Table 3 Comparing mean differences in factors influencing the health policymaking process and use of evidence in the policymaking across the study countries (* indicates p-values <0.05, ** indicates p-values <0.001)

Factors influencing the health policymaking process

1-Lack of coordination in governmental/ministerial relations across different ministries (such as the Ministry of Health, Ministry of Finance, etc.) hindered the health policymaking process.

3.86 (1.02)

4.20 (0.70)

3.93 (0.95)

3.79 (0.92)

4.04 (0.90)

3.2 (1.62)

4.24 (0.87)*

4.27 (0.78)*

3.09 (1.24)*

3.5 (0.96)

3.56 (1.01)

2-Lack of coordination in government/ health provider relations hindered the health policymaking process.

3.62 (1.01)

3.55 (0.83)

3.76 (0.97)

3.82 (0.86)

4.04 (0.82)*

3.20 (1.40)

3.62 (1.12)

3.85 (0.78)

3.04 (1.19)*

3.45 (1.06)

3.00 (1.00)

3-Physician associations exerted a strong influence on the health policymaking process.

2.6 (1.17)

3.35 (1.14)

2.88 (1.10)

2.29 (0.94)

3 (1.07)

2.78 (0.97)

2.48 (1.30)

1.63 (0.79)**

2.14 (1.11)

2.68 (1.25)

3.33 (0.87)*

4-Nursing associations exerted a strong influence on the health policymaking process.

2.22 (0.91)

2.25 (0.79)

2.26 (0.83)

2.18 (0.82)

2.56 (0.85)*

2.67 (0.71)

2.14 (0.95)

1.46 (0.71)**

2.15 (1.09)

2.43 (0.98)

2.88 (0.84)

5-Other types of health professional associations exerted a strong influence on the health policymaking process (e.g., Syndicate of hospitals).

2.59 (1.07)

3.70 (0.80)**

2.67 (0.85)

2.11 (0.88)**

3 (1.18)

2.60 (0.70)

2.34 (0.90)

1.65 (0.85)**

2.19 (1.03)

3.14 (1.08)*

3.11 (0.93)

6-Private health providers exerted a strong influence on the health policymaking process.

2.87 (1.08)

3.60 (1.10)**

2.67 (1.03)

2.96 (1.14)

3.3 (1.03)*

3.30 (0.82)

2.96 (1.02)

2.37 (1.04)*

2.3 (0.88)*

2.71 (1.01)

3.00 (1.00)

7-Private insurers exerted a strong influence on the health policymaking process.

2.42 (1.06)

2.80 (0.95)

2.45 (0.92)

2.32 (0.91)

2.44 (1.03)

2.56 (0.88)

3.1 (1.29)*

1.92 (1.02)*

1.96 (0.98)*

2.09 (1.14)

2.33 (0.87)

8-Values of governing parties exerted a strong influence on the health policymaking process.

3.36 (1.22)

3.65 (1.39)

3.15 (1.04)

3.36 (1.22)

2.67 (1.8)*

3.70 (0.82)

4.00 (1.10)*

3.69 (1.09)

2.43 (1.29)*

3.5 (1.10)

4.22 (0.67)*

9-Public opinion exerted a strong influence on the health policymaking process.

3.04 (1.09)

2.80 (1.20)

2.67 (1.00)**

2.71 (1.08)

3.33 (1.11)

3.7 (0.82)*

3.34 (1.11)

2.81 (0.98)

3.43 (0.99)

3.00 (1.16)

3.44 (0.88)

10-Media exerted a strong influence on the health policymaking process.

3.21 (0.99)

3.40 (0.94)

2.95 (0.99)

2.79 (0.83)

3.67 (0.96)*

3.5 (1.18)

3.57 (1.10)

3.11 (0.93)

3.13 (1.14)

3.14 (0.77)

3.22 (0.67)

11-Research about problems related to healthcare or health systems exerted a strong influence on the health policymaking process.

3.17 (1.13)

3.30 (0.92)

3.12 (1.13)

2.79 (1.20)

2.96 (1.13)

3.5 (0.97)

3.54 (1.04)

2.81 (1.15)

3.78 (1.09)*

2.82 (1.18)

3.78 (0.83)

12-Limited public funding for the health sector exerted a strong influence on the health policymaking process.

4.05 (1.10)

4.25 (0.91)

3.81 (1.38)

4.21 (0.79)

3.63 (1.25)

4.3 (1.25)

4.52 (0.68)*

4.3 (0.95)

3.78 (1.20)

3.86 (1.13)

4.00 (0.87)

13-Other countries’ health policies exerted a strong influence on the health policymaking process.

3.14 (1.00)

2.85 (0.99)

2.76 (0.87)**

3.54 (0.92)

3.37 (0.74)

3.2 (1.03)

3.21 (1.15)

2.96 (0.96)

3.61 (0.94)*

2.95 (1.24)

3.00 (0.87)

14-Donor organizations (e.g., United States Agency for International Development (USAID), United Nations, World Bank, World Health Organization (WHO)) exerted a strong influence on the health policymaking process.

3.83 (1.01)

4.00 (0.97)

3.86 (0.84)

4.32 (0.82)

4.00 (1.04)

3.2 (0.92)

4.07 (0.84)

4.04 (0.90)

3.43 (1.16)

3.14 (1.17)*

3.22 (1.09)

Use of evidence in the health policymaking process

1-I generally look and/or ask for scientific evidence to support my work in formulating and implementing health policies.

4.28 (0.80)

4.70 (0.47)*

4.2 (0.93)

4.36 (0.68)

4.04 (0.76)

4.5 (0.53)

4.52 (0.51)*

3.96 (1.02)

4.48 (0.67)

3.95 (0.95)

4.33 (0.71)

2-I have access to health research through an internet connection at my organization.

3.94 (1.06)

3.75 (1.21)

3.98 (1.28)

4.18 (0.77)

3.81 (1.04)

4.4 (0.70)

4.21 (0.86)

3.63 (1.15)

3.74 (1.14)

3.68 (1.08)

4.44 (0.53)*

3-There are contact and collaborative relations between researchers and health policymakers/ decision makers in my organization.

3.15 (1.07)

3.45 (1.15)

3.17 (1.14)

3.39 (0.99)

2.74 (0.98)*

3.8 (0.63)*

3.14 (0.89)

2.63 (1.15)*

3.3 (1.11)

3.1 (1.07)

3.44 (1.13)

4-I participated in meetings with researchers to identify high-priority policy issues for which research is needed to inform how to address these issues.

3.71 (1.06)

4.15 (0.49)*

3.63 (1.22)

3.82 (0.86)

3.37 (1.18)

4 (0.82)

4.07 (0.96)

3.31 (1.16)

3.65 (1.23)

3.41 (0.96)

4.44 (0.53)*

5-Health policymakers request scientific evidence in the policymaking process.

3.26 (1.09)

3.75 (1.07)

3.22 (1.13)

3.07 (1.09)

2.81 (1.11)*

4.2 (0.63)*

3.07 (1.00)

2.93 (1.21)

3.35 (0.89)

3.50 (1.01)

4.00 (0.87)*

6-The scientific evidence is delivered at the right time.

2.77 (1.01)

2.7 (0.92)

2.9 (1.06)

2.75 (0.80)

2.56 (0.89)

3.6 (0.52)*

2.48 (0.98)

1.85 (0.77)**

3.00 (0.91)

3.52 (1.03)*

3.33 (1.00)

7-There are summaries of evidence with messages that specify possible actions about health policies issues I confronted in my organization.

2.96 (1.08)

3.1 (1.07)

3 (1.13)

3.14 (1.01)

2.7 (0.91)

3.1 (0.99)

2.93 (1.00)

2.41 (1.19)*

3.09 (1.20)

3.41 (1.01)*

2.89 (1.05)

8-The available scientific evidence provides sufficient information on the impacts, costs and concrete benefits of the studied or soon-to-implement health policies.

3.04 (1.05)

3.15 (1.04)

2.83 (1.16)

3.00 (1.05)

2.69 (0.88)

3.6 (0.70)*

3.07 (1.10)

2.67 (1.07)

3 (1.02)

3.64 (0.79)*

3.89 (0.60)*

9-The available scientific evidence is delivered with information about its quality and local applicability.

2.87 (1.05)

3.2 (1.06.)

2.83 (1.05)

2.96 (1.11)

2.62 (0.94)

3.5 (0.71)*

2.69 (1.11)

2.22 (0.97)*

2.95 (0.95)

3.23 (0.92)

3.63 (0.92)

10-There is a sufficient quantity of health research that may contribute to inform the health policymaking/decision making process.

3.02 (1.14)

3.25 (1.12)

3.05 (1.16)

3.04 (1.09)

2.58 (1.14)

3.1 (1.10)

3.1 (1.08)

2.68 (1.25)

2.78 (1.04)

3.5 (0.96)*

3.56 (1.33)

11-There are clearly identified places to find or to ask for scientific evidence that may inform the health policymaking/decision making process.

3.15 (1.09)

3.7 (0.92)*

3.24 (1.14)

3.21 (0.92)

2.69 (1.16)

3.9 (0.74)*

3.07 (1.03)

2.56 (0.89)*

2.7 (1.19)

3.64 (1.00)*

3.78 (0.67)*

12-Health policymakers use scientific evidence in the policymaking process whenever it is available and supplied to them.

3.29 (1.02)

3.3 (1.17)

3.17 (1.18)

2.86 (1.08)*

3.00 (0.98)

3.9 (0.32)**

3.59 (0.83)

3.11 (1.05)

3.96 (0.64)**

3.23 (0.81)

3.44 (1.01)

13-I have received training to acquire, assess the quality and local applicability of scientific evidence, and apply scientific evidence in health policymaking/decision making.

3.26 (1.28)

3.45 (1.40)

3.22 (1.17)

3.50 (1.00)

2.96 (1.37)

3.6 (1.43)

3.54 (1.32)

2.81 (1.42)

3 (1.35)

3.64 (1.09)

3 (1.32)

14-There is explicit budget or funding for both research and evidence- informed health policymaking within my organization.

2.54 (1.13)

2.55 (1.19)

2.61 (1.16)

2.43 (1.17)

2.15 (0.86)*

2.9 (0.99)

2.34 (0.94)

2.44 (1.42)

2.7 (1.02)

3.05 (1.17)

2.67 (1.12)

15-There is an administrative structure suitable to support an evidence- informed health policymaking process (for example; a policy analysis department or a decision support unit, or the availability of resources, incentives and time for the use of scientific evidence in health policymaking).

2.62 (1.18)

2.45 (1.00)

3.18 (1.26)*

2.54 (1.11)

2 (0.83)*

3.3 (1.06)

2.66 (1.05)

2.33 (1.24)

2.26 (1.25)

2.86 (1.28)

2.89 (0.93)

16-The political actors related with health (political parties, ministers, parliament, other ministries, etc.) value the use of scientific evidence in the policymaking process.

2.81 (1.11)

2.5 (1.15)

2.78 (1.39)

2.82 (1.25)

2.85 (0.99)

3.1 (0.57)

2.76 (1.15)

2.56 (0.97)

3.14 (0.94)

2.73 (0.93)

3.56 (0.73)*