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.
Highlights
As health systems have become more complex and public demands for accountability have increased, the salience of health system performance has grown [1]
We develop a conceptual model that identifies the organizational characteristics that facilitate the embedding of health policy and systems research (HPSR) into decision-making and their interaction with decisionmakers in low- and middle-income country (LMIC) health systems
We hypothesized that the quantity, quality, and relevance of HPSR, as well as legislation governing its use would influence the extent to which HPSR was embedded into decision-making in LMICs
Summary
As health systems have become more complex and public demands for accountability have increased, the salience of health system performance has grown [1]. The current international emphasis on evaluating performance has positioned health policy and systems research (HPSR) as an important vehicle for promoting evidence-informed decision-making [2]. Recent work has elucidated how unique organizational arrangements can facilitate this exchange [3,4]. We explore the “embeddedness” of HPSR in decision-making processes in health. We develop a conceptual model that identifies the organizational characteristics that facilitate the embedding of HPSR into decision-making and their interaction with decisionmakers in low- and middle-income country (LMIC) health systems. In identifying dimensions of embeddedness, this work raises important considerations for decision-makers, planners, and researchers alike
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