Building the Field of Health Policy and Systems Research: Framing the Questions

Abstract

The field of Health Policy and Systems Research (HPSR) is currently experiencing an unprecedented level of interest. The First Global Symposium on Health Systems Research, held in Montreux, Switzerland, in November 2010, is the most recent of a succession of conferences and task force deliberations that have spun off a series of debates about the nature of the field and the future directions it should take. Establishing the identity and terrain of HPSR is part of these debates, which is made difficult by the fact that it is an essentially multidisciplinary field delimited not by methodology but by the topic and scope of research questions asked. In this paper, the first of a series of three addressing the current challenges and opportunities for the development of HPSR, we introduce and map the types of research questions that it has addressed over its natural course of evolution, analyze the nature of current heightened attention, and highlight emerging opportunities and challenges for the development of the field. We use the extended term Health Policy and Systems Research for a field that is often referred to simply as Health Systems Research. For us, the broader term better captures the terrain of work it encompasses because it explicitly identifies the interconnections between policy and systems, and highlights the social and political nature of the field. The geographical focus of our concern is low- and middle-income countries (LMICs) [1], but we suggest that our approach also has value for high-income countries. Our understanding of the evolution of HPSR draws primarily from the English language literature, which we acknowledge as a limitation. However, this reflects global discussion about the field, which has tended to neglect literature in other languages.