The interface between policymaking and research in low-income countries is highly complex. Health systems research in such settings face a number of challenges including under-investment, lack of human capacity, lack of public demand, inadequate utilization, and poor dissemination of results [1
]. Mismatch between need for health research and investment has been highlighted and attempts made to address the '10/90' gap including: research capacity strengthening; promotion of research investment; and the establishment of global and national health forums [4
]. In addition, empirical work on mapping health resource flows and health research systems has progressed [6
]. At the same time, the search for strategies to "get research findings into policy and practice" has gained momentum and the global literature has called for further exploration in the area of research to policy
]. In particular, engaging decision makers in specific areas of health research, and promoting the use of surveys of decision makers has been advocated [9
The developed world is the focus of much of the exploration in the arena of research to policy [10
] and specifically on pathways from research to development of clinical guidelines, or on the use of systematic reviews [12
]. A summary of the key challenges to bridging the research-policy gap and strategies to overcome them in the developed world exist [13
]. In recent years, some country specific analyses of the research-policy interface in the developing world have also been articulated. These include analyses from: India [14
]; Lao PDR [15
]; Cambodia [16
]; Viet Nam [17
]; Thailand [18
]; Bangladesh [19
]; Nepal [20
]; Sri Lanka [21
]; Uganda [22
]; Kenya [23
]; Nigeria [24
]; Mali [25
]; and Mexico [26
]. These analyses either focus on health policy making in general
, or focus on specific but divergent health issues and the policies that pertain to them.
Despite the relative paucity of empirical work, the World Health Organization [27
], the Alliance for Health Policy & Systems Research [28
], the Council on Health Research for Development [29
], and other organizations have made important contributions to the knowledge base on the research to policy interface [3
]. These contributions are: reliant on the use of small scale, case study approaches; focused on a few health issues; limited to one country or to specific locations within a country; and largely unpublished in the peer-reviewed literature, although important reports and documents have been produced and circulated. The Alliance for Health Policy and Systems Research has produced such a publication, which presents the common conceptual model of a linear process – evidence is generated, findings are made available, and eventually decisions are influenced [31
]. In reality the process of evidence translation into decision making within government or other institutions is rather more complex.
Drawing on work on policy processes in other arenas, research and the evidence it generates can be seen differently. Evidence is not the rational, objective, set of facts it is sometimes made out to be; rather it can be seen as forms of knowledge
– partial perspectives – forwarded by particular people and institutions, and sometimes contested by others [32
]. Knowledge relevant to health system organization is not just about diseases and technologies (e.g. disease epidemiology, drug or vaccine efficacy), or about nature-society interactions (e.g. social influences on disease pathways). Crucially, the importance of knowledge about society and social institutions, which differs from knowledge about diseases or nature-society interactions, cannot be ignored. More importantly, understanding which knowledge and perspectives come to influence policy, and which are excluded, requires understanding the policy process as non-linear – shaped through politicized negotiations amongst multiple actors [32
]. Furthermore, there is often a process of mutual construction of research and policy, in which policy negotiations shape what kinds of research are funded and carried out, and which are not.
The Research Programme Consortium (RPC), Future Health Systems: Innovations for Equity, funded by the Department for International Development (DFID), United Kingdom hopes to heed the calls made by previous work done in this field, and contribute to both methods and results that are useful for understanding the nexus of research and policy and how that can positively impact the poor [37
]. The overall goal of the 'research to policy' thematic activities in the consortium is to understand the relationship between research (evidence) and the development of policies, especially their impact on the poor. More specifically this consortium seeks to: document previous experiences
of decision makers with health research; understand overall values
placed on health research and evidence by decision makers; define the context and conditions under which decision makers will demand
health research; identify characteristics
of health research that make it attractive to decision makers; and explore the existence and performance of institutional mechanisms
that allow interaction between research evidence and policy development and implementation at national and sub-national level.
Given the above overarching and specific thematic goals, this paper aims to provide the background, conceptual framework, and key research directions for such types of empirical activities in low income settings. Firstly, four key developmental perspectives that are particularly relevant contextual factors to the research-policy interface are considered. Second, three entry points for the research-policy interface in the developing world are discussed. Third, a conceptual framework for use in the analysis of the research-policy interface is proposed. Fourth, potential study designs and methodologies required in responding to the identified knowledge gaps in the research-policy interface in low-income countries are identified. Finally, the overall added value of the entire approach is considered.