Wednesday, March 7, 2012

[EQ] Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development

Guidance for Evidence-Informed Policies about Health Systems:
Rationale for and Challenges of Guidance Development

In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.

Xavier Bosch-Capblanch 1,2*, John N. Lavis 3, Simon Lewin 4, Rifat Atun 5, John-Arne Røttingen 4,6, Daniel Dröschel 1,2, Lise Beck 1,2, Edgardo Abalos 7, Fadi El-Jardal i8, Lucy Gilson 9, Sandy Oliver 10, Kaspar Wyss 1,2, Peter Tugwell 11, Regina Kulier 12, Tikki Pang 12, Andy Haines 13

1 Swiss Tropical and Public Health Institute, Basel, Switzerland, 2 University of Basel, Basel, Switzerland, 3 McMaster Health Forum, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and Department of Political Science, McMaster University, Hamilton, Ontario, Canada, 4 Norwegian Knowledge Centre for the Health Services, Oslo, Norway, and Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa, 5 Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland, 6 Harvard Kennedy School, Cambridge, Massachusetts, United States of America, 7 Centro Rosarino de Estudios Perinatales, Rosario, Argentina, 8 Department of Health Policy and Management, American University of Beirut, Beirut, Lebanon, and McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada, 9 School of Public Health, University of Cape Town and Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom, 10 EPPI-Centre, Social Science Research Unit, Institute of Education, London, United Kingdom, 11 Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada, 12 Innovation, Information, Evidence and Research, World Health Organization, Geneva, Switzerland, 13 Departments of Social and Environmental Health Research and of Nutrition and Public Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom

PLoS Med 9(3): e1001185. doi:10.1371/journal.pmed.1001185 -  March 6, 2012

Available online at:

Summary Points

Weak health systems hinder the implementation of effective interventions; policies to strengthen such systems need to draw on the best available evidence.

Health systems evidence is best delivered in the form of guidance embedded in policy formulation processes, but health systems guidance is poorly developed at present.

The translation of research on problems, interventions, and implementation into decisions and policies that affect how systems are organised is one challenge facing the development of health systems guidance.

The development of guidance that is timely and usable by the broad range of health systems stakeholders, and of methods to appraise the quality of health systems guidance, are additional challenges.

Further research is needed to adapt existing approaches (e.g., those used in clinical guidelines) to produce meaningful advice that accounts for the complexity of health systems, political systems, and contexts.

This is the first paper in a three-part series in PLoS Medicine on health systems guidance.

This is one paper in a three-part series that sets out how evidence should be translated into guidance to inform policies on health systems and improve the delivery of clinical and public health interventions.


This paper, which is the first in a three-part series on health systems guidance aims to:

- Assess to what extent the need for health systems guidance is part of national policies and plans and
  how guidance is currently formulated by analyzing strategic health sector documents from LMICs;

- Describe the methodological challenges in outlining the approaches to produce health systems guidance and to suggest ways to address these challenges.

The second article in this series explores the challenge of linking guidance development and policy development at global and national levels and examines the range of factors that can influence policy development

The third article explores the challenge of assessing how much confidence to place in evidence on health systems interventions

Lavis JN, Røttingen JA, Bosch-Capblanch X, Atun R, El-Jardali F, et al. (2012)
Guidance for evidence-informed policies about health systems: linking guidance development to policy development.
PLoS Med 9: e1001186. doi:10.1371/journal.pmed.1001186.

Lewin S, Bosch-Capblanch X, Oliver S, Akl EA, Vist GE, Lavis J, Ghersi D, Røttingen JA, Steinmann P, Gulmezoglu M, Tugwell P, El-Jardali F, Haines A (2012) Guidance for evidence-informed policies about health systems: assessing how much confidence to place in the research evidence.
PLoS Med 9: e1001187. doi:10.1371/journal.pmed.1001187.



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