Reinterpreting Responsiveness for Health Systems Research in Low and Middle-Income Countries
Reinterpreting Responsiveness for Health Systems Research in Low and Middle-Income Countries
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DOI：
10.1111/bioe.12138
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发表时间：
2015-07-01
期刊：
影响因子：
2.2
通讯作者：
Hyder, Adnan A.
中科院分区：
文献类型：
--
作者：
Pratt, Bridget;Hyder, Adnan A.
反应性的伦理概念在很大程度上是在国际临床研究的背景下解释的。鉴于越来越多的外部资助的卫生系统研究（HSR）在低收入和中等收入国家（LMICs）的行为，本文探讨了如何响应可能会被理解为这样的研究，以及如何可以应用。它认为，四个特点（除其他外）设置HSR在LMICs除了国际临床研究：一个专注于系统;被上下文驱动;被政策驱动;并与发展目标密切相关。这些功能支持重新解释响应HSR在低收入国家的响应系统的需求，卫生系统的性能评估可以依赖于确定系统的需求，和/或响应系统的优先事项，这需要调整研究与HSR的优先事项，通过国家拥有的过程，涉及国家和次国家的政策制定者从东道国。这两个概念在实践中可能都难以实现。国家所有权是不是一个既定的事实，许多国家和调整，他们的优先事项可能是毫无意义的，没有它。有人认为，更多的工作，因此，需要确定战略，如何响应要求可以在道德上满足高速铁路在低收入国家的非理想条件下，如东道国没有通过国家拥有的进程设置高速铁路的优先事项。嵌入性被提议作为一种方法，可以成为进一步发展的重点。
The ethical concept of responsiveness has largely been interpreted in the context of international clinical research. In light of the increasing conduct of externally funded health systems research (HSR) in low- and middle-income countries (LMICs), this article examines how responsiveness might be understood for such research and how it can be applied. It contends that four features (amongst others) set HSR in LMICs apart from international clinical research: a focus on systems; being context-driven; being policy-driven; and being closely linked to development objectives. These features support reinterpreting responsiveness for HSR in LMICs as responsiveness to systems needs, where health system performance assessments can be relied upon to identify systems needs, and/or responsiveness to systems priorities, which entails aligning research with HSR priorities set through country-owned processes involving national and sub-national policymakers from host countries. Both concepts may be difficult to achieve in practice. Country ownership is not an established fact for many countries and alignment to their priorities may be meaningless without it. It is argued that more work is, therefore, needed to identify strategies for how the responsiveness requirement can be ethically fulfilled for HSR in LMICs under non-ideal conditions such as where host countries have not set HSR priorities via country-owned processes. Embeddedness is proposed as one approach that could be the focus of further development.