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  1. Surekha Garimella,
  2. VR Raman,
  3. Joe Varghese,
  4. Kabir Sheikh
  1. PHFI – Public Health Foundation of India, Gurgaon (Haryana), India


Background The production of policy-relevant knowledge for health systems change in India is not adequate to meet country needs. This is attributable partly to inadequacies in numbers of rigorously trained researchers in Health Policy and Systems Research (HPSR), and partly to a fragmented environment for HPSR. Although, skilled researchers exist across diverse organisations, they tend to operate within academic disciplinary silos (economics, political science, anthropology, public health), rather than as part of a cohesive change-creating HPSR community.

KEYSTONE was designed as a joint national initiative of several HPSR organisations, to develop new capacities, and to channelize latent capacities in multiple disciplines, towards addressing critical needs of health systems and policy development in India. The core strategic processes of KEYSTONE were anticipated to lead to activation of a virtuous cycle of change, leading to enhanced production of relevant HPSR knowledge to meet country needs.

Methods Inaugural edition of the KEYSTONE course focused on building HPSR capacity of fellows through a rigorous 10-day short course in current HPSR approaches, frameworks and methodologies for investigating and addressing real-world problems of health systems and policy. This was done through cross-disciplinary engagement (of researchers, health system actors and other learning networks) and built around an active dialogue with health system decision makers and community-based organisations. The design was composed of synergistic ‘Horizontals’ (foundational concepts and common HPSR approaches or lenses), and crosscutting ‘Verticals’ (for individual fellows, health system problem vertical & reading vertical) created the platform to enhance the threshold skills and competencies of the fellows.

Findings The design and delivery of the course contributed in synergising the varied capabilities of the fellows who came from a range of institutions (academic/research organisations, government health departments, technical organisations and NGOs) and moulding them to frame crucial research themes that were grounded in the real world of the health system (see Annex, Table 1), addressing governance issues, policy analysis, political economy analysis and around the organisation of care. HSR experts and health systems decision makers reviewed these and found that such themes were highly relevant for policies.

Abstract OP–49 Annex, Table 1

Research themes identified by KEYSTONE fellows, resulted by the short course

Discussion Inaugural experience of KEYSTONE suggests that a well-designed and delivered HPSR short course can build foundational skills for a health policy and systems researcher. Themes identified by all twenty KEYSTONE fellows demonstrated that they have developed abilities for identifying relevant, complex and diverse HPSR issues requiring examination within the health system. This can be attributed to the focus of the KEYSTONE course on (a) the developing training curricula based on dialogues with key health system actors; (b) a question-driven and case study-rich approach to pedagogy; (c) a multidisciplinary approach to teaching HPSR; (d) a participatory approach, building on the experience of various institutions and faculties; and (e) emphasis on research rigour, ethics, and researcher reflexivity, during the conduct of training. Retaining these will be crucial parameters to scale up the KEYSTONE model, towards developing individual and organizational capacities for HPSR in the country.

No competing interest.

  • India
  • health policy and systems research
  • training
  • research capacity building
  • research themes

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