a conceptual analysis of health care financing arrangements. Health framework for analysis. Health Policy and Planning, Policy, 56(3):171–204.
25(2):104–111.
Rationale for selection: conceptual framework for Rationale for selection: integration is an enduring understanding and investigating financing issues
theme in HPSR and management as part of wider system
Bossert T (1998). Analyzing the decentralization of health
Vian T (2007). Review of corruption in the health sector:
systems in developing countries: decision space,
inno-theory, methods and interventions. Health Policy and vation and performance. Social Science & Medicine,
Planning, 23(2):83–94.
47(10):1513–1527.
Rationale for selection: conceptual framework Rationale for selection: conceptual framework for
for understanding and investigating corruption, understanding and investigating health system
central to governance from decision-making authority perspective
Walt G, Gilson L (1994). Reforming the health sector in Brinkerhoff D (2004). Accountability and health systems:
developing countries: the central role of policy analysis.
toward conceptual clarity and policy relevance. Health
Health Policy and Planning, 9(4):353–370.
Policy and Planning, 19(6):371–379.
Rationale for selection: simple heuristic for under-Rationale for selection: conceptual framework for
standing influences over policy decision-making, understanding & investigating accountability
that is widely used to guide related research issues, central to governance
Franco LM, Bennett S, Kanfer R (2002). Health sector reform and public sector health worker motivation:
a conceptual framework. Social Science & Medicine, 54(8):1255–1266.
Rationale for selection: conceptual framework for understanding and investigating HR motivation and performance
http://dx.doi.org/10.1016/S0277-9536(02)00142-9
http://dx.doi.org/10.1016/S0168-8510(00)00149-4 http://dx.doi.org/10.1093/heapol/czp055
http://dx.doi.org/10.1093/heapol/czm048 http://dx.doi.org/10.1016/S0277-9536(98)00234-2
http://dx.doi.org/10.1093/heapol/9.4.353 http://dx.doi.org/10.1093/heapol/czh052
http://dx.doi.org/10.1016/S0277-9536(01)00094-6
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Part 4
Empirical Papers
Overview: research strategies and papers
Doing good quality Health Policy and Systems Research The introduction to each group of papers includes:
(HPSR) demands an understanding of what research an overview of the research strategy or approach, its strategy is appropriate to the questions of focus. The relevance to HPSR and brief clarification about how
to ensure rigour when conducting such research;
strategy is neither primarily a study design nor a method,
but instead represents an overarching approach to con- a brief description or overview of the selected papers;
ducting the research that considers the most appropriate a summary of papers with reference details, focus of the study, the perspective it takes, and the rationale methods of data collection and sampling strategy for the
for its selection in the Reader.
research purpose and questions.
A summary of the papers is given in Table 9.
The papers provided here are grouped by research strategy in order to encourage critical and creative thinking about the nature and approach of HPSR, and to stimulate new research that goes beyond the often quite descriptive cross-sectional analyses that form the bulk of currently published work in the field. The research strategies were chosen to demonstrate the breadth of HPSR work, covering both dominant and emerging approaches in the field. They are:
1. Cross-sectional perspectives 2. The case-study approach 3. The ethnographic lens 4. Advances in impact evaluation
5. Investigating policy and system change over time 6. Cross-national analysis
7. Action research
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The papers presented in this part of the Reader are examples of good quality and innovative research in the field
of health policy and systems.
Ta b le 9 O ve rv ie w o f p ap er s p re se n te d H um an r es ou rc es (in ce nt iv e pa ck ag es ) H ea lt h ec on om ic s M ic ro : H ea lt h w or ke rs • U se o f di sc re te c ho ic e ex pe rim en ts an d ec on om ic e va lu at io n • Ex am pl e of a na ly si s fo r po lic y G ov er na nc e an d fin an ci ng (p ol ic y ch an ge , he al th s ys te m s re fo rm )
Po lic y an al ys is M ac ro : N at io na l • A pp lic at io n of ‘p ol ic y- m ak er ’ i n an al ys is • Ex am pl e of a na ly si s fo r po lic y Se rv ic e de liv er y (m al ar ia c on tr ol ) Pu bl ic h ea lt h M es o an d m ic ro : Pr im ar y le ve l/c om m un ity • M ix ed -m et ho d st ud y • C on si de rs b ot h de m an d an d su pp ly is su es
B la uu w e t al ., 20 10
1. CROSS-SECTIONAL PERSPECTIVES
G la ss m an e t al ., 19 99 M or ro w e t al ., 20 09 H um an re so ur ce s (c ap ac ity d ev el op m en t) ( So ci al n et w or k an al ys is ) M ic ro : H ea lth w or ke rs • U se o f ne tw or k an al ys is a nd ex pl or at io n of s oc ia l ca pi ta l is su es R am an ad ha n et a l., 20 10 Fi na nc in g (h ou se ho ld ex pe nd it ur es ) H ea lt h ec on om ic s M ic ro : H ou se ho ld s • Se qu en ti al u se o f m et ho ds i n m ix ed - m et ho d st ud y R an so n, J ay as w al & M ill s, 2 01 1 Se rv ic e de liv er y (p ro vi de r – p at ie nt in te ra ct io ns , o bs te tr ic c ar e) So ci o lo g y/ A n th ro p o lo g y M ic ro : H os pi ta l a nd in di vi du al • Th eo ry b ui ld in g • Ex am in at io n of i ns ti tu ti on s of h ea lt h sy st em
R ie w pa ib oo n et a l., 20 05 V ac ci ne s an d se rv ic e de liv er y (im m un iz at io n pr og ra m m e, n es te d in he al th s ys te m )
( Sy st em s t hi nk in g ) M ac ro : S ys te m • R ar e ex am pl e of u se o f s ys te m s th in ki ng Rw as ha na , W ill ia m s & N ee m a, 2 00 9 G ov er na nc e an d se rv ic e de liv er y (H IV c lin ic al g ui de lin e im pl em en ta ti on ) Po lic y an al ys is M ic ro : I nd iv id ua l • D et ai le d an d th eo ry -d ri ve n ex am in at io n of d ec is io n- m ak in g Sh ei kh & P or te r, 20 10
M ul ti -c ou nt ry D om in ic an R ep ub lic V ie t N am Et hi op ia In di a Th ai la nd U ga nd a In di a
Policy/System level addressedDisciplinary perspective (or key approach)Key featuresSystem function(s) of focusPaperCountry
75 83 95 10 5 11 6 12 9 13 9 15 2
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G ov er na nc e (d ec en tr al iz at io n) A nt hr op ol og y M es o: D is tr ic ts a nd fa ci lit ie s • D is tr ic ts a s ca se s • Th eo ry b ui ld in g • Ex am in at io n of c om pl ex c au sa lit y Fi na nc in g (p riv at e in su ra nc e) So ci ol og y C ro ss -l ev el • In te gr at ed a na ly si s of p ol ic y ch an ge ac ro ss s ys te m la ye rs H ea lth in fo rm at io n an d go ve rn an ce (d ec is io n- m ak in g at d is tr ic t le ve l)
M an ag em en t M es o: D is tr ic t • Ex pl or at or y ca se a na ly si s
A tk in so n et a l., 20 00
2. THE CASE STUDY APPROACH
M ur ra y & E ls to n, 20 05 M ut em w a, 20 05 H um an re so ur ce s (p riv at e se ct or ) So ci ol og y M es o: D is tr ic t an d fa ci lit y • St ro ng e xa m pl e of a na ly si s in c as e st ud y w or k • A na ly si s fo r po lic y
R ol fe e t al ., 20 08 Fi na nc in g (h ou se ho ld ex pe nd it ur e) D ev el op m en t ec on om ic s M ic ro : H ou se ho ld s • U se o f lo ng it ud in al h ou se ho ld c as es • Ex am in at io n of c om pl ex c au sa lit y R us se ll & G ils on , 20 06 G ov er na nc e (p ol ic y ch an ge , S af e M ot he r- ho od In iti at iv e)
Po lic y an al ys is M ac ro : N at io na l/g lo ba l • U se o f th eo ry a nd g en er at io n of qu es ti on s fr om a na ly si s Sh iff m an , S ta nt on & S al az ar , 2 00 4 H um an r es ou rc es (t ra in in g pr og ra m m es ) A nt hr op ol og y/ So ci ol og y M ic ro : H ea lth w or ke rs • Th eo ry b ui ld in g A itk en , 1 99 4 G ov er na nc e an d se rv ic e de liv er y (d eb at es a bo ut ap pr oa ch es to m at er na l he al th c ar e pr ov is io n, an d ev id en ce -b as ed po lic y- m ak in g) A nt hr op ol og y/ So ci ol og y M ac ro : G lo ba l d eb at es • D is co ur se a na ly si s B eh ag ue & St or en g, 2 00 8
B ra zi l C hi le Za m bi a U ni te d R ep ub lic o f Ta nz an ia Sr i L an ka H on du ra s N ep al N /A
3. THE ETHNOGRAPHIC LENS
Policy/System level addressedDisciplinary perspective (or key approach)Key featuresSystem function(s) of focusPaperCountry
16 6 18 4 19 7 21 0 22 3 23 9
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H um an re so ur ce s an d go ve rn an ce (m an ag e- m en t, ac co un ta bi lit y) A nt hr op ol og y/ So ci ol og y M ic ro : H ea lth w or ke r– su pe rv is or in te ra ct io ns an d in flu en ce s
• R ic h an al ys is o f k ey h ea lt h sy st em fu nc ti on s G eo rg e, 20 09 Se rv ic e de liv er y (p rim ar y ca re c lin ic ) A nt hr op ol og y/ So ci ol og y M ic ro : C lin ic , p ro vi de r– pa ti en t in te ra ct io ns • U se o f co nc ep ts • Pr og ra m m e an d fa ci lit y fo cu s Le w in & G re en , 20 09
In di a So ut h A fr ic a
3. THE ETHNOGRAPHIC LENS (CONTINUED)
G ov er na nc e (c om m un ity ac co un ta bi lit y m ec ha ni sm ) H ea lt h ec on om ic s M es o: F ac ili ty /c om m un ity • Q ua si e xp er im en ta l ev al ua ti on • U nu su al fo cu s fo r t hi s ev al ua tio n ap pr oa ch B jö rk m an & Sv en ss on , 2 00 9 U ga nd a
4. ADVANCES IN IMPACT EVALUATION
Se rv ic e de liv er y (p ri m ar y ca re m od el ) Ep id em io lo gy M ac ro : N at io na l • Ec ol og ic al a na ly si s us in g av ai la bl e pa ne l da ta M ac in ko e t al ., 20 07 B ra zi l H um an re so ur ce s (m an ag em en t) ( Po lic y ev al ua tio n/ C rit ic al re al is m ) M es o: F ac ili ty • R ar e ex am pl e of c rit ic al re al is t ev al ua tio n M ar ch al , D ed zo & K eg el s, 2 01 0 G ha na Fi na nc in g (c om m un it y- ba se d he al th in su ra nc e) H ea lt h ec on om ic s M ic ro : H ou se ho ld • U nu su al q ua si -e xp er im en ta l e va lu at io n, us in g pr op en si ty m at ch in g sc or es W an g et a l., 20 09 C hi na G ov er na nc e (g lo ba l or ga ni za ti on s an d di sc ou rs e) H is to ry M ac ro : G lo ba l • H is to ri ca l an al ys is • G lo ba l o rg an iz at io n fo cu s B ro w n, C ue to & F ee , 2 00 6 N /A
5. INVESTIGATING POLICY AND SYSTEM CHANGE OVER TIME
G ov er na nc e an d se rv ic e de liv er y (p ol ic y ch an ge , fa m ily p la nn in g)
Po lic y an al ys is M ac ro : N at io na l • U se o f th eo ry C ri ch to n, 20 08 Ke ny a Se rv ic e de liv er y (c hi ld m or ta lit y tr en ds a nd ex pl an at io ns ) Ep id em io lo gy M ac ro : S ys te m • R ic h tr en d an al ys is w it h ex pl an at io n ar ou nd s ys te m d ev el op m en t M as an ja e t al ., 20 08 U ni te d R ep ub lic o f Ta nz an ia
Policy/System level addressedDisciplinary perspective (or key approach)Key featuresSystem function(s) of focusPaperCountry
32 0 33 1 34 3
24 5 25 7 29 2 30 3
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Policy/System level addressedDisciplinary perspective (or key approach)Key featuresSystem function(s) of focusPaper
H um an r es ou rc es (c om m un it y he al th w or ke rs ) H is to ry M ac ro : N at io na l • H is to ri ca l an al ys is • U nu su al u se o f w itn es s se m in ar s V an G in ne ke n, Le w in & B er ri dg e, 20 10
5. INVESTIGATING POLICY AND SYSTEM CHANGE OVER TIME (CONTINUED)
Se rv ic e de liv er y (In te - gr at ed M an ag em en t of C hi ld ho od Il ln es s ap pr oa ch )
Ep id em io lo gy M es o: D is tr ic ts a nd fa ci lit ie s • Se m in al p ap er • C ar ef ul s ys te m e va lu at io n B ry ce e t al ., 20 05 G ov er na nc e an d fin an ci ng (im pl em en tin g po lic y ch an ge , B am ak o In iti at iv e co m m un ity fi na nc in g sc he m es ) Po lic y an al ys is C ro ss -le ve l • C on ce pt ua l f ra m ew or k us ed t o gu id e st ud y • O pp or tu ni st ic c ou nt ry c as es s el ec te d • Ex pl an at or y fo cu s
G ils on e t al ., 20 01
6. CROSS-NATIONAL ANALYSIS
G ov er na nc e an d se rv ic e de liv er y (s us ta in in g fa m ily p la nn in g po lic y im pl em en ta ti on )
Po lic y an al ys is M ac ro : N at io na l • D el ib er at e co un tr y ca se s se le ct ed • C ar ef ul a na ly si s • Ex pl an at or y fo cu s
Le e et a l., 19 98 Fi na nc in g (p ub lic sp en di ng in ci de nc e) H ea lt h ec on om ic s M ac ro : N at io na l • R ig or ou s cr os s- co un tr y an al ys is , w it h ex pl an at io n O ’D on ne ll et a l., 20 07 H ea lt h In fo rm at io n (h os pi ta l r ec or ds sy st em )
A ct io n re se ar ch M es o: H os pi ta l • R ar e ap pl ic at io n of r es ea rc h st ra te gy K hr es he h & B ar cl ay , 2 00 7 H ea lth In fo rm at io n (h os pi ta l r ec or ds sy st em ) A ct io n re se ar ch M es o: H os pi ta l • A cc ou nt o f ac ti on r es ea rc h K hr es he h & B ar cl ay , 2 00 8
7. ACTION RESEARCH
Country
So ut h A fr ic a M ul ti -c ou nt ry M ul ti -c ou nt ry M ul ti -c ou nt ry M ul ti -c ou nt ry Jo rd an Jo rd an
35 1 36 3 36 9
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40 0 41 1 44 5 46 1
1. Cross-sectional perspectives
Rigour in cross-sectional studies
To extend the analysis and interpretation, different studies may be triangulated to provide different perspectives on the same question or may answer different kinds of questions (for example ‘what’
versus ‘why’ questions).
Helen Schneider
Depending on the purpose, data collection in mixed-University of the Western Cape, South Africa
method studies can be either concurrent or sequential
and (Creswell & Plano-Clark, 2007).
Sara Bennett
The findings of such studies often involve what can be Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, United States of America described as a ‘bricolage’, a “pieced together close-knit set of practices that provide solutions to a problem Cross-sectional studies may seek to explore, describe or
in a concrete situation” (Denzin & Lincoln, 1998:3).
explain a phenomenon at a particular moment in time
The study components provide different insights into a (see Part 2: Step 2 of this Reader). This distinguishes
phenomenon and are combined as pieces in a puzzle to them from longitudinal and other studies which describe
explain the phenomenon of focus.
or analyse change over time, and experimental studies which involve interventions. As cross-sectional studies generally require fewer resources than other research strategies, they are the most frequently performed and reported type of research in HPSR.
As with other research strategies, research validity/
Cross-sectional studies encompass a wide universe of
trustworthiness and reliability are important in cross disciplinary perspectives and methods from both the
sectional studies, whether from the fixed or flexible fixed and flexible research traditions. They range from
traditions. Such concerns are especially important in single to mixed (quantitative and qualitative) and
multi-HPSR seeking to shed light on the complex dynamics and method forms of data collection (when the phasing of
relationships between system actors and dimensions (see fixed and flexible research designs allows triangulation
Part 2: Step 1).
from one data collection approach to inform the other
The validity of cross-sectional studies may be undermined
The validity of cross-sectional studies may be undermined
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Health Policy and Systems Research
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