Evidence-based policy-making: The implications of globally-applicable research for context-specific problem-solving in developing countries
Evidence-based policy-making: The implications of globally-applicable research for context-specific problem-solving in developing countries
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DOI：
10.1016/j.socscimed.2009.08.006
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发表时间：
2009-11-01
影响因子：
5.4
通讯作者：
Morrison, Joanna
中科院分区：
文献类型：
--
作者：
Behague, Dominique;Tawiah, Charlotte;Morrison, Joanna
在过去15年左右的时间里，“循证医学”（EBM）框架日益制度化，促进了其在全球范围内的转移。 20世纪90年代末，循证医学的基本原理开始在许多非临床公共政策领域产生显着影响。现在，这些领域的政策制定者被敦促放弃根据政治意识形态制定政策，转而采用基于“科学事实”的更合法的方法，这一过程被称为“基于证据的政策制定”（EBPM）。 EBM 概念向非临床领域的传播暴露了关于“科学”定义的认识论不稳定观点，特别是因为它涉及全球与国家/次国家政策制定的需求。本文利用孕产妇和新生儿子领域作为人种学案例研究，探讨了这些差异对 5 个发展中国家（孟加拉国、布基纳法索、加纳、马拉维和尼泊尔）的 EBPM 的影响。在此过程中，我们的分析旨在解释为什么 EBPM 迄今为止在国家和次国家层面的具体具体规划政策制定和实施领域的影响有限。结果强调，尽管公共卫生文献中反复呼吁学科多样性，但 EBPM 实施的政治背景促进了方法和政策途径的统一。即使在国家 EBPM 偏离国际优先事项的情况下，国家基于证据的政策在对抗全球政策利益方面也几乎没有什么影响力，一些知情人声称这些政策本身是合法的，而不是有证据支持的。知情人士还强调了对研究结果的解释是由更广泛的政治背景塑造的，在这种背景下，捐助者确定优先事项并分配有限的资源，而这些背景是由需要提供基于科学可复制方法的普遍研究建议所驱动的。除此之外，国家内部高级和初级专家之间存在明显的分歧，这限制了国家和次国家研究议程作为增强知识生产和解决问题的工具。最后，我们主张开展多种形式的研究，以更有效地解决特定背景的问题。虽然这种多样性可能使 EBPM 更加充满冲突，但在任何不断发展的知识体系中，辩论绝不是一个不受欢迎的特征，因为它有潜力培养批判性洞察力和局部变革。 (C) 2009 Elsevier Ltd. 保留所有权利。
In the past 15 or so years, the "evidence-based medicine" (EBM) framework has become increasingly institutionalized, facilitating its transfer across the globe. In the late 1990s, the basic principles of EBM began to have a marked influence in a number of non-clinical public policy arenas. Policy-makers working in these areas are now being urged to move away from developing policies according to political ideologies to a more legitimate approach based on "scientific fact," a process termed "evidence-based policy-making" (EBPM). The conceptual diffusion of EBM to non-clinical arenas has exposed epistemologically destabilizing views regarding the definition of "science," particularly as it relates to the demands of global versus national/sub-national policy-making. Using the maternal and neonatal subfield as an ethnographic case-study, this paper explores the effects of these divergences on EBPM in 5 developing countries (Bangladesh, Burkina Faso, Ghana, Malawi and Nepal). In doing so, our analysis aims to explain why EBPM has thus far had a limited impact in the area of context-specific programmatic policy-development and implementation at the national and sub-national levels. Results highlight that the political contexts in which EBPM is played out promote uniformity of methodological and policy approaches, despite the fact that disciplinary diversity is being called for repeatedly in the public health literature. Even in situations where national EBPM diverges from international priorities, national evidence-based policies are found to hold little weight in countering global policy interests, which some informants claim are themselves legitimated, rather than informed, by evidence. Informants also highlight the way interpretations of research findings are shaped by the broader political context within which donors set priorities and distribute limited resources - contexts that are driven by the need to provide generalisable research recommendations based on scientifically replicable methods. Added to this are clear rifts between senior and junior-level experts within countries that constrain national and sub-national research agendas from serving as tools for empowered knowledge production and problem-solving. We conclude by arguing for diverse forms of research that can more effectively address context-specific problems. While such diversity may render EBPM more conflict-ridden, debate is by no means an undesirable characteristic in any evolving system of knowledge, for it has the potential to foster critical insight and localized change. (C) 2009 Elsevier Ltd. All rights reserved.