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Ethics

The ethics of health systems research theme considers the unique ethical challenges associated with long-term research engagement in low- and middle-income countries.


Research questions

  • What are some of the unique ethical challenges when working to reshape health systems in low-and middle-income countries?
  • Does health systems research offer unique ethical dilemmas and require different approaches to ethical review?
  • How do long-term research partnerships with communities and organizations effect the moral obligations of researchers and institutions?

Given the broad-ranging work of FHS in exploring areas of innovation for health systems improvement, thinking through these ethical questions is central to our efforts. It is also important to ensure that we work toward our goals of improved health access and outcomes in a manner consistent with our mission and organisational values.

The FHS Ethics Working Group is dedicated to exploring these ethical questions through engagement with partners, conceptual analysis, and empirical research. 


Recent FHS publications on ethics

Publications

MacGregor H and Bloom G (2016) Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale, Developing World Bioethics, 16(3): 158–167, doi:10.1111/dewb.12115

This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes.

Pratt B, Allen KA and Hyder AA (2016) Promoting equity through health systems research in low- and middle-income countries: Practices of researchers, AJOB Empirical Bioethics, Volume 7, Issue 3, DOI:10.1080/23294515.2015.1122669

Health systems research is increasingly identified as an indispensable means to achieve the goal of health equity between and within countries. While conceptual work has explored what form of health systems research in low and middle-income countries (LMICs) is needed to promote health equity, there have been few attempts to investigate whether it is being performed in practice. This paper describes the results of a survey undertaken with health systems researchers worldwide to assess how equity-oriented current practice is in LMICs.

Pratt B and Hyder AA (2017) Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems, Social Science and Medicine, Volume 174, Pages 113–121, DOI: 10.1016/j.socscimed.2016.11.039

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 that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda.

Pratt B and Hyder AA (2016) How can health systems research reach the worst-off? A conceptual exploration, BMC Health Services Research 16:1868, DOI: 10.1186/s12913-016-1868-6

Health systems research is increasingly being conducted in low and middle-income countries (LMICs). Such research should aim to reduce health disparities between and within countries as a matter of global justice. For such research to do so, ethical guidance that is consistent with egalitarian theories of social justice proposes it ought to (amongst other things) focus on worst-off countries and research populations. Yet who constitutes the worst-off is not well-defined.

Pratt B, Merritt M and Hyder AA (2016) Towards deep inclusion for equity-oriented health research priority-setting: A working model, Social Science and Medicine, vol 151, pp 215-224, doi:10.1016/j.socscimed.2016.01.018

Growing consensus that health research funders should align their investments with national research priorities presupposes that such national priorities exist and are just. Arguably, justice requires national health research priority-setting to promote health equity. Such a position is consistent with recommendations made by the World Health Organization and at global ministerial summits that health research should serve to reduce health inequalities between and within countries. Thus far, no specific requirements for equity-oriented research priority-setting have been described to guide policymakers. As a step towards the explication and defence of such requirements, we propose that deep inclusion is a key procedural component of equity-oriented research priority-setting.

Pratt B, Allen KA and Hyder AA (2016) Health Systems Research Consortia and the Promotion of Health Equity in Low and Middle-Income Countries, Developing World Bioethics, doi: 10.1111/dewb.12116

Recent conceptual work has explored what features might be necessary for health systems research consortia and their research programs to promote health equity. Identified features include selecting research priorities that focus on improving access to high-quality health services and/or financial protection for disadvantaged populations in LMICs and conducting research capacity strengthening that promotes the independent conduct of health systems research in LMICs. Yet, there has been no attempt to investigate whether existing consortia have such characteristics. This paper describes the results of a survey undertaken with health systems research consortia leaders worldwide to assess how consistent current practice is with the proposed ethical guidance.

Pratt B, Allen K A, Hyder A A (2015) Promoting equity through health systems research in low and middle-income countries: Practices of researchers, AJOB Empirical Bioethics, doi:10.1080/23294515.2015.1122669

Health systems research is increasingly identified as an indispensable means to achieve the goal of health equity between and within countries. While conceptual work has explored what form of health systems research in low and middle-income countries (LMICs) is needed to promote health equity, there have been few attempts to investigate whether it is being performed in practice. This paper describes the results of a survey undertaken with health systems researchers worldwide to assess how equity-oriented current practice is in LMICs.

The use of mHealth interventions within health systems research is increasing, with few taking into account the connections between gender and mHealth.

This policy brief attempts to fill this gap by exploring key connections between mHealth and gender that need to be taken into account when conducting or implementing mHealth research and interventions.