title: Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries.
abstract: Health committees, councils or boards (HCs) mediate between communities and health services in many health systems. Despite their widespread prevalence, HC functions vary due to their diversity and complexity, not least because of their context specific nature. We undertook a narrative review to better understand the contextual features relevant to HCs, drawing from Scopus and the internet. We found 390 English language articles from journals and grey literature since 1996 on health committees, councils and boards. After screening with inclusion and exclusion criteria, we focused on 44 articles. Through an iterative process of exploring previous attempts at understanding context in health policy and systems research (HPSR) and the HC literature, we developed a conceptual framework that delineates these contextual factors into four overlapping spheres (community, health facilities, health administration, society) with cross-cutting issues (awareness, trust, benefits, resources, legal mandates, capacity-building, the role of political parties, non-governmental organizations, markets, media, social movements and inequalities). While many attempts at describing context in HPSR result in empty arenas, generic lists or amorphous detail, we suggest anchoring an understanding of context to a conceptual framework specific to the phenomena of interest. By doing so, our review distinguishes between contextual elements that are relatively well understood and those that are not. In addition, our review found that contextual elements are dynamic and porous in nature, influencing HCs but also being influenced by them due to the permeability of HCs. While reforms focus on tangible HC inputs and outputs (training, guidelines, number of meetings held), our review of contextual factors highlights the dynamic relationships and broader structural elements that facilitate and/or hinder the role of health committees in health systems. Such an understanding of context points to its contingent and malleable nature, links it to theorizing in HPSR, and clarifies areas for investigation and action.
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Asha
authors: A
authors: George
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Public Health Foundation of India, New Delhi, India. Electronic address: kerry.e.scott@gmail.com.
authors: Kerry
authors: K
authors: Scott
authors: Public Health Foundation of India, New Delhi, India.
authors: Surekha
authors: S
authors: Garimella
authors: Public Health Foundation of India, New Delhi, India.
authors: Shinjini
authors: S
authors: Mondal
authors: National Health Systems Resource Centre, New Delhi, India.
authors: Rajani
authors: R
authors: Ved
authors: Public Health Foundation of India, New Delhi, India.
authors: Kabir
authors: K
authors: Sheikh
mesh_terms: D003657:Decision Making; D003906:Developing Countries; D006291:Health Policy; D006298:Health Services Administration; D006302:Health Services Research; D006801:Humans; D011050:Policy Making
keywords: Community; Context; Health administration; Health committee; Health facility; Low and middle income countries; Society