Abstract
The evidence-based policy (EBP) movement has received significant attention in the scientific literature; however, there is still very little empirical research to provide insight into how policy decisions are made and how evidence is used. The lack of research on this topic in low- and middle-income countries is of particular note. We examine the maternity waiting home policy in Timor-Leste to understand the role of context, policy characteristics, individual actors, and how evidence is used to influence the policy agenda. The research tracked the maternity waiting home policy from 2005 to 2009 and is based on in-depth interviews with 31 senior policy-makers, department managers, non-government organization representatives, and United Nations advisors. It is also informed by direct observation, attendance at meetings and workshops, and analysis of policy documents. The findings from this ethnographic case study demonstrate that although the post-conflict context opened up space for new policy ideas senior Ministry of Health officials rather than donors had the most power in setting the policy agenda. Maternity waiting homes were appealing because they were a visible, non-controversial, and logical solution to the problem of accessing maternal health services. Evidence was used in a variety of ways, from supporting pre-determined agendas to informing new policy directions. In the pursuit of EBP, we conclude that the power of research to inform policy lies in its timeliness and relevance, and is facilitated by the connection between researchers and policy-makers.
Highlights
In order to improve public health outcomes, the need for evidence-based policy (EBP) has gained prominence over the last two decades
Context The crisis situation in Timor-Leste after the 1999 referendum resulted in many non-government organizations (NGOs) and United Nations (UN) agencies entering the country, each of whom brought new ideas, agendas, and resources
New policy options were introduced through UN agency representatives and the East Timorese Health Professionals Working Group
Summary
In order to improve public health outcomes, the need for evidence-based policy (EBP) has gained prominence over the last two decades. EBP promotes a rational and coordinated approach to policy-making based on a comprehensive assessment of research to build an evidence base [1]. In this sense, evidence is the culmination of knowledge based on rigorous scientific research. Maternal health policy in Timor-Leste the common barriers to using research across all three reviews were: 1. Oliver et al [2] point to the lack of ethnographic and anthropological approaches to policy analysis. An in-depth analysis of the maternity waiting home policy in Timor-Leste helps to illuminate the complex processes behind policy decisions and the use of evidence in post-conflict and low-resource settings
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