Episode 30 – Realist Evaluation and Health Systems with Prashanth Srinivas

How can realist evaluation help us understand health systems, inequality, and social change in marginalised and ecologically sensitive contexts? And what happens when realist thinking moves beyond academic projects and becomes part of long-term, participatory work with communities? In this insightful conversation, Alejandro is joined by Dr Prashanth N Srinivas, a public health researcher and health systems scholar at the Institute of Public Health Bengaluru. Prashanth reflects on his journey into realist evaluation, from his early work as a clinician in community health settings to using realist approaches in health systems research, government health management, and long-term work with Adivasi communities in Southern India. The conversation explores how realist inquiry can help move beyond surface-level explanations of health inequalities, such as remoteness, literacy, or cultural difference, to examine the deeper structures, mechanisms, relationships, and histories that shape health outcomes. Prashanth discusses the value of realist thinking for making sense of complexity, building explanations with communities, and creating research approaches that are less extractive and more participatory. Prashanth also reflects on middle-range theory, participatory workshops, learning sites, global health, donor dependence, resilience, and the importance of humility in research. He highlights how realist approaches can support more grounded, equity-oriented health systems research by helping researchers, practitioners, and communities ask not only what works, but why things are the way they are, for whom, and under what conditions. Whether you’re an evaluator, researcher, public health practitioner, policymaker, student, or someone interested in realist approaches, global health, Indigenous health, or participatory research, this episode offers valuable insights into using realist thinking as a way of building shared understanding, practical wisdom, and more equitable approaches to health systems research