Background. Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization (EMRO).
Methods: To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program (CASP) checklist was used.
Results: 30 studies were selected, conducted between 2011 and 2020. According to the findings of these studies, in the EMRO region, the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited and health research systems in EMRO are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making.
Discussion: Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities.
2. van de Goor I, Hämäläinen RM, Syed A, Lau CJ, Sandu P, Spitters H, et al. Determinants of evidence use in public health policy making: Results from a study across six EU countries. Health Policy Plan. 2017;121(3):273-81.
3. Contandriopoulos D, Benoît F, Bryant-Lukosius D, Carrier A, Carter N, Deber R, et al. Structural analysis of health-relevant policy-making information exchange networks in Canada. Implement Sci. 2017;12(1):116.
4. Cheung KK, Mirzaei M, Leeder S. Health policy analysis: a tool to evaluate in policy documents the alignment between policy statements and intended outcomes. Aust Health Rev. 2010;34(4):405-13.
5. Robert E, Rajan D, Koch K, Muggleworth Weaver A, Porignon D, Ridde V. Policy dialogue as a collaborative tool for multistakeholder health governance: a scoping study. BMJ Glob Health. 2020;4(Suppl 7):pii: e002161.
6. World Health Organization. Health policy 2020 [updated 28 August 2020. Available from: https://www.who.int/topics/health_policy/en/.
7. Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007. Health Policy Plan. 2008;23(5):294-307.
8. Browne J, Coffey B, Cook K, Meiklejohn S, Palermo C. A guide to policy analysis as a research method. Health Promot Int. 2019;34(5):1032-44.
9. Walt G, Gilson L. Can frameworks inform knowledge about health policy processes? Reviewing health policy papers on agenda setting and testing them against a specific priority-setting framework. Health Policy Plan. 2014;29 Suppl 3:iii6-22.
10. Montenegro Martínez G, Carmona Montoya A, Franco-Giraldo Á. [Models for public health policy analysis reported in scientific publications]. Gac Sanit. 2020;pii: S0213-9111(19):30275-4.
11. Walt G, Shiffman J, Schneider H, Murray SF, Brugha R, Gilson L. 'Doing' health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan. 2008;23(5):308-17.
12. Shiffman J, Sultana S. Generating political priority for neonatal mortality reduction in Bangladesh. Am J Public Health. 2013;103(4):623-31.
13. O'Brien GL, Sinnott SJ, Walshe V, Mulcahy M, Byrne S. Health policy triangle framework: Narrative review of the recent literature. Health Policy OPEN. 2020;1(2020):100016.
14. World Health Organization. WHO’s Eastern Mediterranean Region comprises 2020 [updated 28 August 2020. Available from: http://www.emro.who.int/countries.html.
15. Beesley M, Cometto G, Pavignani E. From drought to deluge: how information overload saturated absorption capacity in a disrupted health sector. Health Policy Plan. 2011;26(6):445-52.
16. Zaidi S, Mayhew SH, Cleland J, Green AT. Context matters in NGO-government contracting for health service delivery: a case study from Pakistan. Health Policy Plan. 2012;27(7):570-81.
17. Phillimore P, Zaman S, Ahmad B, Shoaibi A, Khatib R, Khatib R, et al. Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries. Glob Public Health. 2013;8(8):875-89.
18. Seef S, Jeppsson A. Is it a policy crisis or it is a health crisis? The Egyptian context--analysis of the Egyptian health policy for the H1N1 flu pandemic control. Pan Afr Med J. 2013;14:59.
19. Zaidi S, Mohmand SK, Hayat N, Acosta AM, Bhutta ZA. Nutrition policy in the post‐devolution context in Pakistan: An analysis of provincial opportunities and barriers. IDS Bull. 2013;44(3):86-93.
20. El-Jardali F, Bou-Karroum L, Ataya N, El-Ghali HA, Hammoud R. A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: learning from failure. Soc Sci Med. 2014;123:45-54.
21. El-Jardali F, Hammoud R, Younan L, Nuwayhid HS, Abdallah N, Alameddine M, et al. The making of nursing practice law in Lebanon: a policy analysis case study. Health Res Policy Syst. 2014;12:52.
22. Markazi-Moghaddam N, Aryankhesal A, Arab M. The first stages of liberalization of public hospitals in Iran: establishment of autonomous hospitals and the barriers. Iran J Public Health. 2014;43(12):1640-50.
23. Speakman EM, Shafi A, Sondorp E, Atta N, Howard N. Development of the community midwifery education initiative and its influence on women's health and empowerment in Afghanistan: a case study. BMC Womens Health. 2014;14:111.
24. Awadalla H. Implementation of quality assurance program in Sudanese public hospitals: lessons learned. J Med Med Res. 2015;3(2):7-14.
25. Ben Romdhane H, Tlili F, Skhiri A, Zaman S, Phillimore P. Health system challenges of NCDs in Tunisia. Int J Public Health. 2015;60 Suppl 1:S39-46.
26. Faraji O, Etemad K, Akbari Sari A, Ravaghi H. Policies and programs for prevention and control of diabetes in Iran: A document analysis. Glob J Health Sci. 2015;7(6):187-97.
27. Alharbi NS, Alotaibi M, de Lusignan S. An analysis of health policies designed to control and prevent diabetes in Saudi Arabia. Glob J Health Sci. 2016;8(11):233-41.
28. Goshtaei M, Ravaghi H, Sari AA, Abdollahi Z. Nutrition policy process challenges in Iran. Electron Physician. 2016;8(2):1865-73.
29. Moshiri E, Rashidian A, Arab M, Khosravi A. Using an analytical framework to explain the formation of primary health care in rural Iran in the 1980s. Arch Iran Med. 2016;19(1):16-22.
30. Sarfraz M, Hamid S. Exploring managers' perspectives on MNCH program in Pakistan: a qualitative study. PLoS One. 2016;11(1):e0146665.
31. Abolhassani N, Akbari Sari A, Rashidian A, Rastegarpanah M. The establishment of the drug naming committee to restrict look-alike medication names in Iran: a qualitative study. Int J Risk Saf Med. 2017;29(1-2):69-79.
32. Aljumah AA, Aljebreen AM. Policy of screening for colorectal cancer in Saudi Arabia: a prospective analysis. Saudi J Gastroenterol. 2017;23(3):161-8.
33. Azami-Aghdash S, Gorji HA, Shabaninejad H, Sadeghi-Bazargani H. Policy analysis of road traffic injury prevention in Iran. Electron Physician. 2017;9(1):3630-8.
34. Haq Z, Hafeez A, Zafar S, Ghaffar A. Dynamics of evidence-informed health policy making in Pakistan. Health Policy Plan. 2017;32(10):1449-56.
35. Yousefinezhadi T, Mosadeghrad AM, Arab M, Ramezani M, Sari AA. An Analysis of hospital accreditation policy in Iran. Iran J Public Health. 2017;46(10):1347-58.
36. Ansari M, Rassouli M, Akbari ME, Abbaszadeh A, Akbarisari A. Palliative care policy analysis in Iran: a conceptual model. Indian J Palliat Care. 2018;24(1):51-7.
37. Al-Ansari B, Thow AM, Mirzaie M, Day CA, Conigrave KM. Alcohol policy in Iran: policy content analysis. Int J Drug Policy. 2019;pii: S0955-3959(19):30210-5.
38. Edalati S, Omidvar N, Haghighian Roudsari A, Ghodsi D, Zargaraan A. Development and implementation of nutrition labelling in Iran: A retrospective policy analysis. Int J Health Plann Manage. 2019:1-17.
39. Gharaee H, Tabrizi JS, Azami-Aghdash S, Farahbakhsh M, Karamouz M, Nosratnejad S. Analysis of public-private partnership in providing primary health care policy: an experience from Iran. J Prim Care Community Health. 2019;10:2150132719881507.
40. Loloei S, Pouraram H, Majdzadeh R, Takian A, Goshtaei M, Djazayery A. Policy analysis of salt reduction in bread in Iran. AIMS Public Health. 2019;6(4):534-45.
41. Mohseni M, Aryankhesal A, Kalantari N. Prevention of malnutrition among children under 5 years old in Iran: a policy analysis. PLoS One. 2019;14(3):e0213136.
42. Behzadifar M, Azari S, Gorji HA, Martini M, Bragazzi NL. The hepatitis C virus in Iran: health policy, historical, ethical issues and future challenges. J Prev Med Hyg. 2020;61:E109-E18.
43. Doshmangir, Rashidian A, Kouhi F, Sergeevich Gordeev V. Setting health care services tariffs in Iran: half a century quest for a window of opportunity. Int J Equity Health. 2020;19:112.
44. Raoofi A, Takian A, Akbari Sari A, Olyaeemanesh A, Haghighi H, Aarabi M. COVID-19 pandemic and comparative health policy learning in Iran. Arch Iran Med. 2020;23(4):220–34.
45. Embrett MG, Randall GE. Social determinants of health and health equity policy research: exploring the use, misuse, and nonuse of policy analysis theory. Soc Sci Med. 2014;108:147-55.
46. El-Jardali F, Lavis JN, Ataya N, Jamal D. Use of health systems and policy research evidence in the health policymaking in eastern Mediterranean countries: views and practices of researchers. Implement Sci. 2012;7:2.
47. Barnish M, Tørnes M, Nelson-Horne B. How much evidence is there that political factors are related to population health outcomes? An internationally comparative systematic review. BMJ Open. 2018;8(10):e020886.
48. Casey M, Rohde D, Brady AM, Fealy G, Hegarty J, Kennedy C, et al. Developing a new health-related policy analysis tool: An action research cooperative inquiry approach. J Nurs Manag. 2019;27(6):1233-41.
49. Frenk J. Comprehensive policy analysis for health system reform. Health Policy. 1995;32(1-3):257-77.
50. Gibson JL, Martin DK, Singer PA. Setting priorities in health care organizations: criteria, processes, and parameters of success. BMC Health Serv Res. 2004;4(1):25.
51. Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health policy Plan. 1994;9(4):353-70.
52. Araújo Jr JLCd, Maciel Filho R. Developing an operational framework for health policy analysis. Revista Brasileira de Saúde Materno Infantil. 2001;1:203–21.
53. Zaidi S, Bhutta Z, Hussain SS, Rasanathan K. Multisector governance for nutrition and early childhood development: overlapping agendas and differing progress in Pakistan. BMJ Glob Health. 2018;3(Suppl 4):e000678.
54. Collins J, Koplan JP. Health impact assessment: a step toward health in all policies. JAMA. 2009;302(3):315-7.
55. Carlisle S. Health promotion, advocacy and health inequalities: a conceptual framework. Health Promotion International. 2000;15(4):369-76.
56. de Leeuw E. Engagement of Sectors Other than Health in Integrated Health Governance, Policy, and Action. Annu Rev Public Health. 2017;38:329-49.
57. World Health Organization. The world health report 2000 - Health systems: improving performance 2000 [updated 9 November 2020. Available from: https://www.who.int/whr/2000/en/.
58. Ejaz I, Shaikh BT, Rizvi N. NGOs and government partnership for health systems strengthening: a qualitative study presenting viewpoints of government, NGOs and donors in Pakistan. BMC health services research. 2011;11(1):1-7.
59. Shaikh B, Kadir M, Hatcher J. Health care and Public health in South Asia. Public Health. 2006;2(120):142-4.