23/01/2023

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BU5594: Health Policy and

Systems Research (HPSR)
Week 1Re-convene 17:10h

Lucia D’Ambruoso BSc (Hons) MSc PhD PhD FHEA FRSPH

Senior Lecturer School of Medicine Medical Sciences and Nutrition

Overview (Tutorial)

17:00 – 18:00 Tutorial

a/ Recap 10 mins
b/ Group work 20 mins
c/ Plenary 30 mins

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a/ Lecture recap

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Health systems

“A system is not the sum of its

parts, it is the product of the
interaction of its parts” (de
Savigny and Adam 2009)
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Source: WHO

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Health policy
• No single accepted definition
• Working definition ‘the sum total of government
action, from signals of intent to the final
outcomes’
• Important qualifications:
a) it is problematic to conflate what people say
they will do + what they actually do;
b) a policy outcome can be very different from
the intention;
c) policy is made routinely through cooperation
between elected and unelected policymakers
and actors with no formal role in the process;
d) policymaking is also about the power not to
do something
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Bringing health policy and systems together

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Source: Sheikh et al 2011

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Understanding the social and political

complexities of health systems

• HPSR draws on many disciplinary perspectives embracing

a range of perspectives on social and political reality
• Complex causality, comparative analysis
• Engaged, work-based, embedded approach to promoting
learning in and from research
• Acknowledgement that research influenced by
researcher’s view of truth and knowledge
• Consider, develop, acknowledge your worldview!

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HSG Introduction to HPSR: https://healthsystemsresearch.org/hsr2018/news/looking-

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introduction-health-policy-systems-research-start/

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Freedman: Health systems as core social institutions

Human security is a
paradigm for understanding
global vulnerabilities whose
proponents challenges the
traditional notion of national
security through military
security by arguing that the
proper referent for security
should be at the human rather
than national level
Human rights are rights we
have simply because we
exist as human beings -
they are not granted by any
state. These universal rights
are inherent to us al
Globalization is the
process of interaction and
“…we have a chance to push integration among people,
companies, and
past the conventional target- governments worldwide.
based public health approach
and to re-ground health policy
Equity recognizes that
in the most critical debates of each person has different
the day, including circumstances and
globalisation, human security, allocates the exact
equity, human rights, and resources and opportunities
needed to reach an equal
poverty reduction” outcome
Poverty reduction, poverty relief, or poverty alleviation,
is a set of measures, both economic and humanitarian, that
are intended to permanently lift people out of poverty.

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Freedman: Health systems as core social institutions

“Poverty is not just a state of being. Poverty is
also fundamentally relational. It concerns the
interaction between individuals/communities
and structures of power…The experience of
poverty goes beyond the lack of material
goods or the state of poor physical health.
Rather the experience of poverty is profoundly
marked by exclusion, marginalisation,
neglect, and voicelessness. These dynamics in
themselves must be understood as critical
dimensions of poverty”

“When access to health care depends on the

Image credit: Foreign Policy. Image
ability to mobilize cash resources, then it caption: A settlement is seen against
explicitly legitimates exclusion of the poor” the skyline of Manila’s financial district
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Any questions?

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b/ Group activity

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Group work (20 mins)

• Assigned to small groups and will discuss the tutorial readings

• Nominate chairperson and scribe, work through study questions

• Chairpersons use prompts to structure discussion within time
available, guiding discussion and agreeing summary with group
• Rapporteurs record the discussion and present short summary
of the papers, and discussion, to the rest of the class in plenary

• Generate a short (5-minute) summary of your discussion to present

to the class in plenary

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Exchange! 20 mins

• What is a health system? Why is it important to society?

• Discuss/compare health systems in your own country/profession
• What are the strengths and weaknesses of systems thinking?

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c/ Plenary – 30 mins

• What is a health system? Why is it important to society?

• Discuss/compare health systems in your own country/profession
• What are the strengths and weaknesses of systems thinking?

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