title: The bit in the middle: a synthesis of global health literature on policy formulation and adoption.
abstract: Policy formulation and adoption are poorly understood phases of the health policy process. We conducted a narrative synthesis of 28 articles on health policy in low- and middle-income countries to provide insight on what kinds of activities take place in these phases, the actors crafting policies and the institutions in which policy making occurs. The narrative synthesis involved an inductive process to identify relevant articles, extract relevant data from text and reach new understandings. We find that actors exercising decision-making power include not just various governmental entities, but also civil society, commissioners, nongovernmental organizations and even clergy. We also find that most articles identified two or more distinct institutions in which policy formulation and adoption occurred. Finally, we identify seven distinct activities inherent in policy formulation and adoption: generation of policy alternatives, deliberation and/or consultation, advocacy of specific policy alternatives, lobbying for specific alternatives, negotiation of policy decisions, drafting or enacting policy and guidance/influence on implementation development. Health policy researchers can draw on these categories to deepen their understanding of how policy formulation and adoption unfolds.
authors.affiliation: Askew School of Public Administration and Policy, Florida State University, 650 Bellamy, Tallahassee, FL 32306-2250, USA The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland American University, Washington, DC, USA dberlan@fsu.edu.
authors.forename: David
authors.initials: D
authors.lastname: Berlan
authors.affiliation: Askew School of Public Administration and Policy, Florida State University, 650 Bellamy, Tallahassee, FL 32306-2250, USA The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland American University, Washington, DC, USA.
authors.forename: Kent
authors.initials: K
authors.lastname: Buse
authors.affiliation: Askew School of Public Administration and Policy, Florida State University, 650 Bellamy, Tallahassee, FL 32306-2250, USA The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland American University, Washington, DC, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Shiffman
authors.affiliation: Askew School of Public Administration and Policy, Florida State University, 650 Bellamy, Tallahassee, FL 32306-2250, USA The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland American University, Washington, DC, USA.
authors.forename: Sonja
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D003657:Decision Making; D003906:Developing Countries; D014943:Global Health; D006291:Health Policy; D011050:Policy Making
keywords: Policy adoption; policy formulation; policy process