Health policy analysis (HPA) seeks to understand and explain the policy process recognizing the primacy of socio-political and economic forces in influencing policy outcomes. To do so, it analyses the role of factors such as institutions, interests, ideas, and ideologies, and how these interact with each other to influence policy actors and processes. This important area is an understudied one, particularly in low- and middle-income countries (LMICs). In 2017 the Alliance for Health Policy and Systems Research (AHPSR) launched a two year program of work to help strengthen capacity to conduct health policy analysis (HPA) in LMICs.
Coordinated by the University of Cape Town, South Africa, the Health policy analysis program provides support to doctoral level students in various LMIC universities who seek to research the politics of health policy change. The program consists of two week-long thesis workshops, distance learning between workshops, bursary support for the fellows’ PhD research, and commitment to support the development of an LMIC HPA network.
Participants at the first workshop held in Cape Town in December 2017 included eleven fellows, four mentors, and eight student thesis supervisors. The latter were invited to enable them to be part of the process. The work of the program will continue throughout 2018.
The fellows are:
- Aaron Mulaki, University of Cape Town, Cape Town, South Africa
- Abigail Codjoe, Ghana College of Physicians and Surgeons, Accra, Ghana
- Chinyere Okeke, University of Nigeria, Enugu, Nigeria
- Eleanor Whyle, University of Cape Town, Cape Town, South Africa
- Kasapo Chibwe, University of Zambia, Lusaka, Zambia
- Moses Mukuru, Makerere University, Kampala, Uganda
- Rakesh Parashar, Tata Institute of Social Sciences, Mumbai, India
- Ryan Guinaran, Benguet State University, Benguet, Philippines
- Sudha Ramani, Tata Institute of Social Sciences, Mumbai, India
- Ida Okeyo, University of the Western Cape, Cape Town, South Africa
- Raoul Andrada Bermejo III ITM, University of the Philippines, Makati City, Philippines
The Mentors are:
- Prof Lucy Gilson, University of Cape Town
- Dr Irene Agyepong, Ghana Health Service
- Prof Jeremy Shiffman, American University
- Dr Maylene Shung-King, University of Cape Town
The Supervisors are:
- Prof BSC Uzochukwu, University of Nigeria – Enugu Campus, Nigeria
- Dr Sivakami Muthusamy, Tata Institute of Social Sciences, Mumbai, India
- A/Prof Jill Olivier, University of Cape Town, Cape Town, South Africa
- Dr Freddie Ssengooba, Makerere University, Kampala, Uganda
- Dr Nilesh Gawde, Tata Institute of Social Sciences, Mumbai, India
- Dr Joseph Zulu, University of Zambia
- Dr Erlinda Alupias, Benguet State University
- Prof Helen Schneider, University of the Western Cape, South Africa
The fellows described the value the first workshop had for them.
Kindling fires: Learning through Health Policy Analysis fellowship
Rakesh Parashar (School of Health System Studies, Tata Institute of Social Sciences) and Ida Okeyo (School of Public Health, University of the Western Cape)
“The mind is not a vessel to be filled, but a fire to be kindled.” ― Plutarch.
We are a promising (that’s what we like to call ourselves!) group of young researchers who are benefitting from the Alliance’s Health Policy Analysis (HPA) fellowship program. We are PhD students from Ghana, Zambia, Philippines, Nigeria, Uganda, India, Kenya, and South Africa, and describe here our experiences at the first fellowship workshop held in Cape Town, South Africa, December 2017. The workshop was a compact yet comprehensive event that enriched our thinking about concepts of HPA through discussions with peers, supervisors, and mentors who have been at the centre of advancing research in HPA globally. Looking ahead toward a long and meaningful journey into the field of health policy and systems research (HPSR), the HPA workshop was an apt beginning for learning about the ‘P’ of HPSR. The workshop was well planned, the hospitality warm, the food memorable, and everything took place in a beautiful natural setting. The week began with an ice breaker activity where all of us were asked “What led you to do a PhD in the field of health policy analysis?” It was interesting to note, particularly from some of the mentors and supervisors, how our experiences in the health sector, whether as service providers, researchers, or activists had shaped our interests in policy analysis in different ways. This process stimulated us to reflect on our own goals of doing a PhD and regain renewed interest in the topics we had chosen.
“What is your overarching research question?”
This was a fundamental question that brought some serious discussions about what one is trying to study. There is nothing as elusive as trying to articulate a research question that embodies all the ideas you have had running around in your head about what your PhD study will involve. For most of us, one of the main outcomes after the workshop was being able to visualise how our initial ideas had gone through a fine tuning process shaped by reflections, personalised feedback, and discussions with mentors who spent time with us and prompted us to consider different perspectives on our research.
“Where is ‘power’ in your research?”
The workshop consisted of journal club sessions presented by fellows that covered concepts of HPA work such as context, power, and actors. Journal club sessions presented the space to think about methodological aspects that we could include in our research and presented different ways of understanding themes of policy analysis that we may have not considered before. One of these concepts was ‘power,’ which most of us agree is important in HPA work but which we had not really thought about in terms of how to investigate it and how it plays out during policy-making.
“Don’t be afraid to stretch the boundaries of traditional HPA work”
The sessions were well spaced to allow for personal reflection, discussions with supervisors, time for mentoring, and to put together new ideas in our proposals or presentations. As the workshop came to a close, fellows had a lot of common and some specific take-aways from each other’s research. For those fellows who were at an early stage of formulating their research proposals, the week provided the tools needed to start structuring the proposal. This included bringing focus to key research questions, providing a relevant theoretical base to the research, and refining the overall methodological approach. For those who were further along in the proposal stage, the workshop assisted in helping us think about methodological aspects such as where to start with document review processes and process tracing. Some of the conceptual learnings however, were equally important for and applicable to everyone. Understanding that HPA research has diffuse boundaries and that researchers should not be afraid of stretching them, for example, allowed fellows to look for theoretical and methodological lenses beyond their original proposals. Similarly, everyone was able to understand that ‘policy is political’ and that HPA research cannot be disassociated from studying politics in policy change, including understanding political contexts, examining the practices of power, agenda setting , actor or network influences, and resource politics.
Overall, for most of the fellows this experience was a deep dive into what HPA research could entail. By the end of the week fellows were already using HPA terminology in their conversations! Without a doubt, we became aware of many new concepts as well as new meanings of some concepts and looked forward to more interactions with mentors and peers during the course of this fellowship program and beyond.