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Publications

Filtering by Tag: Adnan Hyder

Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship

Future Health Systems

Pratt B and Hyder AA (2017) Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship, Bioethics,31(6):454-466, DOI: 10.1111/bioe.12350

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non-domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients.

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Building the field: ethics in health systems research

Future Health Systems

Members of the Future Health Systems (FHS) consortium have spearheaded important and previously unexplored work on the ethics of health systems research (HSR). FHS has contributed empirical knowledge on understanding how researchers are dealing with the ethics of HSR on the ground, as well as conceptual thinking, including exploring issues of justice, health capabilities, and responsiveness. The work has engaged new actors, built a movement of parties interested in the issues, and influenced the agendas of global institutions such as the World Health Organization.

Promoting equity through health systems research in low- and middle-income countries: Practices of researchers

Future Health Systems

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.

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Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems

Future Health Systems

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.

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Designing research funding schemes to promote global health equity: An exploration of current practice in health systems research

Future Health Systems

Pratt B and Hyder AA (2016) Designing research funding schemes to promote global health equity: An exploration of current practice in health systems research, Developing World Bioethics, DOI: 10.1111/dewb.12136

International research is an essential means of reducing health disparities between and within countries and should do so as a matter of global justice. Research funders from high-income countries have an obligation of justice to support health research in low and middle-income countries (LMICs) that furthers such objectives. This paper investigates how their current funding schemes are designed to incentivise health systems research in LMICs that promotes health equity.

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How can health systems research reach the worst-off? A conceptual exploration

Future Health Systems

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.

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Towards deep inclusion for equity-oriented health research priority-setting: A working model

Future Health Systems

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.

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Health Systems Research Consortia and the Promotion of Health Equity in Low and Middle-Income Countries

Future Health Systems

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.

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Promoting equity through health systems research in low and middle-income countries: Practices of researchers

Future Health Systems

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.

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Global Justice and Health Systems Research in Low- and Middle-Income Countries

Future Health Systems

Pratt, B. and Hyder, A. A. (2015), Global Justice and Health Systems Research in Low- and Middle-Income Countries. The Journal of Law, Medicine & Ethics, 43: 143–161. doi: 10.1111/jlme.12202

Scholarship focusing on how international research can contribute to justice in global health has primarily explored requirements for the conduct of clinical trials. Yet health systems research in low- and middle-income countries (LMICs) has increasingly been identified as vital to the reduction of health disparities between and within countries. This paper expands an existing ethical framework based on the health capability paradigm – research for health justice – to externally-funded health systems research in LMICs. It argues that a specific form of health systems research in LMICs is required if the enterprise is to advance global health equity. “Research for health justice” requirements for priority setting, research capacity strengthening, and post-study benefits in health systems research are derived in light of the field's distinctive characteristics. Specific obligations are established for external research actors, including governments, funders, sponsors, and investigators. How these framework requirements differ from those for international clinical research is discussed.

Applying a Global Justice Lens to Health Systems Research Ethics: An Initial Exploration

Future Health Systems

B. Pratt and A. A. Hyder (2015) Applying a Global Justice Lens to Health Systems Research Ethics: An Initial Exploration, Kennedy Institute of Ethics Journal, Volume 25, Number 1, March 2015, pp. 35-66, DOI: 10.1353/ken.2015.0005

Health systems research is increasingly being performed in low and middle income countries and is essential to reducing global health disparities. This paper provides an initial description of the ethical issues related to priority setting, capacity-building, and the provision of post-study benefits that arise during the conduct of such research. It presents a selection of issues discussed in the health systems research literature and argues that they constitute ethical concerns based on their being inconsistent with a particular theory of global justice (the health capability paradigm).

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A bioethical framework for health systems activity: a conceptual exploration applying ‘systems thinking’

Future Health Systems

Recognizing that the health system is a complex and dynamic network of actors and activities, this paper seeks to push the field of bioethics to develop a more holistic approach from the health systems perspective. Expanding upon the work of existing public health frameworks and drawing upon concepts from related areas such as governance, human rights, and organizational ethics, our provisional list of ethical considerations for health systems fall under the following categories: Holism, Sustainability, Evidence & Effectiveness, Efficiency, Public Engagement & Transparency, Accountability & Feedback, Equity & Empowerment, Justice & Fairness, Responsiveness, Collaboration, and Quality.

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Stakeholder Analysis for a Maternal and Newborn Health Project in Eastern Uganda

Future Health Systems

Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders’ interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country.
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Exploring the Ethics of Long-Term Research Engagement With Communities in Low- and Middle-Income Countries

Future Health Systems

Over the past few decades, there has been increasing attention focused on the ethics of health research, particularly in low- and middle-income countries. Despite the increasing focus on the literature addressing human protection, community engagement, appropriate consent procedures and ways to mitigate concerns around exploitation, there has been little discussion about how the duration of the research engagement may affect the ethical design and implementation of studies. In other words, what are the unique ethical challenges when researchers engage with host communities for longer periods (10 years or more), and what special considerations does this time commitment generate when applying ethical principles to these kinds of studies? This article begins to outline key areas of ethical concern that arise during long-term, sustained research activities with communities in low-resource settings. Through a review of the literature and consultations with experts in health systems, we identified the following key themes: fair benefits and long-term beneficence; community autonomy, consultation and consent; impacts on local health systems; economic impacts of research participation; ethical review processes; and institutional processes and oversight within research organizations. We hope that this preliminary exploration will stimulate further dialogue and help inform ethical guidance around long-term research engagements in the developing world.
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Research translation to inform national health policies: learning from multiple perspectives in Uganda

Future Health Systems

Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally.
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National policy-makers speak out: are researchers giving them what they need?

Future Health Systems

The objective of this empirical study was to understand the perspectives and attitudes of policy-makers towards the use and impact of research in the health sector in low- and middle-income countries.
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Stakeholder analysis for health research: Case studies from low- and middle-income countries

Future Health Systems

Future Health Systems: Innovations for Equity (FHS) is working in six partner countries in Asia and Africa, focusing on strengthening the research–policy interface in relation to specific health system research projects. These projects present an opportunity to study the influence of stakeholders on research and policy processes.
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Exploring evidence-policy linkages in health research plans: A case study from six countries

Future Health Systems

Three key activities were undertaken by FHS during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon.
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