This paper responds to the growing interest in the ethics of Health Policy and Systems Research (HPSR) by examining ethical issues that arose for researchers at the Kemri Wellcome Trust Research Programme. 

Researchers conducted three HPSR studies in Kenya, in which health managers and providers were key participants, all three studies involved qualitative work including observations and individual and group interviews and focused on the micro-level processes of governance at sub-national and local levels, and the implications for heath system resilience and responsiveness to local communities.

The paper makes evident how many of the ethical dilemmas researchers faced only emerged over the course of the fieldwork, or on completion, and were related to interactions and relationships between individuals operating at different levels or positions in health/research systems. 

“As long as researchers make it their business to study work that has murky everyday ethical decision-making, they have to learn to live with the ethical mess of [their own and] other people's work”

The dilemmas reveal significant ethical challenges for these forms of HPSR, and show that potential ‘solutions’ to dilemmas often lead to new issues and complications.

The paper stresses the value of research ethics frameworks which can be enriched by incorporating careful consideration of context embedded social relations into research planning and conduct. 

Find out more in this video from RinGs in which researchers from the Kemri Wellcome Trust in Kenya outline some of the ethical dilemmas that they encounter in their day to day lives.