Health policy analysis (HPA) is a critical approach to health policy and systems research (HPSR) that seeks to understand how health policies are formed and implemented. Through gaining a better understanding of the forces involved in decision-making, HPA can offer insights into how policy change unfolds and can shed a light on the so-called implementation gap in global health. Indeed, a new special issue presents a number of HPA studies that do just that.
The special issue is the result of the Health Policy Analysis Fellowship Programme, supported by the Alliance and coordinated by the University of Cape Town in South Africa. The fellowship programme aims to sharpen the HPA skills of researchers working in and conducting their PhDs in low- and middle-income countries (LMICs). The first group of nine scholars participated in the fellowship between 2017-2019, which involved a combination in-person workshops and ongoing support to their research studies.
In addition to their doctoral theses, some of their work is now published in a new special issue of the International Journal of Health Policy and Management. The special issue includes a mix of empirical, methodological and conceptual work, with three of the articles presenting qualitative syntheses of existing literature. The collection addresses health policy topics ranging from indigenous health policy in the Philippines, to primary health care in India, maternal health policies in Uganda, out-of-pocket payments within health insurance schemes in sub-Saharan Africa, the first 1 000 days of childhood, an intersectoral initiative in South Africa, and the role of values in health systems.
The studies all put a primary focus on the forces influencing policy change in these settings, adopting an actor-centric approach in their analysis. They consider how actors influence how policy ideas emerge and are translated (or not) into policies and routine practices within health systems. Importantly, four of the papers explicitly examine issues of implementation, considering the local forces shaping policy practices – an area often overlooked within the wider body of HPA work in LMICs, where the focus tends to be on agenda setting and the influence of global actors in national contexts.
The papers also offer critical insights about the interface between health policy change and health system development. They show, for example, how bureaucratic norms, structures and siloes act to constrain policy implementation where relationships across programmes or sectors are required. Such relationships are necessary both in implementing policies and in re-orienting health systems to be better prepared for the emerging health shocks and conditions of the 21st century.
Taken together these papers present rich insights into health policy in various LMIC settings, as well as offering methodological and conceptual insights of importance both for future research and for health system development. They also offer a good starting point for the eleven new Health Policy Analysis Fellows, who started their HPA journeys in 2020.