Gilson Lucy, Raphaely Nika
Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa.
Health Policy Plan. 2008 Sep;23(5):294-307. doi: 10.1093/heapol/czn019. Epub 2008 Jul 22.
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.
本文首次对分析低收入和中等收入国家（LMICs）卫生政策过程的文献进行了综述。基于使用两个领先国际数据库对已发表文献的系统检索，本文从政策主题、研究方向和地理范围等方面描绘了1994年至2007年间发表的研究领域，同时批判性地评估了其优势和劣势。该综述的总体目标是为这一工作领域的进一步发展提供一个平台。从最初的数千篇文章中，仅识别出391篇与研究重点相关。其中，164篇被选作详细综述，因为它们呈现了对LMICs环境中卫生政策变化过程的实证分析。对这些文章的审查清楚地表明，LMICs的卫生政策分析仍处于起步阶段。此类分析数量较少，而在众多国家背景下涉及的政策领域、主题和分析问题的多样性导致该领域的覆盖深度有限。此外，大多数文章本质上主要是描述性的，限制了对国家内部或国家之间政策变化过程的理解。尽管如此，从这些文章中可以识别出的广泛经验特征清楚地证实了将对政治、过程和权力的关注纳入卫生政策研究的重要性。通过了解影响政策变化经验和结果的因素，此类分析可为加强未来政策制定和实施的行动提供信息。本文最后概述了加强LMICs卫生政策分析领域所需的五项关键行动，包括能力建设以及努力形成系统且连贯的研究成果，这些成果既要基于进行严谨分析工作的意图，也要关注支持政策变革。
