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The Great Transformation: from public health professional to health policy and systems researcher in just two weeks

By Vikash R Keshri
on April 12, 2015

In this short blog I hope to explain how the two-week KEYSTONE course (23 February-6 March) in Delhi has transformed me by giving me a much wider field of vision. In these two weeks, it’s safe to say that I was pretty much “reborn” as a health policy and systems researcher, getting to know plenty of new lenses to understand the world and health systems more in particular. Let me go a bit into detail.

I have a passion for public health. I am a physician turned public health professional with a special interest in issues related to maternal and child health in the context of a health system. My strong belief in the public health system keeps me going and believing that one day our health system will be there for each and every one in need.  Having worked for almost two years in some of the biggest technical support programmes for health sector reforms in two of the largest states of India, Madhya Pradesh and Bihar, my belief is still intact that one day the Indian health system will be there for everyone in need.

Are you wondering when research caught my interest? I too wonder but perhaps here my public health training can be “blamed”. I always believed that almost everything under the sky is researchable but unfortunately, I had only one lens to do so i.e. epidemiology. With only one weapon in my arsenal, I was not sure how to put findings from the health system as well as health system challenges and solutions in research format. Then I learnt about the KEYSTONE course on Health Policy and System Research (HPSR) in Delhi. I quickly realized this course could be the first step on my journey to learn how to structure knowledge and acquire the skills needed to become a researcher in an area of my interest. I applied for the course and got selected as one of twenty participants from across India.

On day 1, with a curious mind about what would be in store for me and the other participants, I rushed towards the registration desk and settled in the classroom quite early. We got an informal and pleasant introduction after which my confusion resurfaced when I learnt about the diverse backgrounds of the participants ranging from geographic researchers to programme managers to gastro-surgeons. There seemed to be only one common thread: almost all of them had gotten some kind of public health training. As the day unfolded, things became a bit clearer, right from what HPSR involves to why it is important. Some new terminologies like high and low politics, system hardware and software and ‘mixed system syndrome’ were equally exciting to know. We also learnt that HPSR is not methodology driven but rather research problem or question driven. This already cleared millions of doubts from my inquiring mind. So far, so good!

As epidemiological researchers’ brains always revolve around causation theory and we spend plenty of our energy on establishing causality, never ever do we learn about ontology and epistemology. An epistemological self-diagnosis test on day two made me realize how,  starting from a positivist background, I am now becoming a constructivist. Understanding system complexity was as challenging as understanding human relationships, with the role which different actors play contributing to the complexity.

On day 3 came a couple of economists, washing away everything.  I think the power of economics lies in the fact that everything (or almost everything) can be explained in economic terms and it’s appealing for all concerned because at the end of the day money drives everything. I wondered how economists always manage to convince us with demand and supply curves and whether we ought to agree with these explanations.

The policy analysis exercise, the day after the economic analysis, helped us to reorganize our grey matter a bit from the day before (when economic analysis had overwhelmed our intellectual world). For me learning about types, actors, and policy triangles was almost as fascinating as learning to ride a bicycle for a young kid.  Learning about realist and theory driven approaches to HPSR made us realize that all health programmes are driven by some theories. It’s nobody’s fault but the terminology or even the term “realist” itself was so new for me that to translate it properly into a research framework will require some more in depth study of course materials provided. The session on ethnography taught us to apply an ethnic lens to research the health system. Our facilitator even suggested some movies to understand ethnographic angles; one of them was ‘Invention of lying’, this again was a revelation as we tend to think that lying is just part of human psychology. Implementation research (IR) and participatory action research (PAR) were two methodologies where I could connect with actual practice. So with little experience of conducting PAR and IR, I was still  quite at ease learning these two lenses.  The session on knowledge translation (KT) sort of reiterated what we already knew but one important take home message was that as researchers our biggest tool is to write: we need to write down our ideas and disseminate those ideas. As you can see, one early result of this take home message is visible in the form of me writing this blog!

During the final lap of the course we were supposed to finalize our research problems and protocol. A research methodology workshop was organized where we could present our initial research ideas – thanks to all facilitators for their inputs by the way! We really managed to convert identified research problems into a researchable protocol. For me day 9 was perhaps the most exciting part of the course, since I am a believer in ‘learning by doing’. Working on the research write-up and finalizing the presentation for the “grand finale” strengthened my insights and I just kept going. As always I kept thinking about the problem and write-up and kept roaming around to alleviate my tensions and to enjoy others’. Finally at 4 am on day 10, I could switch off the lights after submitting a research plan. Well done, Vikash, I thought.

On the final day, with a mind full of mixed feelings, I felt like returning from an unknown island. Watching research presentations by the other Keystone fellows was another great cross-learning platform: it was a treat to watch how participants had remodelled their thinking based on newly acquired HPSR lenses. The final day was so full of nostalgia that it felt like the Grand finale of a reality show, with 20 participants tied up in a superb building with little scope to go out for days, and then finally having to leave each other full of wonderful memories. The moment when I left the venue was emotion heavy and I felt like staying a bit longer (I probably wasn’t the only one), almost everything that had happened over the last 10 days was flashed back through our brains. The journey back home felt like returning after major surgery with the stent of knowledge now instilled into the brain. It had been so fascinating to acquire new lenses to see the world. HPSR lenses truly widen my field of vision. On the flight back home, I tried to understand the fix. And then I realized: these were all symptoms of my transformation from a medical public health researcher to a socio-politico-economic-anthropological researcher or say HPSR researcher.

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