The ethics of health systems research in low- and middle-income countries: A call to action

Adnan A. Hyder, Bridget Pratt, Joseph Ali, Nancy Kass, Nelson Sewankambo

Research output: Contribution to journalArticlepeer-review


The increasing conduct of health systems research (HSR) in low- and middle-income countries (LMICs) has not been matched by concurrent work to clarify the field's ethical dimensions. To begin to address this gap, a two-day workshop on the ethics of HSR in LMICs was convened at Johns Hopkins University in June 2013. Participants included health systems researchers, philosophers, lawyers, bioethicists and institutional review board members from Botswana, Uganda, the UK, USA and Zambia. Based on discussions from the workshop, the paper affirms that, while HSR in LMICs raises ethical issues in relation to constructs (i.e. consent, risk, equipoise) common to international clinical research, the nature of the issues that arise often differ between the two fields. Three salient features of HSR and the ethical considerations associated with each of them in LMICs are described to demonstrate this point. Recommendations for institutional review boards’ oversight of HSR in LMICs are presented. Finally, a call is made for further action to develop thinking and guidance around the ethics of HSR in resource-poor settings.

Original languageEnglish (US)
Pages (from-to)1008-1022
Number of pages15
JournalGlobal public health
Issue number9
StatePublished - Oct 13 2014


  • IRB oversight
  • developing countries
  • ethics
  • health systems research

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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