Embedding health policy and systems research into decision-making processes in low- and middle-income countries

Health Research Policy and Systems

Abdul Ghaffar¹  Nhan T Tran¹  Krishna D Rao³  Adam D Koon² 

[1] Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, Geneva, 1211, Switzerland;Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK;Public Health Foundation of India, 4 Institutional Area, Vasant Kunj, New Delhi, 110070, India

关键词: Low- and middle-income countries;    Health policy and systems research;    Evidence-informed policy-making;    Embeddedness;   

Others  :  809700
DOI  :  10.1186/1478-4505-11-30

 received in 2013-02-13, accepted in 2013-07-30,  发布年份 2013

【 摘 要 】

Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization’s Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems.

【 授权许可】

   
2013 Koon et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]WHO: Health systems: improving performance. In World Health Report. Geneva: World Health Organization; 2000.
• [2]Hanney SR, Gonzalez-Block MA, Buxton MJ, Kogan M: The utilisation of health research in policy-making: concepts, examples and methods of assessment. Health Res Policy Syst 2003, 1:2. BioMed Central Full Text
• [3]Bennett S, Corluka A, Doherty J, Tangcharoensathien V, Patcharanarumol W, Jesani A, Kyabaggu J, Namaganda G, Hussain AMZ, Aikins A-G: Influencing policy change: the experience of health think tanks in low- and middle-income countries. Health Policy Plan 2012, 27(3):194-203.
• [4]Bennett S, Corluka A, Doherty J, Tangcharoensathien V: Approaches to developing the capacity of health policy analysis institutes: a comparative case study. Health Res Policy Syst 2012, 10:7. BioMed Central Full Text
• [5]Polanyi K: The economy as instituted process. In Trade and Market in the Early Empires: Economies in History and Theory. Edited by Polanyi K, Arensberg C, Pearson H. Glencoe, IL: Free Press; 1957.
• [6]Nee V, Ingram P: Embeddedness and beyond: institutions, exchange, and social structure. In The New Institutionalism in Sociology. Edited by Binton M, Nee V. Stanford, CA: Stanford University Press; 1998:19-45.
• [7]Granovetter M: Economic action and social structure: the problem of embeddedness. Am J Sociol 1985, 91(3):481-510.
• [8]Wasko MML, Faraj S: Why should I share? Examining social capital and knowledge contribution in electronic networks of practice. MIS Q 2005, 29(1):35-57.
• [9]Klandermans B, van der-Toorn J, van-Stekelenburg J: Embeddedness and grievances: collective action participation among immigrants. Am Sociol Rev 2008, 73:992-1012.
• [10]Hinrichs CC: Embeddedness and local food systems: notes on two types of direct agricultural market. J Rural Stud 2000, 16:295-303.
• [11]Saltman RB: Convergence versus social embeddedness. Eur J Public Health 1997, 7:449-453.
• [12]Huang K, Provan KG: Structural embeddedness and organizational social outcomes in a centrally governed mental health services network. Public Manag Rev 2007, 9:169-189.
• [13]Provan KG, Huang K, Milward HB: The evolution of structural embeddedness and organizational social outcomes in a centrally governed health and human services network. J Publ Adm Res Theor 2009, 19:873-893.
• [14]Villadsen AR: Structural embeddedness of political top executives as explanation of policy isomorphism. J Publ Adm Res Theor 2011, 21:573-599.
• [15]Milward HB, Provan KG, Fish A, Isett KR, Huang K: Governance and collaboration: an evolutionary study of two mental health networks. J Publ Adm Res Theor 2010, 20(Suppl. 1):i125-i41.
• [16]Berardo R: Processing complexity in networks: a study of informal collaboration and its effect on organizational success. Policy Stud J 2009, 37:521-539.
• [17]Varda D, Shoup J, Miller S: A systematic review of collaboration and network research in the public affairs literature: implications for public health practice and research. Am J Public Health 2012, 102:564-571.
• [18]Innvaer S, Vist G, Trommald M, Oxman A: Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy 2002, 7:239-244.
• [19]Lavis JN, Lomas J, Hamid M, Sewankambo NK: Assessing country-level efforts to link research to action. Bull World Health Organ 2006, 84:620-628.
• [20]Hennink M, Stephenson R: Using research to inform health policy: barriers and strategies in developing countries. J Health Commun 2005, 10:163-180.
• [21]Behague D, Tawiah C, Rosato M, Some T, Morrison J: Evidence-based policy-making: the implications of globally-applicable research for context-specific problem-solving in developing countries. Soc Sci Med 2009, 69:1539-1546.
• [22]Hyder AA, Corluka A, Winch PJ, El-Shinnawy A, Ghassany H, Malekafzali H, Lim MK, Mfutso-Bengo J, Segura E, Ghaffar A: National policy-makers speak out: are researchers giving them what they need? Health Policy Plan 2010, 26:73-82.
• [23]WHO: Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action. Geneva: World Health Organization; 2007.
• [24]van-Olmen J, Marchal B, Van-Damme W, Kegels G, Hill P: Health systems frameworks in their political context: framing divergent agendas. BMC Publ Health 2012, 12:774. BioMed Central Full Text
• [25]Woelk G, Daniels K, Cliff J, Lewin S, Sevene E, Fernandes B, Mariano A, Matinhure S, Oxman AD, Lavis JN, Lundborg CS: Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries. Health Res Policy Syst 2009, 7:31. BioMed Central Full Text
• [26]Ashford LS, Smith RR, De-Souza RM, Fikree FF, Yinger NV: Creating windows of opportunity for policy change: incorporating evidence into decentralized planning in Kenya. Bull World Health Organ 2006, 84:669-672.
• [27]Kroeger A, Hernandez JM: Health services analysis as a tool for evidence-based policy decisions: the case of the Ministry of Health and Social Security in Mexico. Trop Med Int Health 2003, 8:1157-1164.
• [28]Ssengooba F, Atuyambe L, Kiwanuka SN, Puvanachandra P, Glass N, Hyder AA: Research translation to inform national health policies: learning from multiple perspectives in Uganda. BMC Int Health Hum Rights 2011, 11(Suppl. 1):S13.
• [29]Williams HA, Vincent-Mark A, Herrera Y, Chang OJ: A retrospective analysis of the change in anti-malarial treatment policy: Peru. Malar J 2009, 8:85. BioMed Central Full Text
• [30]Tantivess S, Walt G: The role of state and non-state actors in the policy process: the contribution of policy networks to the scale-up of antiretroviral therapy in Thailand. Health Policy Plan 2008, 23:328-338.
• [31]Jirawattanapisal T, Kingkaew P, Lee TJ, Yang MC: Evidence-based decision-making in Asia-Pacific with rapidly changing health-care systems: Thailand, South Korea, and Taiwan. Value Health 2009, 12(Suppl. 3):S4-11.
• [32]Thatte U, Hussain S, de-Rosas-Valera M, Malik MA: Evidence-based decision on medical technologies in Asia Pacific: experiences from India, Malaysia, Philippines, and Pakistan. Value Health 2009, 12(Suppl. 3):S18-25.
• [33]Gessner BD, Duclos P, Deroeck D, Nelson EA: Informing decision makers: experience and process of 15 national immunization technical advisory groups. Vaccine 2010, 28(Suppl. 1):A1-5.
• [34]Burchett HE, Mounier-Jack S, Griffiths UK, Mills AJ: National decision-making on adopting new vaccines: a systematic review. Health Policy Plan 2012, 27(Suppl. 2):ii62-76.
• [35]Albert MA, Fretheim A, Maiga D: Factors influencing the utilization of research findings by health policy-makers in a developing country: the selection of Mali’s essential medicines. Health Res Policy Syst 2007, 5:2. BioMed Central Full Text
• [36]Tomson G, Paphassarang C, Jonsson K, Houamboun K, Akkhavong K, Wahlstrom R: Decision-makers and the usefulness of research evidence in policy implementation–a case study from Lao PDR. Soc Sci Med 2005, 61:1291-1299.
• [37]Hornby P, Perera HS: A development framework for promoting evidence-based policy action: drawing on experiences in Sri Lanka. Int J Health Plann Manage 2002, 17:165-183.
• [38]Rommelmann V, Setel PW, Hemed Y, Angeles G, Mponezya H, Whiting D, Boerma T: Cost and results of information systems for health and poverty indicators in the United Republic of Tanzania. Bull World Health Organ 2005, 83:569-577.
• [39]Gething PW, Noor AM, Goodman CA, Gikandi PW, Hay SI, Sharif SK, Atkinson PM, Snow RW: Information for decision making from imperfect national data: tracking major changes in health care use in Kenya using geostatistics. BMC Med 2007, 5:37. BioMed Central Full Text
• [40]WHO: Integrated Disease Surveillance and Response: A Regional Strategy for Communicable Diseases. Africa Regional Office, Harare: World Health Organization; 1999.
• [41]Kabatereine NB, Malecela M, Lado M, Zaramba S, Amiel O, Kolaczinski JH: How to (or not to) integrate vertical programmes for the control of major neglected tropical diseases in sub-Saharan Africa. PLoS Negl Trop Dis 2010, 4:e755.
• [42]Lodenstein E, Dao D: Devolution and human resources in primary healthcare in rural Mali. Hum Resour Health 2011, 9:15. BioMed Central Full Text
• [43]Africa Health Workforce Observatory. http://www.hrh-observatory.afro.who.int/ webcite
• [44]Chopra M, Munro S, Lavis JN, Vist G, Bennett S: Effects of policy options for human resources for health: an analysis of systematic reviews. Lancet 2008, 371:668-674.
• [45]Joint Learning Initiative: Human Resources for Health: Overcoming the Crisis. Cambridge, MA: Harvard University Press; 2004.
• [46]WHO: World health report 2006: working together for health. In Word Health Report. Geneva: World Health Organization; 2006.
• [47]Beaglehole R, Dal Poz MR: Public health workforce: challenges and policy issues. Hum Resour Health 2003, 1:4. BioMed Central Full Text
• [48]WHO: Increasing access to health workers in remote and rural areas through improved retention. In Global Policy Recommendations. Geneva: World Health Organization; 2010.
• [49]Gilson L, McIntyre D: The interface between research and policy: experience from South Africa. Soc Sci Med 2008, 67:748-759.
• [50]Gilson L, Bowa C, Brijlal V, Doherty J, Antezana I, Daura M, Lake S, Mbatsha S, McIntyre D, Mabandhla M, Masiye F, Mulenga S, Mwikisa C, Odegaard K, Thomas S: The Dynamics of Policy Change: Lessons from Health Financing Reform in South Africa and Zambia. Bethesda, MD: Abt Associates Inc.; 2000.
• [51]Gilson L, Doherty J, Lake S, McIntyre D, Mwikisa C, Thomas S: The SAZA study: implementing health financing reform in South Africa and Zambia. Health Policy Plan 2003, 18:31.
• [52]Agyepong IA, Adjei S: Public social policy development and implementation: a case study of the Ghana national health insurance scheme. Health Policy Plan 2008, 23:150-160.
• [53]Tangcharoensathien V, Wibulpholprasert S, Nitayaramphong S: Knowledge-based changes to health systems: the Thai experience in policy development. Bull World Health Organ 2004, 82:750-756.
• [54]Knaul FM, Arreola-Ornelas H, Mendez-Carniado O, Bryson-Cahn C, Barofsky J, Maguire R, Miranda M, Sesma S: Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. Lancet 2006, 368:1828-1841.
• [55]Gonzalez Block MA: Leadership, institution building and pay-back of health systems research in Mexico. Health Res Policy Syst 2009, 7:22. BioMed Central Full Text
• [56]Moynihan R, Oxman A, Lavis J, Paulsen E: Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier. Oslo: Norwegian Knowledge Center for the Health Services; 2008.
• [57]Huss R, Green A, Sudarshan H, Karpagam S, Ramani K, Tomson G, Gerein N: Good governance and corruption in the health sector: lessons from the Karnataka experience. Health Policy Plan 2011, 26:471-484.
• [58]Harpham T, Tuan T: From research evidence to policy: mental health care in Viet Nam. Bull World Health Organ 2006, 84:664-668.
• [59]Zwi AB, Blignault I, Bunde-Birouste AW, Ritchie JE, Silove DM: Decision-makers, donors and data: factors influencing the development of mental health and psychosocial policy in the Solomon Islands. Health Policy Plan 2011, 26:338-348.
• [60]Alonso A, Brugha R: Rehabilitating the health system after conflict in East Timor: a shift from NGO to government leadership. Health Policy Plan 2006, 21:206-216.
• [61]Stone D: Policy Paradox: The Art of Political Decision Making. 3rd edition. London: W.W. Norton & Company Ltd.; 2012.
• [62]Pang T, Sadana R, Hanney S, Bhutta ZA, Hyder AA, Simon J: Knowledge for better health: a conceptual framework and foundation for health research systems. Bull World Health Organ 2003, 81:815-820.
• [63]Kok MO, Schuit AJ: Contribution mapping: a method for mapping the contribution of research to enhance its impact. Health Res Policy Syst 2012, 10:21. BioMed Central Full Text
• [64]Koon AD, Mayhew SH: Strengthening the health workforce and rolling out universal health coverage: the need for policy analysis. Glob Health Action 2013, 6:21852.