Mapping the existing body of health policy implementation research in lower income settings: what is covered and what are the gaps?
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford University Press (OUP)
Abstract
This article uses 85 peer-reviewed articles published between 1994 and 2009 to
characterize and synthesize aspects of the health policy analysis literature focusing
on policy implementation in low- and middle-income countries (LMICs). It seeks
to contribute, first, to strengthening the field of LMIC health policy analysis by
highlighting gaps in the literature and generating ideas for a future research
agenda and, second, to thinking about the value and applicability of qualitative
synthesis approaches to the health policy analysis field. Overall, the article
considers the disciplinary perspectives from which LMIC health policy implementation
is studied and the extent to which the focus is on systems or programme issues. It then works with the more specific themes of the key thrusts of the reviewed articles, the implementation outcomes studied, implementation improvement recommendations made and the theories used in the reviewed articles. With respect to these more specific themes, the article includes explorations of patterns within the themes themselves, the contributions of specific disciplinary perspectives and differences between systems and programme articles. It concludes, among other things, that the literature remains small, fragmented, of limited depth and quite diverse, reflecting a wide spectrum of health system dimensions studied and many different suggestions for improving policy implementation. However, a range of issues beyond traditional ‘hardware’ health system concerns, such as funding and organizational structure, are understood to influence policy implementation, including many ‘software’ issues such as the understandings of policy actors and the need for better communication and actor relationships. Looking to the future, there is a need, given the fragmentation in the literature, to consolidate the existing body of work where possible and, given the often broad nature of the work and its limited depth, to draw more explicitly on theoretical frames and concepts to deepen work by sharpening and focusing concerns and questions.
Description
Keywords
Health policy analysis, LMIC, Policy implementation, Synthesis
Citation
Erasmus, E. et al. (2014). Mapping the existing body of health policy implementation research in lower income settings: what is covered and what are the gaps?. Health Policy and Planning, 29 ( 3):iii35-iii50