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      Health policy analysis in Eastern Mediterranean region using a health policy triangle framework: Historical and ethical insights from a systematic review

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          Summary

          Background

          Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization.

          Methods

          To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program checklist was used.

          Results

          We selected 30 studies, conducted between 2011 and 2020. According to the findings of these studies, in the Eastern Mediterranean region, organization region, and the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited, and health research systems in Eastern Mediterranean region organization are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making.

          Discussion

          Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities.

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          Most cited references58

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          Reforming the health sector in developing countries: the central role of policy analysis.

          Policy analysis is an established discipline in the industrialized world, yet its application to developing countries has been limited. The health sector in particular appears to have been neglected. This is surprising because there is a well recognized crisis in health systems, and prescriptions abound of what health policy reforms countries should introduce. However, little attention has been paid to how countries should carry out reforms, much less who is likely to favour or resist such policies. This paper argues that much health policy wrongly focuses attention on the content of reform, and neglects the actors involved in policy reform (at the international, national sub-national levels), the processes contingent on developing and implementing change and the context within which policy is developed. Focus on policy content diverts attention from understanding the processes which explain why desired policy outcomes fail to emerge. The paper is organized in 4 sections. The first sets the scene, demonstrating how the shift from consensus to conflict in health policy established the need for a greater emphasis on policy analysis. The second section explores what is meant by policy analysis. The third investigates what other disciplines have written that help to develop a framework of analysis. And the final section suggests how policy analysis can be used not only to analyze the policy process, but also to plan.
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            The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

            This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work. From an initial set of several thousand articles, only 391 were identified as relevant to the focus of inquiry. Of these, 164 were selected for detailed review because they present empirical analyses of health policy change processes within LMIC settings. Examination of these articles clearly shows that LMIC health policy analysis is still in its infancy. There are only small numbers of such analyses, whilst the diversity of policy areas, topics and analytical issues that have been addressed across a large number of country settings results in a limited depth of coverage within this body of work. In addition, the majority of articles are largely descriptive in nature, limiting understanding of policy change processes within or across countries. Nonetheless, the broad features of experience that can be identified from these articles clearly confirm the importance of integrating concern for politics, process and power into the study of health policy. By generating understanding of the factors influencing the experience and results of policy change, such analysis can inform action to strengthen future policy development and implementation. This article, finally, outlines five key actions needed to strengthen the field of health policy analysis within LMICs, including capacity development and efforts to generate systematic and coherent bodies of work underpinned by both the intent to undertake rigorous analytical work and concern to support policy change.
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              ‘Doing’ health policy analysis: methodological and conceptual reflections and challenges

              The case for undertaking policy analysis has been made by a number of scholars and practitioners. However, there has been much less attention given to how to do policy analysis, what research designs, theories or methods best inform policy analysis. This paper begins by looking at the health policy environment, and some of the challenges to researching this highly complex phenomenon. It focuses on research in middle and low income countries, drawing on some of the frameworks and theories, methodologies and designs that can be used in health policy analysis, giving examples from recent studies. The implications of case studies and of temporality in research design are explored. Attention is drawn to the roles of the policy researcher and the importance of reflexivity and researcher positionality in the research process. The final section explores ways of advancing the field of health policy analysis with recommendations on theory, methodology and researcher reflexivity.
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                Author and article information

                Journal
                J Prev Med Hyg
                J Prev Med Hyg
                JPMH
                Journal of Preventive Medicine and Hygiene
                Pacini Editore Srl
                1121-2233
                2421-4248
                31 July 2022
                June 2022
                : 63
                : 2
                : E351-E373
                Affiliations
                [1 ] Social Determinants of Health Research Center, Lorestan University of Medical Sciences , Khorramabad, Iran
                [2 ] Health Management and Economics Research Center, Iran University of Medical Sciences , Tehran, Iran
                [3 ] School of Health Management & Information Sciences, Iran University of Medical Sciences , Tehran, Iran
                [4 ] World Health Organization Regional Office for the Eastern Mediterranean , Cairo, Egypt
                [5 ] Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS) , Tehran, Iran
                [6 ] Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences , Shiraz, Iran
                [7 ] Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences , Tabriz, Iran
                [8 ] Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences , Tehran, Iran
                [9 ] Department of Health Sciences, University of Genoa , Genoa, Italy
                [10 ] English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences , Tehran, Iran
                [11 ] Laboratory for Industrial and Applied Mathematics (LIAM) , Department of Mathematics and Statistics, York University , Toronto, ON, Canada
                Author notes
                Correspondence: Hamid Ravaghi, School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran. E-mail: ravaghih@ 123456yahoo.com ; ravaghi.h@ 123456iums.ac.ir
                Article
                10.15167/2421-4248/jpmh2022.63.2.2450
                9351417
                35968073
                6cef90af-043c-4fbd-af10-772bf7848155
                ©2022 Pacini Editore SRL, Pisa, Italy

                This is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further information: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.en

                History
                : 29 December 2021
                : 07 June 2022
                Page count
                Figures: 4, Tables: 2, Equations: 0, References: 61, Pages: 23
                Categories
                History of Medicine and Ethics

                health policy,health policy triangle framework,decision making

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