Erasmus E, Orgill M, Schneider H, Gilson L
Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Health Economics Unit, School of Public Health and Family Medicine, University of Cape, Cape Town, South Africa School of Public Health, University of the Western Cape, Cape Town, South Africa Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Health Economics Unit, School of Public Health and Family Medicine, University of Cape, Cape Town, South Africa School of Public Health, University of the Western Cape, Cape Town, South Africa Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
Health Policy Plan. 2014 Dec;29 Suppl 3:iii35-50. doi: 10.1093/heapol/czu063.
This article uses 85 peer-reviewed articles published between 1994 and 2009 to characterize and synthesize aspects of the health policy analysis literature focusing on policy implementation in low- and middle-income countries (LMICs). It seeks to contribute, first, to strengthening the field of LMIC health policy analysis by highlighting gaps in the literature and generating ideas for a future research agenda and, second, to thinking about the value and applicability of qualitative synthesis approaches to the health policy analysis field. Overall, the article considers the disciplinary perspectives from which LMIC health policy implementation is studied and the extent to which the focus is on systems or programme issues. It then works with the more specific themes of the key thrusts of the reviewed articles, the implementation outcomes studied, implementation improvement recommendations made and the theories used in the reviewed articles. With respect to these more specific themes, the article includes explorations of patterns within the themes themselves, the contributions of specific disciplinary perspectives and differences between systems and programme articles. It concludes, among other things, that the literature remains small, fragmented, of limited depth and quite diverse, reflecting a wide spectrum of health system dimensions studied and many different suggestions for improving policy implementation. However, a range of issues beyond traditional 'hardware' health system concerns, such as funding and organizational structure, are understood to influence policy implementation, including many 'software' issues such as the understandings of policy actors and the need for better communication and actor relationships. Looking to the future, there is a need, given the fragmentation in the literature, to consolidate the existing body of work where possible and, given the often broad nature of the work and its limited depth, to draw more explicitly on theoretical frames and concepts to deepen work by sharpening and focusing concerns and questions.
本文使用了1994年至2009年间发表的85篇经过同行评审的文章，来描述和综合卫生政策分析文献中关注低收入和中等收入国家（LMICs）政策实施的各个方面。它旨在做出两方面贡献，其一，通过突出文献中的差距并为未来研究议程提出想法，来加强LMICs卫生政策分析领域；其二，思考定性综合方法在卫生政策分析领域的价值和适用性。总体而言，本文考虑了研究LMICs卫生政策实施的学科视角，以及对系统或项目问题的关注程度。然后，它围绕所审查文章的关键要点、所研究的实施成果、提出的实施改进建议以及所审查文章中使用的理论等更具体的主题展开探讨。关于这些更具体的主题，本文探讨了主题内部的模式、特定学科视角的贡献以及系统文章和项目文章之间的差异。文章得出的结论包括，除其他外，该文献数量仍然较少、零散、深度有限且相当多样，反映了所研究的卫生系统维度范围广泛以及许多关于改进政策实施的不同建议。然而，人们认识到一系列超出传统“硬件”卫生系统关注点（如资金和组织结构）的问题会影响政策实施，包括许多“软件”问题，如政策行为者的理解以及更好沟通和行为者关系的必要性。展望未来，鉴于文献的零散性，有必要在可能的情况下整合现有工作成果，并且鉴于工作通常具有宽泛的性质及其有限的深度，需要更明确地借鉴理论框架和概念，通过强化和聚焦关注点及问题来深化研究工作。
