Module-2

Specific Learning Objectives:

• To describe the existing frameworks of ethical reasoning in medical ethics, research ethics, public health ethics and bioethics as a whole;

• To differentiate between medical ethics and public health ethics;

• To describe the key ethical considerations in public health ethics as a background for ethics of health systems and implementation research (IR);

• To describe the ethical considerations of health systems and IR;

• To apply the ethical considerations to health systems research (HSR) addressing various building blocks of the health system;

• To apply the ethical principle of health systems and IR to practical situations.

Learning Methodology:

Interactive lecture; group discussion; small group work with plenary discussion, case study 1 in Annex 1.

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
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MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
MODULE 2

Ethical Considerations in

Implementation Research

Ethics in Implementation research

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
• To describe the existing frameworks of ethical reasoning in medical, research, public health and bioethics

• To differentiate medical and public health ethics

• To describe the key ethical considerations in public health as a background for ethics of health systems research and implementation research

• To describe the ethical considerations of health systems research and implementation research

• To apply the ethical considerations to health systems research addressing various building blocks of the health system

• To apply ethical principles of health systems research and implementation research to practical situations

Slide 2

Ethical Considerations in Implementation Research

Learning Objectives

Ethical Considerations in Implementation Research

Slide 2

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 3

Ethical Considerations in Implementation Research

Session Outline

1. Ethical frameworks

2. Key ethical considerations in health systems research and implementation research

3. Case study one

4. Ethical justification for health systems research and implementation research

Ethical Considerations in Implementation Research

Slide 3

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 4

Ethical Considerations in Implementation Research

Ethics of Health Systems Research and Implementation Research

• Relatively new discipline

New framework needed

• Draws on different ethical traditions and frameworks:

• Medical ethics

• Research ethics

• Bioethics

• Public health ethics

Ethical Considerations in Implementation Research

Slide 4

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 5

Ethical Considerations in Implementation Research

Ethics of Health Systems Research and Implementation Research

• Medical ethics: over 2,000 years old (Hippocrates, Sun Tse Miao, Ibn-Sina)

• Research ethics: Germany, Nuremberg Code 1947, Declaration of Helsinki 1964, etc.

• Bioethics: whole biosphere – humans, animals and plants − formulation of four basic principles

• Public health ethics: relatively recent discipline; addresses issues in public health

Ethical Considerations in Implementation Research

Slide 5

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 6

Ethical Considerations in Implementation Research

Medical Ethics, Research Ethics, Public Health Ethics

Public health ethics focuses on:

• Population health

• Health programmes and policy issues

• Scientific evidence

• Public participation

• Preventive measures

Medical ethics focuses on:

• Individual patients

• Doctor-patient relationship

• Duties of doctors/nurses

Research ethics focuses on:

• Protection of study participants

• Informed consent

• Risk-benefit analysis

• Equitable selection & access etc.

Ethical Considerations in Implementation Research

Slide 6

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 7

Ethical Considerations in Implementation Research

Central Questions and Current Topics in Public Health Ethics

• What extent of risk is acceptable at the individual and community level?

• Is coercion justifiable?

• Individual interest vs. the common (public) good

• Health promotion: how much should the government interfere with personal choices on health?

• How to ensure fair participation in decision-making?

• Priority-setting and rationing: who will get what if resources are short?

Ethical Considerations in Implementation Research

Slide 7

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 8

Ethical Considerations in Implementation Research

Substantive Ethical Principles

• Maximize benefits to the population

• Minimize harms to the individual and community

• Proportionality

• Respect individual autonomy

• Reciprocity

• Equity

• Efficiency

• Trust

• Solidarity

• Stewardship

Ethical Considerations in Implementation Research

Slide 8

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 9

Ethical Considerations in Implementation Research

Procedural Ethical Principles

• Transparency

• Relevance

• Inclusivity

• Responsiveness

• Accountability

• Participation

• Sustainability

Ethical Considerations in Implementation Research

Slide 9

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 10

Ethical Considerations in Implementation Research

Procedural Ethical Principles

• Autonomy vs. benefits/risk

• Autonomy vs. solidarity

• Equity vs. efficiency

• Confidentiality vs. disclosure

• Autonomy vs. stewardship

Importance of procedural principles

Ethical Considerations in Implementation Research

Slide 10

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Medical ethics

Public
health ethics

Research
ethics

Slide 11

Ethical Considerations in Implementation Research

Ethics of Health Systems Research and Implementation Research

Implementation research ethics

Ethical Considerations in Implementation Research

Slide 11

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 12

Ethical Considerations in Implementation Research

Ethics of Health Systems Research and Implementation Research

• Relatively new

• Draws on the different ethics frameworks

• Example: Ebola surveillance and contact tracing

Medical ethics and research ethics:

• Focus on protecting confidentiality; informed consent

Public health ethics:

• Focus on benefit to community; solidarity, often no informed consent

Ethical Considerations in Implementation Research

Slide 12

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 13

Ethical Considerations in Implementation Research

Key Ethical Considerations in Health Systems Research

Balancing benefits
and risks

• Who are the beneficiaries?

• Who are at risk?

• Is there balance between risks and benefits?

Upholding participants’ autonomy

• Levels of research participants

• Who should give consent?

• Is consent necessary, feasible, meaningful?

Justice

• Fairness in participant selection

• Need for health systems research among vulnerable populations

Other issues

• Responsiveness

• Sustainability

• Standard of care/ancillary care

• Empowerment

Ethical Considerations in Implementation Research

Slide 13

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 14

Ethical Considerations in Implementation Research

Ethical Principles of Health Systems Research

Ethical Considerations in Implementation Research

Slide 14

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 15

Ethical Considerations in Implementation Research

Leadership and Governance

Leadership and governance

In Country X abolishing unofficial payments to health-care workers by regularizing them lead to lower overall health care expenditure.

• Can this be adopted to your
country?

Health systems building block

Example of
implementation research

Ethical considerations

Ethical Considerations in Implementation Research

Slide 15

Notes

MODULE 1

Introduction to

Implementation Research

MODULE 2

Ethical Considerations in

Implementation Research

MODULE 3

Ethical Issues in Planning

Implementation Research

MODULE 4

Ethical Issues in the

Conduct of Implementation

Research

MODULE 5

Ethical Issues in the

Post–Research Phase of

Implementation Research

MODULE 6

In-Depth Ethical Analysis of

Implementation Research

Using Case Studies
Slide 16

Ethical Considerations in Implementation Research

Health Care Financing

Health care financing

Social insurance schemes have been shown to be effective method for universal health coverage. Can this be implemented in your country?

Health systems building block

Example of
implementation research

Ethical considerations

Ethical Considerations in Implementation Research

Slide 16

Notes