BACKGROUND:Attention to evidence-informed policy has grown; however, efforts to strengthen the quality and use of evidence are not starting from a blank slate. Changes in health architectures and financing pose different considerations for investments in evidence-informed policy than in the past. We identify major trends that have shifted the environment in which health policies are made, and use the evolution and future aspirations of National Immunization Technical Advisory Groups (NITAGs) in low- and middle-income countries to identify questions the sector must confront when determining how best to structure and strengthen evidence-informed health policy. DISCUSSION:Trends over the last two decades have resulted in a dense arena with many issue-specific groups, discrete initiatives to strengthen evidence-informed policy and increasing responsibility for subnational institutions. Many countries face a shifting resource base, which for some reduces the amount of resources for health. There is global momentum around universal health coverage, reflecting a broader systems approach, but few examples of how the vast array of stakeholders relate within it are available. NITAG aspirations reflect four interconnected themes related to their scope, their integration in national policy processes, health financing and relationships with ministries of finance, and NITAG positioning relative to other domestic and international entities, raising questions such as, What are the bounds of issue-specific groups and their relationship to allocation decision-making processes across health areas? How do technical advisory groups interface with what are inherently political processes? When are finances considered, by whom and how? What is the future of existing groups whose creation was intended to enhance national ownership but who need continued external support to function? When should new entities be created, in what form and with what mandate? CONCLUSIONS:Countries must determine who makes decisions about resources, when, using what criteria, and how to do so in a robust yet efficient way given the existing and future landscape. While answers to these questions are necessarily country specific, they are collective matters that cannot be addressed by specialised groups alone and have implications for new investments in evidence-informed policy.

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背景:人们越来越重视以证据为依据的政策;但是,增强证据质量和使用证据的努力并非一帆风顺。与过去相比,卫生架构和资金的变化对以证据为依据的政策进行投资提出了不同的考虑因素。我们确定已经改变了制定卫生政策的环境的主要趋势,并利用中低收入国家的国家免疫技术咨询小组(NITAG)的演变和未来愿望,确定该部门在确定如何应对时必须面对的问题最好构造和加强有据可依的健康政策。
讨论:过去二十年来的趋势导致了一个密集的竞技场,其中有许多针对特定问题的团体,采取了一些离散的举措来加强以证据为依据的政策,并增加了对地方机构的责任。许多国家面临着不断变化的资源基础,这在某些方面减少了卫生资源。围绕全民健康覆盖的全球动力,反映了一种更广泛的系统方法,但是很少有有关广泛的利益相关者如何与之联系的例子。 NITAG的愿望反映了四个相互关联的主题,这些主题涉及其范围,它们在国家政策流程中的整合,卫生筹资以及与财政部的关系,以及NITAG在其他国内和国际实体中的相对位置,提出了以下问题:特定群体及其与跨卫生领域分配决策过程的关系?技术咨询小组如何与固有的政治流程互动?何时考虑财务,由谁以及如何考虑?现有团体的成立是为了增强国家所有权,但需要持续的外部支持才能发挥作用,它们的前景如何?什么时候应该以什么形式和什么任务创建新实体?
结论:在给定现有和未来形势的情况下,国家必须确定谁来决定资源,何时,使用什么标准以及如何以健壮而有效的方式做出决定。尽管对这些问题的回答必然是针对特定国家的,但它们是集体问题,不能由专门小组单独解决,并且对以证据为依据的政策进行新的投资具有影响。

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