Ethical practices are central to the conduct of all types of research including health systems research. This brief discusses the specific ethical challenges faced when health systems researchers are embedded in the institutions they study. It also includes video interviews with researchers from the Kemri Wellcome Trust Research Programme.
Key messages
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Health systems research, that relies on long-term engagements with participants and ‘embedded’ researchers, raises significant ethical dilemmas that are not easily tested and checked by ethics committees.
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Many ethical dilemmas only emerge over the course of the fieldwork and are related to complex interactions and relationships between researchers, community members, health providers and managers.
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The blurring of roles between researcher and participant, whilst having important benefits, can create ethical challenges relating to the need to maintain trusting relationships with multiple actors, in managing expectations appropriately, and in the consent process.
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For this type of research, careful consideration and planning is needed to ensure that relationships are not harmed, and that unequal power imbalances are not exacerbated.
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All researchers have a responsibility to build ethical mindfulness in their day-today practice. Regular reflective practice sessions, where researchers can deliberate on ethical dilemmas faced and how these should be handled, are an invaluable way of achieving this.
This brief outlines the ethical dilemmas faced by the researchers in their work and the solutions they devised to minimise these. Their experiences are relevant for health policy and systems researchers, as well as others conducting long-term, embedded, research.
