Between participation and signature: a response to "Autonomy and risk in HPSR studies"

Health Policy and Systems Research (HPSR) is defined as the "production of new knowledge to improve how societies organise themselves to achieve health goals" (1: p 4); the focus of HPSR studies is on generating, using and disseminating research to strengthen health systems, particularly in low-and middle-income countries. There has been an increasing focus on defining HPSR clearly and on its ethical components and challenges, especially as this domain, is fundamentally different from biomedical /clinical research. One of the imperatives of HPSR is the "co-production of knowledge" (1: p 4) by the researcher, the communities involved, and healthcare providers; and this calls for shared responsibility and ownership, which is not an essential aspect of biomedical research.