- Oral presentation
- Open Access
Contextual influences on the role of evidence in health policy development: insights from India and Nigeria
BMC Health Services Research volume 14, Article number: O5 (2014)
The context is a complex and important influence on decision-making, affecting degree of responsiveness and people-centred health systems. Although theoretical frameworks to understand context are available, limited empirical research exists exploring contextual influences on evidence-informed health policymaking. This presentation compares contextual influences on the role of evidence in health policy development within two large countries within their continents: India and Nigeria.
Materials and methods
In each country, the contextual influences on the development of three specific health policies were explored. The study was guided by a conceptual framework, developed from the literature. Context includes factors at three levels: macro (e.g. political and resource environment), meso (e.g. organisation’s roles and practices) and micro (e.g. individual values and preferences). Data was collected using 72 in-depth interviews with key policy actors and document reviews, and analysed using framework approach.
All policies were perceived as evidence-informed. Both formal (e.g. research) and informal (e.g. experiences) evidence was used in India; in Nigeria reliance was mostly on formal evidence. Key macro-level facilitators of evidence-informed decisions were international treaties driving reform agendas, leadership changes and political will. Key constraints included limited resources and opposition from powerful actors. At meso-level, civil society was particularly influential in India; whereas international agencies had greater role in policy decisions, including evidence use, in Nigeria. At micro-level, individuals had different understandings of what constitutes ‘robust’ evidence for policymaking, shaping their evidence preferences and decision-making practices.
Understanding context is essential in ensuring responsiveness of policy decisions to the needs of key policy actors within people-centred systems, for example through recognising actors’ agendas and interests. Powerful civil society can catalyse greater recognition of citizens voice through communicating informal evidence, as we found in India; and influential donors can favour costly surveys, thus undermining use of evidence from government health information systems, as in Nigeria.
About this article
Cite this article
Mirzoev, T., Das, M., Ebenso, B. et al. Contextual influences on the role of evidence in health policy development: insights from India and Nigeria. BMC Health Serv Res 14, O5 (2014). https://doi.org/10.1186/1472-6963-14-S2-O5
- Civil Society
- Health Information System
- Contextual Influence
- Reform Agenda
- Leadership Change