Justice

Despite the growth of HSR being conducted worldwide, we lack guidance and consensus statements regarding the ethical considerations that are specific to the field. One area that I think is particularly necessary to think about is justice. This is because HSR has been identified as an essential means to reduce health disparities through helping identify how governance, service delivery, financing, and human resource components of health systems can best be organized to improve access and financial protection for disadvantaged groups in low- and middle-income countries.

Ethical considerations relating to equity arise during all phases of HSR, from the selection of research questions and participants to research design to implementation and monitoring and evaluation:

“Where HSR contributes to the planning of services and policymaking, the voice of the socially excluded may be muffled, and that of the better educated and materially secure, artificially amplified”

Where participants in HSR are representative of a relatively limited and privileged subset of the population, HSR will not be set up to determine how disadvantaged groups will be affected by, for example, changes to models of service delivery or insurance schemes.

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