Department of Health, Physical Education and Recreation (HPER), University of Cape Coast, Cape Coast, Ghana.
Health Res Policy Syst. 2024 Apr 15;22(1):47. doi: 10.1186/s12961-024-01129-3.
Generally, public health policy-making is hardly a linear process and is characterized by interactions among politicians, institutions, researchers, technocrats and practitioners from diverse fields, as well as brokers, interest groups, financiers and a gamut of other actors. Meanwhile, most public health policies and systems in Africa appear to be built loosely on technical and scientific evidence, but with high political systems and ideologies. While studies on national health policies in Africa are growing, there seems to be inadequate evidence mapping on common themes and concepts across existing literature.
The study seeks to explore the extent and type of evidence that exist on the conflict between politics and scientific evidence in the national health policy-making processes in Africa.
A thorough literature search was done in PubMed, Cochrane Library, ScienceDirect, Dimensions, Taylor and Francis, Chicago Journals, Emerald Insight, JSTOR and Google Scholar. In total, 43 peer-reviewed articles were eligible and used for this review.
We found that the conflicts to evidence usage in policy-making include competing interests and lack of commitment; global policy goals, interest/influence, power imbalance and funding, morals; and evidence-based approaches, self-sufficiency, collaboration among actors, policy priorities and existing structures. Barriers to the health policy process include fragmentation among actors, poor advocacy, lack of clarity on the agenda, inadequate evidence, inadequate consultation and corruption. The impact of the politics-evidence conflict includes policy agenda abrogation, suboptimal policy development success and policy implementation inadequacies.
We report that political interests in most cases influence policy-makers and other stakeholders to prioritize financial gains over the use of research evidence to policy goals and targets. This situation has the tendency for inadequate health policies with poor implementation gaps. Addressing these issues requires incorporating relevant evidence into health policies, making strong leadership, effective governance and a commitment to public health.
一般来说，公共卫生政策制定过程并非线性的，其特点是政治家、机构、研究人员、技术专家和来自不同领域的从业者以及经纪人、利益集团、金融家和其他各种行为体之间相互作用。与此同时，非洲的大多数公共卫生政策和系统似乎是松散地建立在技术和科学证据基础上，但具有高度的政治制度和意识形态。虽然关于非洲国家卫生政策的研究在不断增加，但似乎没有足够的证据来映射现有文献中常见的主题和概念。
本研究旨在探讨在非洲国家卫生政策制定过程中，政治与科学证据之间存在冲突的程度和类型。
在 PubMed、Cochrane Library、ScienceDirect、Dimensions、Taylor and Francis、芝加哥期刊、Emerald Insight、JSTOR 和 Google Scholar 中进行了全面的文献检索。共有 43 篇同行评议文章符合条件并用于本综述。
我们发现，政策制定中证据使用的冲突包括利益冲突和缺乏承诺、全球政策目标、利益/影响、权力失衡和资金、道德；以及循证方法、自给自足、行为体之间的合作、政策优先事项和现有结构。卫生政策过程的障碍包括行为体之间的碎片化、宣传不力、议程不明确、证据不足、磋商不足和腐败。政治-证据冲突的影响包括政策议程被取消、政策制定成功欠佳和政策执行不足。
我们报告说，在大多数情况下，政治利益会影响政策制定者和其他利益相关者，使他们优先考虑金融收益，而不是将研究证据用于政策目标和指标。这种情况往往导致卫生政策不足，执行存在差距。解决这些问题需要将相关证据纳入卫生政策，建立强有力的领导、有效的治理和对公共卫生的承诺。
