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This article is part of the supplement: Health Services Research: Evidence-based practice

Open Access Open Badges Oral presentation

Contextual influences on the role of evidence in health policy development: insights from India and Nigeria

Tolib Mirzoev1*, Mahua Das1, Bassey Ebenso1, Bindiya Rawat2, Nkoli Uguru3, Giuliano Russo4, Roger Bymolt5 and Reinhard Huss1

  • * Corresponding author: Tolib Mirzoev

Author Affiliations

1 University of Leeds, Leeds, UK

2 Association for Stimulating Know How, New Delhi, India

3 College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria

4 Instituto de Higiene e Medicina Tropical, Lisbon, Portugal

5 Royal Tropical Institute, Amsterdam, The Netherlands

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BMC Health Services Research 2014, 14(Suppl 2):O5  doi:10.1186/1472-6963-14-S2-O5

The electronic version of this article is the complete one and can be found online at:

Published:7 July 2014

© 2014 Mirzoev et al; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


The context is a complex and important influence on decision-making, affecting degree of responsiveness and people-centred health systems. Although theoretical frameworks to understand context are available, limited empirical research exists exploring contextual influences on evidence-informed health policymaking. This presentation compares contextual influences on the role of evidence in health policy development within two large countries within their continents: India and Nigeria.

Materials and methods

In each country, the contextual influences on the development of three specific health policies were explored. The study was guided by a conceptual framework, developed from the literature. Context includes factors at three levels: macro (e.g. political and resource environment), meso (e.g. organisation’s roles and practices) and micro (e.g. individual values and preferences). Data was collected using 72 in-depth interviews with key policy actors and document reviews, and analysed using framework approach.


All policies were perceived as evidence-informed. Both formal (e.g. research) and informal (e.g. experiences) evidence was used in India; in Nigeria reliance was mostly on formal evidence. Key macro-level facilitators of evidence-informed decisions were international treaties driving reform agendas, leadership changes and political will. Key constraints included limited resources and opposition from powerful actors. At meso-level, civil society was particularly influential in India; whereas international agencies had greater role in policy decisions, including evidence use, in Nigeria. At micro-level, individuals had different understandings of what constitutes ‘robust’ evidence for policymaking, shaping their evidence preferences and decision-making practices.


Understanding context is essential in ensuring responsiveness of policy decisions to the needs of key policy actors within people-centred systems, for example through recognising actors’ agendas and interests. Powerful civil society can catalyse greater recognition of citizens voice through communicating informal evidence, as we found in India; and influential donors can favour costly surveys, thus undermining use of evidence from government health information systems, as in Nigeria.