Health Systems and Implementation Research
Implementation Research (IR) is a form of enquiry into the process of translating clinical and public health evidence into practice. It addresses issues of improving access to and use of specific interventions within a local context of implementation. There is an ethical imperative to conduct implementation research as there is a need to understand access, acceptability, reach and utilization issues in a local context.
Unless there is reasonable doubt about potential contextual differences in implementation between one location and another, however, contextual equipoise is absent and it does not justify IR. Similarly, unless there is a local plan for sustaining or scaling up of a successful intervention, IR may not be justified. When justified, the planning and conduct of IR raises several important ethical issues. Issues of acceptable standards of care especially in control groups, and ancillary care responsibilities arising during the conduct of IR must be anticipated and addressed.
Community engagement is an ethical imperative in IR, given that contextual, social and political issues are crucial to acceptability and effectiveness and of an intervention. IR should empower the community, and strengthen the health system and the local health system research capacity.
The Global Health Ethics Unit has been collaborating with TDR, the Special Programme for Research and Training in Tropical Diseases, in a project to develop a training course to increase awareness of ethical considerations in IR.
Health Systems Research
Health Systems Research raises similar ethical issues as IR. The Global Health Ethics Unit collaborates with the Alliance HPSR to develop WHO Guidance.
Joint WHO meeting on Ethics guidance for Health Policy and Systems Research in collaboration with University of Zurich, Zurich, Switzerland (July 23-24 2015)
Members of GHE, the Alliance HPSR, and external experts met with a view to developing tailored guidance on ethical considerations in Health Policy and Systems Research, prompted by a lack of consistency in the application of existing ethical review frameworks to HPSR proposals by Review Committees. The group identified core differences between HPSR and other kinds of research in order to identify where specific ethical guidance is needed. A guidance document will be generated based on this.