Limits...
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.

Show MeSH

Related in: MedlinePlus

The four dimensions of embeddedness.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3750690&req=5

Figure 2: The four dimensions of embeddedness.

Mentions: In Figure 2, the ring surrounding the decision-making sphere is explored in greater detail. Here, we attempt to marry the dimensions or attributes of embedded organizations in a network with the generic configuration of research organizations in LMICs (shown in Figure 1); these dimensions are essential for evidence to penetrate the decision-making sphere. The first two dimensions describe the quantity and quality of organizational connections. If a given organization has several linkages to decision-makers, as well as other organizations within the network, then it is more likely to have greater centrality and embeddedness in the network. The “quality” of these connections also matter – an organization that has links with another highly central organization in the network will possess at least as high a degree of embeddedness[13]. Also, strong links to decision-makers, or highly influential decision-makers, greatly enhance the degree to which an organization becomes embedded in the flow of evidence into policy. We discussed the third dimension earlier, when we defined “reputation” as the perception that an organization produces quality outputs for others within its domain. Reputable organizations and their products, therefore, are much more likely to be embedded and can command the attention of decision-makers. Reputable organizations may, however, produce reliable and relevant evidence in only select domains (building blocks). For this reason, we introduce the fourth dimension of capacity. Organizations that have the capacity to produce timely, accurate evidence to meet the needs of decision-makers are more likely to be embedded organizations; this type of evidence is largely HPSR. Further, we hypothesize that organizations that produce HPSR within a few given health system building block(s) tend to possess a lower degree of embeddedness than organizations that produce HPSR across more or all domains.


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)

The four dimensions of embeddedness.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: The four dimensions of embeddedness.
Mentions: In Figure 2, the ring surrounding the decision-making sphere is explored in greater detail. Here, we attempt to marry the dimensions or attributes of embedded organizations in a network with the generic configuration of research organizations in LMICs (shown in Figure 1); these dimensions are essential for evidence to penetrate the decision-making sphere. The first two dimensions describe the quantity and quality of organizational connections. If a given organization has several linkages to decision-makers, as well as other organizations within the network, then it is more likely to have greater centrality and embeddedness in the network. The “quality” of these connections also matter – an organization that has links with another highly central organization in the network will possess at least as high a degree of embeddedness[13]. Also, strong links to decision-makers, or highly influential decision-makers, greatly enhance the degree to which an organization becomes embedded in the flow of evidence into policy. We discussed the third dimension earlier, when we defined “reputation” as the perception that an organization produces quality outputs for others within its domain. Reputable organizations and their products, therefore, are much more likely to be embedded and can command the attention of decision-makers. Reputable organizations may, however, produce reliable and relevant evidence in only select domains (building blocks). For this reason, we introduce the fourth dimension of capacity. Organizations that have the capacity to produce timely, accurate evidence to meet the needs of decision-makers are more likely to be embedded organizations; this type of evidence is largely HPSR. Further, we hypothesize that organizations that produce HPSR within a few given health system building block(s) tend to possess a lower degree of embeddedness than organizations that produce HPSR across more or all domains.

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