Research for stronger health systems during and after crisis

Engaging with the politics of policy: process and power


Date: October 10th 2018


About the session

This session comprises several oral presentations. Sophie Witter, of the Institute for Global Health and Development, Queen Margaret University, UK and ReBUILD, will present, What, why and how do health systems learn from one another? Insights from eight low and middle income country case studies.


What, why and how do health systems learn from one another? Insights from eight low and middle income country case studies.

Background to the presentation

All health systems struggle to meet health needs within constrained resources. This is especially true for low income countries. It is critical that they are able to learn from wider international lessons and insights in order to improve their performance. This study examines demand for international evidence, how it is (or is not) met and what barriers are perceived to exist. It draws on eight case studies from Africa, Asia, Europe and Oceania.


Case studies were selected from countries that were categorized as low income in 2000 and performed well in meeting MDG targets by 2015, and which represented a range of regions and also anglophone and francophone contexts. The counties selected were: Bangladesh, Burkina Faso, Cambodia, Ethiopia, Georgia, Nepal, Rwanda and Solomon Islands. One or two recent health system reforms were selected in each case to provide concrete examples for interrogation of whether and how international evidence had been used to guide the conceptualisation, formation and contextualisation, internalisation, operationalisation and evaluation of national policies, as well as how national policy experiences had been shared with others. 148 key informants were interviewed in 2017, using a semi-structured tool focused on different stages of the policy cycle. Interviewees were selected for their engagement in the policy process and represented political, technical, development partner, non-governmental, academic and civil society constituencies. Analysis took place initially by case study and then across the eight cases.


The policies adopted demonstrated a range of influences in relation to conceptualisation, from externally imposed to co-produced and finally home-grown solutions. Uptake of policy was strongly driven in most settings by local political economic considerations. Policy development post-adoption demonstrated some strong internal review, monitoring and sharing processes but there is a more contested view of the role of evaluation.  Many of the mechanisms which supported learning were facilitated by direct personal relationships with local development partner staff. Barriers and facilitators included a range of supply and demand factors. Those relating to incentives and capacity for evidence use appeared most powerful.


The findings emphasise the agency of local players and the importance of developing national and sub-national institutions for gathering, filtering and sharing evidence. Developing demand for and capacity to use evidence appears more important than augmenting supply, although specific gaps were identified. The findings also highlight the importance of the local political economy in setting parameters within which evidence is considered.


Ian Anderson, Peter Annear, Abiodun Awosusi, Nitin N Bhandari, Nouria Brikci, Blandine Binachon, Tata Chanturidze, Katherine Gilbert, Charity Jensen, Tomas Lievens, Snehashish Raichowdhury and Alex Jones.