Catálogo de publicaciones - libros

Individuals working within the health sector widely embrace the idea of using evidence to achieve their goals of improving individual and population health. Yet while these actors embrace an ideal form of rational-instrumental evidence use under the banner of ‘evidence based policymaking’, they often struggle to understand when, why, or how evidence is used in policy processes. This chapter sets out the conceptual framework employed in this volume to study the use of evidence within policymaking from a public policy perspective. It explores the importance of both political contestation and institutional context to understand when and how evidence will be used within policy processes. The chapter then outlines the structure of this book and the focus of subsequent chapters, highlighting how each of these talks to these themes.

The multi-sectoral nature of nutrition policymaking adds complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change may come about within different country settings. Using a case study of Ethiopia, this chapter examines multi-sectoral nutrition policymaking, reflecting on different sectorial perspectives and the role and use of evidence within these. It draws on 23 in-depth semi-structured interviews conducted with stakeholders from health sector organisations, and a related documentary analysis. The chapter describes three issues which we argue remain unresolved: the framing of nutrition in Ethiopia; the development of internal nutrition logics in complementary sectors; and the remaining gaps in the evidence base. Despite Ethiopia’s strategic framework and its progress in terms of achieving nutrition targets, it shares the challenge of countries elsewhere in addressing nutrition as a multi-sectoral issue.

This chapter examines how evidence is used in major policy health policy initiatives in a highly contested political context. Through a case study of legislation proposed in the context of Colombia’s ongoing health systems reformed process, it explores how such use is affected by the specific role played by the legislature within a highly fragmented polity. It draws on an analysis of evidence cited in the drafting of relevant laws in the process of health systems reform. Reflecting the role of the legislature in Colombia’s contested political system, evidence cited in legislative debates was unable to forge consensus amongst relevant policy actors over health system reforms. While scientific research was available and at the disposal of legislators, it was unable to provide the common ground on which to overcome embedded policy positions and form the basis of compromise over the direction of health systems reforms.