Contextual influences on the role of evidence in health policy development: what can we learn from six policies in India and Nigeria?

Mirzoev, Tolib; Das, Madhusweta; Ebenso, Bassey; Uzochukwu, Benjamin; Rawat, Bindiya; Blok, Lucie; Russo, Giuliano; Thepthien, Bang On; Huss, Reinhard

doi:10.1332/174426415x14454407579925

Cited by 24 publications

(31 citation statements)

References 19 publications

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“…It is interesting to note here that as opposed to child mortality quantitative data and charts, critical incidence evidence was chosen as adequate evidence for advocacy. Actors’ preferences for different types of evidence for policy have been noted to be influenced by among other things the characteristics of evidence itself, actors’ roles in the evidence process, and their perception of the importance of the evidence [ 44 , 45 ]. Where there is no such evidence, policymakers and political elites may ignore the issue either because they are unaware of the existence of the problem [ 37 ] or such evidence vacuum can be filled by less credible evidence.…”

Section: Discussionmentioning

confidence: 99%

What makes advocacy work? Stakeholders’ voices and insights from prioritisation of maternal and child health programme in Nigeria

Uzochukwu

Onyedinma

Okeke

et al. 2020

BMC Health Serv Res

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Background The Nigerian government introduced and implemented a health programme to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015 and was followed by increased advocacy for sustaining the MCH (antenatal, delivery, postnatal and immunization) services as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization, and bringing different forces/actors together. Therefore, the study set out to understand how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcomes. Methods The study used a Realist Evaluation design through a mixed quantitative and qualitative methods case study approach. The programme theory (PT) was developed from three substantive social theories (power politics, media influence communication theory, and the three-streams theory of agenda-setting), data and programme design documentation, and subsequently tested. We report information from 22 key informant interviews including national and State policy and law makers, policy implementers, CSOs, Development partners, NGOs, health professional groups, and media practitioners and review of relevant documents on advocacy events post-SURE-P. Results Key advocacy organizations and individuals including health professional groups, the media, civil society organizations, powerful individuals, and policymakers were involved in advocacy activities. The nature of their engagement included organizing workshops, symposiums, town hall meetings, individual meetings, press conferences, demonstrations, and engagements with media. Effective advocacy mechanism involved alliance brokering to increase influence, the media supporting and engaging in advocacy, and the use of champions, influencers, and spouses (Leadership and Elite Gendered Power Dynamics). The key contextual influences which determined the effectiveness of advocacy measures for MCH included the political cycle, availability of evidence on the issue, networking with powerful and interested champions, and alliance building in advocacy. All these enhanced the entrenchment of MCH on the political and financial agenda at the State and Federal levels. Conclusions Our result suggest that advocacy can be a useful tool to bring together different forces by allowing expression of voices and ensuring accountability of different actors including policymakers. In the context of poor health outcomes, interest from policymakers and politicians in MCH, combined with advocacy from key policy actors armed with evidence, can improve prioritization and sustained implementation of MCH services.

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Section: Discussionmentioning

confidence: 99%

What makes advocacy work? Stakeholders’ voices and insights from prioritisation of maternal and child health programme in Nigeria

Uzochukwu

Onyedinma

Okeke

et al. 2020

BMC Health Serv Res

Self Cite

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“…It is interesting to note here that as opposed to child mortality quantitative data and charts, critical incidence evidence was chosen as adequate evidence for advocacy. Actors' preferences for different types of evidence for policy have been noted to be in uenced by among other things the characteristics of evidence itself, actors' roles in the evidence process, and their perception of the importance of the evidence [45,46]. Where there is no such evidence, policymakers and political elites may ignore the issue either because they are unaware of the existence of the problem [38] or such evidence vacuum can be lled by less credible evidence.…”

Section: Discussionmentioning

confidence: 99%

What makes advocacy work? Stakeholders’ voices and insights from prioritisation of Maternal and Child Health programme in Nigeria

Uzochukwu¹,

Onyedinma

Okeke

et al. 2020

Preprint

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Background: The Nigerian government introduced and implemented a health programme to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015 and was followed by increased advocacy for sustaining the MCH (antenatal, delivery, postnatal and immunization) services as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization, and bringing different forces/actors together. Therefore, the study set out to understand how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcomes. Methods: The study used a Realist Evaluation design through a mixed quantitative and qualitative methods case study approach. The programme theory (PT) was developed from three substantive social theories (power politics, media influence communication theory, and the three-streams theory of agenda-setting), data and programme design documentation, and subsequently tested. We report information from 22 key informant interviews including national and State policy and law makers, policy implementers, CSOs, Development partners, NGOs, health professional groups, and media practitioners and review of relevant documents on advocacy events post-SURE-P. Results: Key advocacy organizations and individuals including health professional groups, the media, civil society organizations, powerful individuals, and policymakers were involved in advocacy activities. The nature of their engagement included organizing workshops, symposiums, town hall meetings, individual meetings, press conferences, demonstrations, and engagements with media. Effective advocacy mechanism involved alliance brokering to increase influence, the media supporting and engaging in advocacy, and the use of champions, influencers, and spouses (Leadership and Elite Gendered Power Dynamics). The key contextual influences which determined the effectiveness of advocacy measures for MCH included the political cycle, availability of evidence on the issue, networking with powerful and interested champions, and alliance building in advocacy. All these enhanced the entrenchment of MCH on the political and financial agenda at the State and Federal levels. Conclusions: Our result suggest that advocacy can be a useful tool to bring together different forces by allowing expression of voices and ensuring accountability of different actors including policymakers. In the context of poor health outcomes, interest from policymakers and politicians in MCH, combined with advocacy from key policy actors armed with evidence, can improve prioritization and sustained implementation of MCH services.

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“…Mirzoev et al emphasized that contextual differences should be considered in health policymaking. This study exemplified India and Nigeria in this regard and stated that although health policymaking is often centralized at the national level in both countries, there is enough flexibility in the local level to develop their own unique health policies (17).…”

Section: Discussionmentioning

confidence: 99%

Perceived gaps in early childhood development-related health policies in Iran: Findings from a qualitative exploratory study

Atashbahar

Sari

Takian

et al. 2019

Med. J. Islam. Republ. Iran

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There are different sporadic policies related to ECD in Iran and there are some barriers in various sectors that impede the optimal development of children. →What this article adds: For the first time in Iran, in this study, health sector policies were investigated from the perspective of ECD. Also, this study showed that there is a need for an integrated and comprehensive approach in policymaking for ECD. Emphasizing the importance of ECD in social development policies and tackling with existing inequalities were other important issues that need the due attention of the policymakers.

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Contextual influences on the role of evidence in health policy development: what can we learn from six policies in India and Nigeria?

Cited by 24 publications

References 19 publications

What makes advocacy work? Stakeholders’ voices and insights from prioritisation of maternal and child health programme in Nigeria

What makes advocacy work? Stakeholders’ voices and insights from prioritisation of maternal and child health programme in Nigeria

What makes advocacy work? Stakeholders’ voices and insights from prioritisation of Maternal and Child Health programme in Nigeria

Perceived gaps in early childhood development-related health policies in Iran: Findings from a qualitative exploratory study

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