Ethics of health policy and systems research: a scoping review of the literature

Abstract

Health policy and systems research (HPSR) is increasingly funded and undertaken as part of health system strengthening efforts worldwide. HPSR ethics is also a relatively new and emerging field, with numerous normative and descriptive questions that have largely not been considered. Normative questions include what ethical principles and values should guide HPSR. Descriptive questions include what ethical concerns arise when conducting HPSR. A small but growing body of scholarly work characterizes the various ethics issues inherent in HPSR. Towards informing the future development of ethics guidance for HPSR, a scoping review was undertaken to: (1) identify the range of ethics issues relevant to the conduct of HPSR-with a deliberate (though not exclusive) focus on low- and middle-income country settings and (2) describe existing guidance on key ethics issues relevant to HPSR. Using the Cochrane methods as a basis, the review identified formal and informal literature on HPSR ethics by searching the following databases: PubMed's Medline, Embase, Global Health, Scopus, WHO Global Health Regional Libraries, LILACs, OpenDOAR and Bielefeld Academic Search Engine. In total, 11 062 documents were identified from the formal (10 519) and informal (543) literature. One hundred and seven of these documents (formal 99 and informal 8) met at least one inclusion criterion and underwent thematic analysis. Ethical issues in four main categories were identified: upholding autonomy, identifying and balancing risks and benefits, justice and determination of ethical review requirements. The review indicated that the ethical values behind HPSR place an emphasis on its contributing to the reduction of health disparities. Unsurprisingly then, numerous ethical concerns relating to justice arise in HPSR. However, the majority of existing guidance focuses on obtaining or waiving informed consent and, thus, appears to be insufficient for HPSR. A list of priority ethics issues in HPSR in need of guidance development is provided.

Interventions to increase facility births and provision of postpartum care in sub-Saharan Africa: a scoping review

“…Nine studies used a quasi-experimental design [ 20 , 22 – 25 , 30 , 32 – 34 ]. Four studies were cross-sectional [ 21 , 29 , 31 , 35 ]. In terms of assessment methods, two studies used mixed methods [ 21 , 31 ].…”

“…Voucher program coverage was associated with a two-fold increase in delivering at a health facility (OR: 2.1; 95% CI: 1.5–3.1). Also in Kenya, vouchers were distributed to women in two districts (Suguta and Barsaloi) to cover the costs of hospital ambulance transportation to the health facility for childbirth [ 21 ]. As a result, 98% (N = 52) in Suguta and 100% (N = 33) in Barsaloi delivered at a health facility compared to only 30% (N = 16 and 10, respectively) in the control groups [no statistical comparison performed].…”

What constitutes expertise in research ethics and integrity?

“…Research ethics and research integrity, the two strands of dealing with the ethical aspects of doing research and innovation, have been mainstreamed in the past decade (Mertz et al, 2016; Ormerod and Ulrich, 2013, Pratt et al, 2017). However, there is still discernible work to be done to improve standards on good scientific practice in order to achieve clarity and calculability for participants, transparency for users, and reliability for policymakers in ethical considerations related to research.…”

A social–ecological framework: A model for addressing ethical practice in nursing

“…As the importance of evidence‐based practices in health care gains increasing recognition, there is a need to expand the lens of evidence beyond scientific data to include the lived experiences of people in need of health care, those who provide care, and the people, systems and communities that are affected by the ethical conflicts and dilemmas that are faced in everyday healthcare encounters. Issues such as access and equity have become as important as understanding the scientific basis of health care (Pratt, Paul, Hyder, & Ali, ).…”