Where is the policy in health policy and systems research agenda?

Perspectives In the last 15 years there has been considerable growth in the amount of – and funding for – health policy and systems research. 1 However, research addressing health policy decision-making, across all stages of the policy process, has been relatively neglected. 2 Here we argue for an increased emphasis on policy in health systems research. We focus specifically on low-and middle-income country contexts where such research has an important role to play in improving health systems and health care delivery. Health policy and systems research aims to produce new knowledge to improve how societies organize themselves to achieve health goals. Its objectives are to promote the coverage, quality, efficiency and/or equity of the health system, 3 with the goal of achieving improved health and health equity. 4 While much health policy and systems research is characterized by its pursuit of better health policies, only a part of it concerns research on policy, i.e. how policies emerge, are formed and are implemented (health policy analysis). 5 The policy component of health systems research directs attention not only to the formal content and instruments of health policy (the outputs of decision-making) but also to the forces influencing the decision-making: actors, power and politics; institutions, interests and ideas. 6,7 The research focus on actors and processes draws from the broad and well-established fields of political science, public administration and organizational science. 8–10 Health policies are courses of action and inaction that affect the sets of institutions, organizations, services and funding arrangements of the health system. 11 Health policy analysis embraces ethnographic and sociologically-informed studies 12,13 and considers global influences on health system development. The analysis supports understanding of the influences on policy agendas and priorities 15 and how power influences health policy implementation. 16 It also directs attention to the ways in which health system hardware – the functional and quantifi-able pieces – and software – the ideas, values, norms and power that dictate relationships – combine to shape health system functioning. 17,18 Health policy analysis also illuminates how past policies , including those directly addressing specific services, programmes or interventions, have unintended consequences on other health system elements or on other health policies. Hence such analyses are part of the complex context of health system development. From its name, it may appear that the field of health policy and systems research contains two domains: health policy analysis and health systems …