The many meanings of evidence: a comparative analysis of the forms and roles of evidence within three health policy processes in Cambodia (original) (raw)
Related papers
PLoS ONE, 2013
Background: There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making. Methods: We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review. Findings: 56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies. Conclusions: This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies.
Evidence Use in Health Policy Making
International Series on Public Policy, 2018
contributions to the field of public policy, dealing with analytical and substantive policy and governance issues across a variety of academic disciplines. A comparative and interdisciplinary venture, it examines questions of policy process and analysis, policymaking and implementation, policy instruments, policy change and reforms, politics and policy, encompassing a range of approaches, theoretical, methodological, and/or empirical. Relevant across the various fields of political science, sociology, anthropology, geography, history, and economics, this cutting edge series welcomes contributions from academics from across disciplines and career stages, and constitutes a unique resource for public policy scholars and those teaching public policy worldwide.
Journal of Hospital Administration, 2013
Calls for evidence-based health policy have gathered force as an extension of the movement for evidence-based medicine. In clinical medicine, major investment has been made in efforts to systematize the collection and analysis of data and distinguish effective interventions from those that are less likely to work. In contrast, there is little consensus on what data are needed and what research methods are suitable and acceptable to produce a robust evidence base for social policy in the health sector. Evidence gathering for health policy must synthesize diverse sources, recognize the extent to which context influences policy outcomes, accommodate potentially conflicting interests and be flexible enough to respond to the time and resources pressures that are at play. Despite the challenges, there is scope for the development of a methodology that can draw on a wide range of evidence sources while retaining sufficient scientific rigor. These sources should extend from data generated using causal methods (randomized controlled trials) to information that can shed light on the many contextual and political issues that are also pertinent to health policy decision making.
Health policy-makers' perceptions of their use of evidence: a systematic review
Journal of Health …, 2002
The empirical basis for theories and common wisdom regarding how to improve appropriate use of research evidence in policy decisions is unclear. One source of empirical evidence is interview studies with policymakers. The aim of this systematic review was to summarise the evidence from interview studies of facilitators of, and barriers to, the use of research evidence by health policy-makers.
Health Research Policy and Systems
Calls for evidence-informed public health policy-making often ignore that there are multiple, and often competing, bodies of potentially relevant evidence to which policy-makers have recourse in identifying policy priorities and taking decisions. In this paper, we illustrate how policy frames may favour the use of specific bodies of evidence. For the sixth Dutch Public Health Status and Foresight report (2014), possible future trends in population health and healthcare expenditure were used as a starting point for a deliberative dialogue with stakeholders to identify and formulate the most important societal challenges for the Dutch health system. Working with these stakeholders, we expanded these societal challenges into four normative perspectives on public health. These perspectives can be regarded as policy frames. In each of the perspectives, a specific body of evidence is favoured and other types of evidence are neglected. Crucial outcomes in one body may be regarded as irrele...
Health Policy and Planning, 2015
Increasing the use of evidence in policy making means strengthening capacity on both the supply and demand sides of evidence production. However, little experience of strengthening the capacity of policy makers in low-and middle-income countries has been published to date. We describe the experiences of five projects (in Bangladesh, Gambia, India and Nigeria), where collaborative teams of researchers and policy makers/policy influencers worked to strengthen policy maker capacity to increase the use of evidence in policy. Activities were focused on three (interlinked) levels of capacity building: individual, organizational and, occasionally, institutional. Interventions included increasing access to research/data, promoting frequent interactions between researchers and members of the policy communities, and increasing the receptivity towards research/data in policy making or policy-implementing organizations. Teams were successful in building the capacity of individuals to access, understand and use evidence/data. Strengthening organizational capacity generally involved support to infrastructure (e.g. through information technology resources) and was also deemed to be successful. There was less appetite to address the need to strengthen institutional capacity-although this was acknowledged to be fundamental to promoting sustainable use of evidence, it was also recognized as requiring resources, legitimacy and regulatory support from policy makers. Evaluation across the three spheres of capacity building was made more challenging by the lack of agreed upon evaluation frameworks. In this article, we propose a new framework for assessing the impact of capacity strengthening activities to promote the use of evidence/ data in policy making. Our evaluation concluded that strengthening the capacity of individuals and organizations is an important but likely insufficient step in ensuring the use of evidence/data in policy-cycles. Sustainability of evidence-informed policy making requires strengthening institutional capacity, as well as understanding and addressing the political environment, and particularly the incentives facing policy makers that supports the use of evidence in policy cycles.
Evidence-based health policy: context and utilisation
Social Science & Medicine, 2004
Evidence-based decision-making is centred on the justification of decisions. In the shift from an individual-clinical to a population-policy level, the decision-making context becomes more uncertain, variable and complex. To address this we have developed a conceptual framework for evidence-based decision-making, focusing on how context impacts on what constitutes evidence and how that evidence is utilised. We present two distinct orientations towards what constitutes evidence, representing different relationships between evidence and context. We also categorise the decisionmaking context based on the ways in which context impacts on evidence-based decision-making. Furthermore, we invoke the concept of axes of evidence-based decision-making to describe the relationship between evidence and context as we move from evidence-based medicine to evidence-based health policy. From this, we suggest that it may be more important how evidence is utilised than how it is defined. Based on the research and knowledge utilisation literature, we present a process model of evidence utilisation, which forms the basis for the conceptual framework for context-based evidence-based decision-making. The conceptual framework attempts to capture the role that context plays in the introduction, interpretation and application of evidence. We illustrate this framework with examples from policy development for colorectal cancer screening. r
In the Shadow of Politics: The Pathways of Research Evidence to Health Policy Making
Journal of Health Politics, Policy and Law, 2018
Research-based evidence has the potential to influence health policy making but its impact is contingent on a number of factors. Past analyses have underscored the role of politics in shaping policy choices, reflecting the nature of the social learning process and the access of political forces at every stage of the policy continuum from agenda formation to policy enactment and implication. This essay focuses on the mechanisms of the research evidence enterprise itself, delving directly into that what influences the pathways of research evidence into policy making taking into consideration both the production and consumption functions of such evidence. It presents a process model of the role of research evidence in policy making, examining in conceptual detail variations in the production of evidence in the research community; the communication through translation, framing, and other means of policy-relevant results; the methods of acquisition of the evidence by policy makers and their advisers; and the multiple ways in which evidence is put to use in policy decision making. I use examples from health care reform to illustrate features of the process model.
BMC Public …, 2012
Background: Use of evidence in health policymaking plays an important role, especially in resource-constrained settings where informed decisions on resource allocation are paramount. Several knowledge translation (KT) models have been developed, but few have been applied to health policymaking in low income countries. If KT models are expected to explain evidence uptake and implementation, or lack of it, they must be contextualized and take into account the specificity of low income countries for example, the strong influence of donors. The main objective of this research is to elaborate a Middle Range Theory (MRT) of KT in Uganda that can also serve as a reference for other low-and middle income countries.
Evidence-based policymaking: a critique
Perspectives in biology and medicine, 2009
The idea that policy should be based on best research evidence might appear to be self-evident. But a closer analysis reveals a number of problems and paradoxes inherent in the concept of "evidence-based policymaking." The current conflict over evidence-based policymaking parallels a long-standing "paradigm war" in social research between positivist, interpretivist, and critical approaches. This article draws from this debate in order to inform the discussions over the appropriateness of evidence-based policymaking and the related question of what is the nature of policymaking. The positivist, empiricist worldview that underpins the theory and practice of evidence-based medicine (EBM) fails to address key elements of the policymaking process. In particular, a narrowly "evidence-based" framing of policymaking is inherently unable to explore the complex, context-dependent, and value-laden way in which competing options are negotiated by individuals and interest groups. Sociolinguistic tools such as argumentation theory offer opportunities for developing richer theories about how policymaking happens. Such tools also have potential practical application in the policymaking process: by enhancing participants' awareness of their own values and those of others, the quality of the collective deliberation that lies at the heart of policymaking may itself improve.