+ All Categories
Home > Documents > Click to add presenter’s name Health Economics Unit University of Cape Town Click to add...

Click to add presenter’s name Health Economics Unit University of Cape Town Click to add...

Date post: 17-Dec-2015
Category:

Documents
Upload: gyles-pierce
View: 214 times
Download: 1 times
Download Report this document
Share this document with a friend
Popular Tags:
system professor lucy
power professor lucy
field professor lucy
terrain professor lucy
health systems policies
health policies
health systems important
health policy focus
30
Recognising the range of questions and methodological approaches in HPSR Lucy Gilson University of Cape Town and London School of Hygiene and Tropical Medicine Professor Lucy Gilson, 14 Dec 2011
Transcript
Page 1: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Recognising the range of questions and methodological approaches in

HPSR

Lucy Gilson University of Cape Town and London

School of Hygiene and Tropical Medicine

Professor Lucy Gilson, 14 Dec 2011

Page 2: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

HPSR

• The terrain• The diversity• Developing the field• Funding development of the field

Professor Lucy Gilson, 14 Dec 2011

Page 3: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Professor Lucy Gilson, 14 Dec 2011

Page 4: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

THE TERRAIN

Professor Lucy Gilson, 14 Dec 2011

Page 5: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

HPSR seeks to understand

• what health systems are & how they function• what needs to be done to strengthen them• how to influence policy agendas on health

system development• how to develop and implement policies in

ways that strengthen health systems

Professor Lucy Gilson, 14 Dec 2011

Page 6: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Constraint Disease-programme issues Health system issues

Poorly motivated staff

Financial incentives to reward delivery of particular priority services

Institution of proper performance review systems Creating greater clarity of roles and expectations regarding performance of roles Review of salary structures and promotion procedures

Goes beyond assessing & strengthening dedicated disease/condition specific programmes

Travis et al. 2004Professor Lucy Gilson, 14 Dec 2011

Page 7: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Why include health policy focus?

• Health policies are deliberate actions to strengthen health systems

• Policies become effective– if there is enough political support AND– if they take root within health systems

• Important to understand – the politics of influencing policy agendas– the organizational dynamics of health systems

Professor Lucy Gilson, 14 Dec 2011

Page 8: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Health policy

• Not just an output of decision making but rather the entire process of decision-making

• Encompasses the– formal documents, guidelines and rules– the decision-making practices of the full range of

policy actors• that translate the documents into policy-as-

experienced

• Analysis focuses on people, processes, power Professor Lucy Gilson, 14 Dec 2011

Page 9: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Health systems are dynamic & interconnected systems at whose heart are people

People

governance

Information

financing

service delivery

human resources

medicines &

technology

De Savigny & Adams, 2009

‘It is the multiple relationships and interactions among the building blocks ... that convert these blocks into a system’

Professor Lucy Gilson, 14 Dec 2011

Page 10: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Health Policy:

Content & Instruments

Actors, Power & Politics

Institutions, Interests & Ideas

Health Systems:

Hardware: Structure; Organisation; Technology; Resourcing

Software: Actors & Relationships; Values; Norms

Policy Change

&

Health System Development

Global & National forces

Scope of HPSR

Professor Lucy Gilson, 14 Dec 2011

Page 11: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

THE DIVERSITY OF HPSR

Professor Lucy Gilson, 14 Dec 2011

Page 12: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Different perspectives

Epidemiology& Clinical Sciences

Policy & Practice

Social Sciences

HPSR

Professor Lucy Gilson, 14 Dec 2011

Page 13: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

What are health systems?

Machine-like organisations which can be controlled from the top through rules and incentives

Complex social and political phenomena, constructed

through human action

Professor Lucy Gilson, 14 Dec 2011

Page 14: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

What is the nature of the social reality being investigated?

Epidemiology/Clinical science: There are a set of facts to be gathered (one reality)

Social science: Reality is

constructed by actors drawing

on their ‘contexts’ (different

parallel realities)

Positivism Relativism

Professor Lucy Gilson, 14 Dec 2011

Page 15: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Purposes of research & related questions

• Normative/evaluative

• Exploratory/ explanatory

• What interventions work best?

• What works for whom under what circumstances?

• What are the social processes, including power relations, influencing actors’ understandings and experiences, and shaping impacts of interventions?

Professor Lucy Gilson, 14 Dec 2011

Page 16: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Knowledge paradigm

-------------------------------------------------------------------------Positivism Critical Realism Relativism (interpretivism /

social constructionism)

Types of questions addressed

Is the policy or intervention effective/cost-effective?

What works for whom under which conditions?

What are the social processes, including power relations, influencing actors’ understandings and experiences?

Key research approaches and methods

Deductive: Hypothesis driven

Emphasis on measurement through surveys, data records & Statistical analysis; some qualitative data

Deductive and inductive : theory testing & building

Multiple data collection methods; Mixed method studies

Inductive: theory building & testing

Emphasis on qualitative data collection approaches & Interpretive analysis

Professor Lucy Gilson, 14 Dec 2011

Page 17: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Ensuring rigour

Positivist: Validity &

reliability of data &

analysis

Relativist: Trustworthi

ness of interpretive judgements

Professor Lucy Gilson, 14 Dec 2011

Page 18: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

DEVELOPING THE FIELD

Professor Lucy Gilson, 14 Dec 2011

Page 19: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

The value of combining perspectives

Assessing household level impacts of user fees

Survey data & statistical analysis: What is the impact of out of pocket payments on household poverty levels across countries?

Qualitative, longitudinal household case studies: How do out of pocket payments combine with other influences over health seeking behavior to impact on the dynamics of household poverty?

Professor Lucy Gilson, 14 Dec 2011

Page 20: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Balance in questions asked

• Past emphasis on normative/evaluative work and ‘generalizable’ answers

• More work on exploratory & explanatory questions considering socio-cultural-political constructions of health systems (not just health)

Sheikh et al. 2011

Professor Lucy Gilson, 14 Dec 2011

Page 21: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

In HPSR

• Value the range of perspectives and questions• No hierarchy of method

Professor Lucy Gilson, 14 Dec 2011

Page 22: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Strengthening study design

1. Research focus identified from understanding of

– local context AND relevant literature AND relevant theory

2. Clear, answerable research questions3. Question-driven research strategy4. Approaches to ensuring research rigour that

are relevant to strategy chosen5. Apply ethical principles

Professor Lucy Gilson, 14 Dec 2011

Page 23: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

From RQ to research strategy (Yin 2009)

Form of RQ Requires behavioural control of events?

Focus on contemporary events?

Research strategy

Who, what, where, how many, how much?

No Yes Survey

Who, what, where, how many, how much?

No Yes/no Archival analysis

How, why? Yes Yes ExperimentHow, why? No No HistoryHow, why? No Yes Case study

Professor Lucy Gilson, 14 Dec 2011

Page 24: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

The value of mixed method studies

• Deliberately combine strategies to expand the scope of studies, and deepen insights e.g:– initial small-scale intensive study to develop

detailed understanding of a phenomenon, followed by larger-scale structured survey to generate more extensive understanding of the same phenomenon, using tool developed from the initial study.

•

Professor Lucy Gilson, 14 Dec 2011

Page 25: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Ensuring rigour in HPSR

• An active process of questioning and checking during the inquiry

• A constant process of conceptualizing and reconceptualizing

• Crafting, trustworthy interpretive judgements • Researcher reflexivity

Professor Lucy Gilson, 14 Dec 2011

Page 26: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Procedural steps in building trustworthiness

• Prolonged engagement• Use of theory• Case selection:

– Purposive selection to allow prior theory and initial assumptions to be tested or to examine ‘average’ or unusual experience

• Sampling– Of people, places, times etc, to include as many as possible of the factors that might

influence the behavior of those people central to the topic of focus– Gather views from wide range of respondents

• Multiple methods (case studies)• Triangulation • Negative case analysis• Peer debriefing and support• Respondent validation (Member checking)• Clear report of methods of data collection and analysis (Audit trail)

Professor Lucy Gilson, 14 Dec 2011

Page 27: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

FUNDING HPSR DEVELOPMENT

Professor Lucy Gilson, 14 Dec 2011

Page 28: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Critical elements

• Long term, large-scale funding for research programmes– focused on particular contexts/systems & driven by

questions; combining empirical, methodological & conceptual work; linked to educational programmes

• Multi-disciplinary research teams, working collaboratively with other health system actors

• Opportunities for cross-national work and learning

Professor Lucy Gilson, 14 Dec 2011

Page 29: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Working across capacity dimensions

Professor Lucy Gilson, 14 Dec 2011

Page 30: Click to add presenter’s name Health Economics Unit University of Cape Town Click to add conference title Click to add conference date & venue Recognising.

Thank youwww.heu-uct.org.za

Professor Lucy Gilson, 14 Dec 2011


Recommended
Click to add subtitle

Click to add subtitle

Documents

Schools + School Nurses = Safe and Healthy Students Add Presenter’s name and credentials here.

Schools + School Nurses = Safe and Healthy Students Add Presenter’s name and credentials here.

Documents

Click to add Title Comunicación y Gerencia Click To add Subtitle Click to add Text Fundamentals of Assembly Language.

Click to add Title Comunicación y Gerencia Click To add Subtitle Click to add Text Fundamentals of Assembly Language.

Documents

LOGO PowerPoint Template . Company Name Contents 1. Click to add Title 2. Click to add Title 3. Click to add Title 4. Click to add.

LOGO PowerPoint Template . Company Name Contents 1. Click to add Title 2. Click to add Title 3. Click to add Title 4. Click to add.

Documents

Click to add presenter’s name Symantec Backup Exec™ 2010: Protect More, Store Less, Save More 1 Deduplication Everywhere, Unified Archiving. Virtualize.

Click to add presenter’s name Symantec Backup Exec™ 2010: Protect More, Store Less, Save More 1 Deduplication Everywhere, Unified Archiving. Virtualize.

Documents

Working in Partnership with Click to add Peter … files/FNMHF.pdf · ©2008 FNMHF 1 Click to add title Click to add First Nation Click to add date 1 AFOA Saskatchewan Band Managers

Working in Partnership with Click to add Peter … files/FNMHF.pdf · ©2008 FNMHF 1 Click to add title Click to add First Nation Click to add date 1 AFOA Saskatchewan Band Managers

Documents

Click here to add text Click here to add text. The Short Story 1.

Click here to add text Click here to add text. The Short Story 1.

Documents

Click to add title Click to add subtitle. Waste Doesn’t Go Away !

Click to add title Click to add subtitle. Waste Doesn’t Go Away !

Documents

Click to add presenter’s name Click to add date Click to add venue Click to add presenter’s job title.

Click to add presenter’s name Click to add date Click to add venue Click to add presenter’s job title.

Documents

Click here to add text Click here to add text.. Click here to add text Click here to add text. God can use me? Church of Christ at MedinaJuly 14 th, 2013.

Click here to add text Click here to add text.. Click here to add text Click here to add text. God can use me? Church of Christ at MedinaJuly 14 th, 2013.

Documents

A connected University Presenter’s Name Add Date using Insert | Header & Footer.

A connected University Presenter’s Name Add Date using Insert | Header & Footer.

Documents

CLICK TO ADD TITLE

CLICK TO ADD TITLE

Documents

Anatomy of an Interper 2013 - ohsdebateteam.weebly.com€¦ · Click here to add text Click here to add text. Click here to add text. Click here to add text. Click here to add text.

Anatomy of an Interper 2013 - ohsdebateteam.weebly.com€¦ · Click here to add text Click here to add text. Click here to add text. Click here to add text. Click here to add text.

Documents

Beginning September 13 Fall Teaching Series. CLICK HERE TO ADD TITLE CLICK HERE TO ADD SUBTITLE Click here to add text. Click here to add text. Click.

Beginning September 13 Fall Teaching Series. CLICK HERE TO ADD TITLE CLICK HERE TO ADD SUBTITLE Click here to add text. Click here to add text. Click.

Documents

แผนก :. Contents Click to add Title 1. Click to add Title 2. Click to add Title 3. Click to add Title 4.

แผนก :. Contents Click to add Title 1. Click to add Title 2. Click to add Title 3. Click to add Title 4.

Documents

Click to edit text Presentation Title Presenter’s name Presenter’s Title Date Be Efficient – Accurate – Connected™

Click to edit text Presentation Title Presenter’s name Presenter’s Title Date Be Efficient – Accurate – Connected™

Documents

HEADLINE TEXT HERE Click here to add text. Click here to add text. Click here to add text. Click here to add text. Click here to add text. Click here to.

HEADLINE TEXT HERE Click here to add text. Click here to add text. Click here to add text. Click here to add text. Click here to add text. Click here to.

Documents

L o g o PowerPoint Template. Company Logo Contents 1. Click to add Title 2. Click to add Title 3. Click to add Title 4. Click to add Title 5. Click to.

L o g o PowerPoint Template. Company Logo Contents 1. Click to add Title 2. Click to add Title 3. Click to add Title 4. Click to add Title 5. Click to.

Documents