Table. HPSR Researcher Competency Domains, Explanatory Domain Descriptions, and Suggested Competencies .

	Competency Statements	Explanatory Descriptions
Domain 1	Understand health systems, their complexity, and policy process	As a starting point, HPSR researchers should have a deep understanding of the nature of health systems (context, actors, financing, organization, other functions, including policy functions), and understand their nature as complex adaptive systems.
	Competencies • Define health systems frameworks (theoretically or empirically derived) that can address health policy and program research questions in a comprehensive whole. • Compare relationships between different actors in health systems (eg, patients, health workers, managers, politicians etc) in the context of societal contracts, power and agency. • Analyse and evaluate complex interactions of elements and functions of health systems (functioning as subsystems), and how these affect policy processes. • Embed governance, stewardship and leadership as cross-cutting functions when designing and implementing research on health systems. • Deconstruct the policy processes that inform decision-making and relationships between multiple stakeholders in the health system.
Domain 2	Assess health system-related policies and programs	HPSR professionals should be able to ask policy-relevant research questions, design research using a wide variety of theories, methods, and approaches, and effectively carry out meaningful research on health-related policies, programs and interventions.
	Competencies • Formulate policy-relevant research questions that capture and reflect the complexity of HPSR issues. • Design research that captures the multiple dimensions of context (social and political environment, values and history) shaping policies and programs and their influence on health systems and health outcomes • Apply relevant disciplinary or inter-disciplinary approaches (eg, from economics, policy analysis, epidemiology, implementation science, anthropology etc) while making connections to broader systems research theory and practice. • Integrate a wide range of theories, approaches (eg, systems thinking, implementation science, participatory research) and methods to develop questions of inquiry and design appropriate studies, including those addressing health systems complexities. • Assess the relevance of different sources and methods of data collection and analysis, building and managing teams able to apply an appropriate mix of research methods when answering HPSR questions, going beyond one’s own disciplinary expertise. • Assess when mixed methods are required to answer the research question and to combine and analyse data from these. • Integrate health systems research with analysis of and engagement with the underlying policy processes. • Generate evidence to address a problem while accepting the iterative nature of the health system design and implementation processes. • Analyse, evaluate and create strategies on how health system structures and policies can be: (a) designed, (b) implemented effectively and (c) adapted to overcome barriers and challenges (drawing on implementation research) while questioning conventions and assumptions.
Domain 3	Critically appraise data and evidence related to health systems	HPSR researchers should be able to organize, analyse, interpret, reflect on, communicate, and apply different kinds of data and evidence.
	Competencies Critically appraise and use evidence to address health systems problems or support policy development in different settings. Apply principles of good quality data collection according to the scientific method and interpret how limitations in data collection affect interpretations about evidence in health systems Analyse data in transparent, reproducible, and robust ways according to scientific method. Synthesize knowledge obtained from across different disciplines (economics, epidemiology, anthropology, etc) to address real-world health systems issues.
Domain 4	Ethical reasoning and practice	HPSR researchers need the ability to identify and respond with integrity to ethical issues in diverse contexts involved in HPSR, and to promote the accountability for policies that affect people’s health.
	Competencies • Identify and address ethical issues of HPSR related to the overall process of identifying questions, generating findings and applying lessons. This may include using appropriate methodologies for the respective settings, ensuring safety, reducing risks and enhancing benefits for participants, or the unintended use of research findings to justify decisions that may have adverse outcomes. • Demonstrate sensitivity and capacity to resolve common ethical issues related to undertaking and translating HPSR in different economic, political, and cultural contexts. • Critique research on health systems and their attributes from an equity perspective. • Enable communities, particularly vulnerable populations and those in disadvantaged settings, to have a voice in decisions concerning research questions and approaches.
Domain 5	Lead and mentor	HPSR researchers should be able to get teams to work together towards common purposes, foster collaboration and individual development of other professionals, and influence other health policy and systems stakeholders.
	Competencies • Act as a leader in supporting health systems research teams, working with stakeholders involved in research, and in engaging in policy processes. • Integrate research within HPSR teaching and learning, promoting personal and institutional capacity development. • Demonstrate awareness of the role of personal and institutional positionality.
Domain 6	Build partnerships and networks	HPSR researchers should be able to build trusted partnerships within academia, government, and with stakeholders in civil society and across the health system.
	Competencies • Understand the position of key stakeholders (Ministries of Health, policy-makers, health agencies, health professionals, community organizations, non-governmental agencies, business) in conducting and sharing health systems research. • Foster a collaborative research environment based on mutual respect throughout the research process, linking researchers and networks and stakeholders outside academic institutions, including advocates and those working on health systems across different sectors. • Co-produce HPSR with research participants, key local stakeholders and communities to support empowerment and health improvement. • Incorporate understanding of the social and political context of doing HPSR into how to work across stakeholder constituencies (policy, practice, media, civil society).
Domain 7	Communicate, translate knowledge, and apply health systems evidence	HPSR researchers should be able to incorporate evidence into ways to improve people’s health and strengthen health systems, use multiple methods of communication, and communicate effectively with different audiences.
	Competencies • Work with stakeholders to distil policy and practice problems, create HPSR research designs to address them, and incorporating research into policy, program and health system change. • Deconstruct policy processes in order to address policy and practice problems and inform policy development and decision-making. • Promote uptake of findings through communicating HPSR effectively, engaging with various audiences and explaining meaning and relevance of findings. • Translate evidence into policy designs and implementation, including pragmatic approaches to research and HPSR for program monitoring and evaluation. • Promote health systems development leading to improved health status and access to essential services.

Abbreviation: HPSR, Health Policy and Systems Research.