Department of Health, Behavior and Society, Johns Hopkins Center for Communication Programs, Islamabad, Pakistan.
Health Services Academy, Islamabad, Pakistan.
Health Policy Plan. 2017 Dec 1;32(10):1449-1456. doi: 10.1093/heapol/czx128.
Incorporating evidence is fundamental to maintaining the general acceptance and efficiency in public policies. In Pakistan, different actors-local and global-strive to facilitate the development of evidence-informed health policies. Effective involvement however, requires knowledge of the country-context, i.e. knowing the intricacies of how policies are formulated in Pakistan. Obtaining this knowledge is one of the key steps to making interventions impactful. We carried out a qualitative study to explore the environment of evidence-informed health policy in Pakistan. The study involved 89 participants and comprised three phases including: (1) literature review followed by a consultative meeting with key informants to explore the broad contours of policy formulation, (2) in-depth interviews with participants belonging to various levels of health system to discuss these contours and (3) a roundtable with experts to share and solidify the findings. Policy development is a slow, non-linear process with variable room for incorporation of evidence. Political actors dominate decisions that impact all aspects of policy, i.e. context, process and content. Research contributions are mostly influenced by the priorities of donor agencies-the usual proponents and sponsors of the generation of evidence. Since the devolution of health system in 2012, Pakistan's provinces continue to follow the same processes as before 2012, with little capacity to generate evidence and incorporate it into health policy. This study highlights the non-systematic, nearly ad hoc way of developing health policy in the country, overly dominated by political actors. Health advocates need to understand the policy process and the actors involved if they are to identify points of impact where their interaction with policy brings the maximum leverage. Moreover, an environment is needed where generation of data gains the importance it deserves and where capacities are enhanced for communicating and understanding evidence, as well as its incorporation into policy.
将证据纳入公共政策中对于保持其普遍接受度和效率至关重要。在巴基斯坦，地方和全球的不同行为体都努力促进循证卫生政策的制定。然而，要想有效参与，就需要了解国家背景，即了解政策在巴基斯坦制定的复杂性。获得这些知识是使干预措施产生影响的关键步骤之一。
我们进行了一项定性研究，以探索巴基斯坦循证卫生政策的环境。该研究涉及 89 名参与者，包括三个阶段：（1）文献综述，随后与主要知情人进行协商会议，以探讨政策制定的大致轮廓；（2）与不同卫生系统级别的参与者进行深入访谈，以讨论这些轮廓；（3）与专家举行圆桌会议，以分享和巩固研究结果。
政策制定是一个缓慢、非线性的过程，纳入证据的空间变化不定。政治行为体主导着影响政策各个方面的决策，即背景、过程和内容。研究成果主要受到捐助机构的优先事项的影响，这些机构通常是证据生成的主要支持者和赞助者。自 2012 年卫生系统权力下放以来，巴基斯坦各省继续沿用 2012 年前的相同程序，几乎没有能力生成证据并将其纳入卫生政策。
本研究强调了该国卫生政策制定的非系统性、几乎临时的方式，政治行为体过度主导。卫生倡导者需要了解政策过程和参与的行为体，如果他们要确定其与政策互动带来最大影响力的切入点。此外，需要创造一个环境，使数据生成获得应有的重视，并增强沟通和理解证据以及将其纳入政策的能力。
