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Contextual influences on the role of evidence in health policy development: insights from India and Nigeria

  • Tolib Mirzoev
  • Mahua Das
  • Bassey Ebenso
  • Bindiya Rawat
  • Nkoli Uguru
  • Giuliano Russo
  • Roger Bymolt
  • Reinhard Huss
Open Access
Oral presentation

Keywords

Civil Society Health Information System Contextual Influence Reform Agenda Leadership Change 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Background

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.

Results

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.

Conclusions

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.

Copyright information

© Mirzoev et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Tolib Mirzoev
    • 1
  • Mahua Das
    • 1
  • Bassey Ebenso
    • 1
  • Bindiya Rawat
    • 2
  • Nkoli Uguru
    • 3
  • Giuliano Russo
    • 4
  • Roger Bymolt
    • 5
  • Reinhard Huss
    • 1
  1. 1.University of LeedsLeedsUK
  2. 2.Association for Stimulating Know HowNew DelhiIndia
  3. 3.College of Medicine, University of Nigeria Enugu CampusEnuguNigeria
  4. 4.Instituto de Higiene e Medicina TropicalLisbonPortugal
  5. 5.Royal Tropical InstituteAmsterdamThe Netherlands

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