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

Koon AD, Rao KD, Tran NT, Ghaffar A - Health Res Policy Syst (2013)

Bottom Line: The results of the literature review were organized according to the World Health Organization's Building Blocks Framework.We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. adam.koon@lshtm.ac.uk

ABSTRACT
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.

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Evidence-generating organizations in LMIC health systems.
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Figure 1: Evidence-generating organizations in LMIC health systems.

Mentions: The organizational arrangement for producing research across countries can be conceptualized through a generic framework as depicted in FigureĀ 1. Here, the different agents that produce HPSR are placed in concentric circles with decision-makers at the core. This model situates research-producing institutions in relative proximity to those making health policy decisions. The innermost ring consists of government organizations, such as special committees, research units, and advisory bodies. In this ring, actors tend to commission or actively source HPSR from the surrounding environment rather than conducting empirical HPSR themselves. They are shown outside the decision-making sphere in this diagram because their primary responsibility is to assist, not make, decisions in the health sector; however, the distinction is not always clear in some countries. The next circle consists of government-supported research organizations such as agencies, universities, think tanks, and individuals who are funded or technically assisted by the government but not directly part of it. The outer most layer consists of independent research institutions which are privately funded and managed like those belonging to multi-lateral and bi-lateral agencies, universities, NGOs, and research consortia. While proximity to decision-makers or government could increase the embeddedness of HPSR organizations, it is not necessarily the case. Decision-makers do not operate in isolation and the ring around the decision-making sphere serves as a filter for evidence absorbed into the policy process from the surrounding layers.


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

Koon AD, Rao KD, Tran NT, Ghaffar A - Health Res Policy Syst (2013)

Evidence-generating organizations in LMIC health systems.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750690&req=5

Figure 1: Evidence-generating organizations in LMIC health systems.
Mentions: The organizational arrangement for producing research across countries can be conceptualized through a generic framework as depicted in FigureĀ 1. Here, the different agents that produce HPSR are placed in concentric circles with decision-makers at the core. This model situates research-producing institutions in relative proximity to those making health policy decisions. The innermost ring consists of government organizations, such as special committees, research units, and advisory bodies. In this ring, actors tend to commission or actively source HPSR from the surrounding environment rather than conducting empirical HPSR themselves. They are shown outside the decision-making sphere in this diagram because their primary responsibility is to assist, not make, decisions in the health sector; however, the distinction is not always clear in some countries. The next circle consists of government-supported research organizations such as agencies, universities, think tanks, and individuals who are funded or technically assisted by the government but not directly part of it. The outer most layer consists of independent research institutions which are privately funded and managed like those belonging to multi-lateral and bi-lateral agencies, universities, NGOs, and research consortia. While proximity to decision-makers or government could increase the embeddedness of HPSR organizations, it is not necessarily the case. Decision-makers do not operate in isolation and the ring around the decision-making sphere serves as a filter for evidence absorbed into the policy process from the surrounding layers.

Bottom Line: The results of the literature review were organized according to the World Health Organization's Building Blocks Framework.We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. adam.koon@lshtm.ac.uk

ABSTRACT
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.

Show MeSH
Related in: MedlinePlus