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Cited by 404Healthcare Systems and ReformsHealthcare Systems and PracticesGlobal Public Health Policies and Epidemiology

The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007

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Gilson, L., Raphaely, N.·2008·Health Policy and Planning
DOI 10.1093/heapol/czn019PMC PMC2515407
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Abstract

This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work. From an initial set of several thousand articles, only 391 were identified as relevant to the focus of inquiry. Of these, 164 were selected for detailed review because they present empirical analyses of health policy change processes within LMIC settings. Examination of these articles clearly shows that LMIC health policy analysis is still in its infancy. There are only small numbers of such analyses, whilst the diversity of policy areas, topics and analytical issues that have been addressed across a large number of country settings results in a limited depth of coverage within this body of work. In addition, the majority of articles are largely descriptive in nature, limiting understanding of policy change processes within or across countries. Nonetheless, the broad features of experience that can be identified from these articles clearly confirm the importance of integrating concern for politics, process and power into the study of health policy. By generating understanding of the factors influencing the experience and results of policy change, such analysis can inform action to strengthen future policy development and implementation. This article, finally, outlines five key actions needed to strengthen the field of health policy analysis within LMICs, including capacity development and efforts to generate systematic and coherent bodies of work underpinned by both the intent to undertake rigorous analytical work and concern to support policy change.

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  • Few studies have explored how tobacco control policy change comes about, particularly in LMICs and on tobacco tax policy.

    “Unfortunately, few studies have explored how tobacco control policy change comes about, particularly in the context of low-income and middle-income countries (LMICs) and on the topic of tobacco tax policy.20–24”

    From Seven-year tobacco tax plan in Ukraine: a case study of the actors, tactics and factors motivating policy passage (2022) · cites this paper as [20]

    Table 3 in “Policies and issues examined” identifies only five empirical analyses of tobacco policy change in LMICs from 1994–2007, supporting the claim that few studies examined that topic. The paper does not establish a separate finding about tobacco tax policy, so that more specific part is not supported by this source. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Powerful actors in countries across the globe and across industries threatened by policy change similarly use lobbying to water down policy to their benefit, sometimes behind closed doors.

    “Additionally, like the tobacco industry in Ukraine, powerful actors in countries across the globe and across industries threatened by policy change similarly use lobbying to water down policy to their benefit, sometimes behind closed doors.20–22 24–26 28 33 34 63–65”

    From Seven-year tobacco tax plan in Ukraine: a case study of the actors, tactics and factors motivating policy passage (2022) · cites this paper as [20]

    The review’s ‘Policies and issues examined’ section reports resistance from powerful actors whose interests are challenged by reform. Its ‘Critical evaluation’ section also notes that opposition can occur within a closed bureaucratic arena. It does not establish that such actors use lobbying to water down policies for their benefit across countries and industries. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Authors
Gilson, L., & Raphaely, N.
Affiliations
  • University of Cape Town (ZA)
  • University of the Witwatersrand (ZA)
Corresponding author
Gilson, L.
ORCID
Gilson, L.
Venue
Health Policy and Planning
Publisher
Oxford University Press (OUP)
Published
2008-07-22
Volume
23
Issue
5
Pages
294-307
ISSN
  • 0268-1080 (ISSN-L)
  • 1460-2237
DOI
10.1093/heapol/czn019
PMC
PMC2515407
OpenAlex
W2160009727
Cited by
404
References
134
Citations by year
2026: 19 · 2025: 21 · 2024: 10 · 2023: 10 · 2022: 14 · 2021: 33 · 2020: 35 · 2019: 26 · 2018: 30 · 2017: 24 · 2016: 35 · 2015: 23 · 2014: 28 · 2013: 28 · 2012: 24
FWCI
5.81
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Health Policy and Planning (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
  • Rockefeller Foundation
  • Department for International Development
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
Keywords
health policy analysis, low- and middle-income countries, health policy change, policy process, politics of health policy, capacity building
MeSH terms
Decision Making, Organizational, Decision Support Techniques, Developing Countries, Health Policy, Health Services Research, Humans, Policy Making, Politics, Power, Psychological, Bibliometrics, Databases, Bibliographic, Empirical Research

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