The Dialogic Health Systems Research Framework (DHSRF): A tool for facilitating self-criticality, researcher...

Health Systems Research (HSR) has witnessed significant progress in theory, methodology and practice over the last two decades. The complexity of health systems has allowed for diverse lenses for HSR. However, given the absence of dialogue between the different streams of HSR, the diversity of this field, perhaps its greatest strength, is turning out to be quite the challenge. Without a common language that enables researcher interaction and critical examination of the field, diversity can easily turn into a din. To overcome this confusion, evidence-based policy making requires tools that can assess the diverse evidence generated for designing systems coherent with the desired values and principles. Hence, we need a common research framework for HSR, to understand, describe and explain the systems' structure and functioning, including observed and projected processes of change, across streams. It should be able to make sense of the formulation of HSR, allowing diverse research paradigms their appropriate place in HSR, and make them talk to each other rather than against each other. This paper presents the Dialogic Health Systems Research Framework (DHSRF), developed through a multi-method approach which was theory-based, iterative and reflexive involving an initial systematic narrative review and a later national expert consultation for feedback and validation. The DHSRF locates itself within a public health disciplinary frame and draws upon the comprehensive primary health care principles and a complexity lens. This led to adopting a comprehensive socio-cultural approach to health systems, incorporating their formal and informal components, addressing the techno-managerial and social-economic-political-cultural aspects with understandings drawn from epidemiology, historical analysis, knowledge pluralism and a bottom-up approach, making the framework context-sensitive, open to diverse perspectives, adaptable to different settings, value-critical and dialogic. It potentially contributes to knowledge management by a) allowing for a comprehensive review of HSR at the proposal and design stage to ensure a 'good fit for purpose', and b) assessing the strength of the outcomes of HSR in relation to the purpose and objective(s) of the research. By surfacing the inner workings of HSR, the framework can galvanise dialogue and debate to enrich the field and facilitate utilisation of its outcomes for policy, planning and implementation.