Building the field of health policy and systems research: Framing the questions

Abstract

The field of Health Policy and SystemsResearch (HPSR) is currently experienc-ing an unprecedented level of interest. TheFirst Global Symposium on Health Sys-tems Research, held in Montreux, Swit-zerland, in November 2010, is the mostrecent of a succession of conferences andtask force deliberations that have spun offa series of debates about the nature of thefield and the future directions it shouldtake. Establishing the identity and terrainof HPSR is part of these debates, which ismade difficult by the fact that it is anessentially multidisciplinary field delimitednot by methodology but by the topic andscope of research questions asked. In thispaper, the first of a series of threeaddressing the current challenges andopportunities for the development ofHPSR, we introduce and map the typesof research questions that it has addressedover its natural course of evolution,analyze the nature of current heightenedattention, and highlight emerging oppor-tunities and challenges for the develop-ment of the field.We use the extended term Health Policyand Systems Research for a field that isoften referred to simply as Health SystemsResearch. For us, the broader term bettercaptures the terrain of work it encompass-es because it explicitly identifies theinterconnections between policy and sys-tems, and highlights the social and polit-ical nature of the field. The geographicalfocus of our concern is low- and middle-income countries (LMICs) [1], but wesuggest that our approach also has valuefor high-income countries. Our under-standing of the evolution of HPSR draws primarily from the English languageliterature, which we acknowledge as alimitation. However, this reflects globaldiscussion about the field, which hastended to neglect literature in otherlanguages.