Table 2 Extracted data

(Abubakar et al., 2021)

Assess the pros and cons of evidence generation and decision-making, discuss potential impacts and derive lessons for Nigeria, sub-Saharan Africa, and beyond

Qualitative/Nigeria

Challenges with the coproduction model included lack of transparency, bureaucratic barriers and a narrow focus on the direct health impacts of the disease rather than considering the broader social and economic effects of response measures

COVID-19 response guidelines

The guidelines helped in achieving its goal of slowing down the spread of the virus

However, COVID-19 has inflicted significant social and economic hardships on many Nigerian households and individuals, complicating efforts to address the country’s broader health challenges amidst economic contraction

A multidisciplinary approach, integrating epidemiological, social science and economic analyses, along with evidence coproduction with policy-makers, is key to addressing the dual social and public health challenges of the COVID-19 pandemic in Nigeria and beyond

(Agyepong et al., 2021)

To explore why and how collaborations and fragmentations occur during national policy and programme agenda setting

Qualitative/Ghana and Sierra Leone

1.Country and global level factors

2.Power imbalances attached to funding

3.Disruptions in the flow of funds

4. Lack of political commitment and prioritization

Health Policies

UHC

HS

HP

Accountability and trust issues collapse the synergy in the entire process of policy-making

Synergies and fragmentations are prevalent in policy agenda setting, formulation and implementation

Fragmentations are detrimental to achieving policy goals

Country actors require commitment, technical expertise and leadership to tilt the power balance towards

Prioritization and political commitment of country actors

(Alhelou et al., 2022)

Explore the opportunities and challenges countries have experienced and identify gaps to advance policy-making on menstrual hygiene and health

Qualitative/India, Kenya, Senegal and the United States

Policy drivers identified include:

1.Strong leadership and political will

2. Employing evidence-based approaches

3. Non-dependency/self-sufficiency

4. Prioritization of basic needs

5. Acknowledging weaknesses in the system and resolving them

Menstrual hygiene and health policies

Policies are being implemented smoothly but with some systemic challenges

African countries can initiate, formulate and implement policies to solve complex health problems with political will and minimal external interference

(Akhnif et al., 2020)

Document the developmental process of a consolidated health financing strategy in Morocco

Qualitative/ Morocco

Success factors:

1.High political commitment

2. All actors adopted a common path of action

Health financing policy

Collaborative nature of the process favoured consensus building and collective ownership of the policy

The policy document was produced through collaboration among actors

The process was devoid of the usual top-down approach and was more participatory in nature

(Amukugo et al., 2021)

Analyse Namibia’s policies on NCD prevention

Assess the government’s readiness to adopt a sugar-sweetened beverage tax policy

Qualitative/Namibia

The lack of interest on the part of government

No progress towards the enactment of the sugar-sweetened beverage policy

Although there is the endorsement of the sugar-sweetened beverage (SSB) policy, there are no steps to its adoption due to lack of convincing data on its impact

This makes advocacy difficult and policy actors are latent

(Blystad et al., 2019)

Examined the relationship between the abortion law, policy and access to safe abortion services

Qualitative/Zambia, Tanzania and Ethiopia

Ambiguity of the language used in the laws and policies

Complexities between the laws, policy and actual access to health services

Abortion law

Safe Abortion policy

(Colvin et al., 2021)

Explore the barriers to and opportunities for improvement of, effective TB infection prevention and control

Qualitative/South Africa

Barriers include fragmentation of institutional responsibility and accountability for TB-IPC

Inability of advocates to present TB-IPC as an urgent policy problem

Barriers to policy innovation from lack of evidence to justify new policy

TB Infection Prevention and Control

TB-IPC is a chronic and complex health system challenge and requires both policy- and behavioural-level interventions. There is the need to effectively deal with the upstream barriers to policy formulation and implementation

(Croke, 2020)

Identified the success factors of model primary healthcare programmes in Ethiopia

Qualitative/Ethiopia

Political will,

Characteristics of political leaders

A clear strategic plan of action informed by several policy experiments over a period

Primary healthcare programme

Tremendous success of the model programme informing its replication at the national level

Government models of federalism and policy to involve the population in service delivery models, to ensure political stability and development yielded the desired results

(Dalglish et al., 2017)

Examine processes of health policy development in a case study of Niger

Qualitative/Niger

Government policy-makers showed adeptness in negotiating with donors and weighing conflicting factors but lacked the capacity and resources to formally evaluate and document programmes, limiting their ability to draw reliable lessons from them

Community case management of childhood illness (iCCM) policy

Government actors employed logical and ethical reasoning in making decisions that were subsequently identified as crucial to the success of iCCM

Access to codified knowledge empowers participants in policy discussions, yet it constitutes only one facet of knowledge utilized in the policy process, potentially not the most significant

(Ditlopo et al., 2013)

Examine and identify the implementation and success factors of financial incentives among nurses

Qualitative case study/South Africa

Weaknesses identified include incomplete and inaccurate data on specialized nurses. Poor management of time and resources, improper coordination and communication. Rush in implementation, lack of consultation with health facility managers and poor orientation for implementors

Occupation-specific dispensation (OSD) policy; a financial incentive policy for health works in the public sector

Suboptimal implementation of the policy

Successful implementation of financial incentives requires adequate planning and management to maintain the morale of staff and reduce their grievances

(Ditlopo et al., 2014)

Analyse the dynamics, strengths and weaknesses of nurses to participate national health workforce policies

Qualitative/South Africa

Poor awareness creation among policy beneficiaries

Lack of consensus among policy actors

No representation of the policy beneficiaries in policy-making process

Lack of consensus over which nursing group represents nurses in policy-making

Policy regarding nursing practice, scope of practice framework for nursing qualifications and renumeration policy

Negative effect on how nurse’s views and inputs were regarded and included into the policy

There is the need for strong leadership, improved health policy capacity and skills of nurses to contribute effectively to health policy

(Etiaba et al., 2023)

The study analyses government collaboration in implementing maternal, neonatal and child health (MNCH) programmes, derived from an integrated strategy. It aims to identify principles applicable to multilevel governance, especially in low-income countries

Qualitative case study/ Nigeria

Memoranda of Understanding were signed collaboratively but remained unimplemented. State did not meet programme goals due to a disconnect in the national governance structure, despite contextual differences

Maternal, neonatal and child health (MNCH) policies

Misaligned governance structures constrained implementation

Resource-limited countries need ongoing advocacy and tailored models for distributed leadership across government levels. Stakeholders must understand available collaboration drivers and system context requirements

(Gavriilidis & Östergren, 2012)

Analyse the ATM policy

Quantitative/South Africa

Facilitators: importance of the policy to communities, employment, education promotion, entrepreneurship and resource mobilization at the periphery

Barriers: centralised conception, planning and implementation, lack of local adaptations, authoritative legislation

African Traditional Medicine Policy

There is the need for deliberate community representation in policy-making, through conception, design to implementation. This participatory approach improves

(Haaland et al., 2020)

Address gaps between knowledge, policy and practice

Explore processes involved in translating policy into practice

Qualitative/Zambia

Issues of morality are key barriers to the policy implementation

Regulate and ensure safe abortion services

Healthcare facilities do not make safe abortion services available to women who seek them especially in rural areas

The discourse on safe abortion is even during policy meetings due to the dominant moral regime in Zambia

(Holcombe & Gebru, 2022)

Describe the actors and processes involved in the policy process

Qualitative/Ethiopia

Drivers of the process: Government’s receptiveness, the pressure from civil society, health professionals and other NGOs

Safe abortion policy to promote the access to safe legal abortion services to prevent maternal mortality

Policy process was smooth and fast

The policy was internally driven with minimal external influence. There was a strong collaboration between government and civil society, and this is the major driver of the success achieved

(Hussein et al., 2021)

Describe how the development of a community health policy contributes to attaining UHC and PHC targets in Kenya

Qualitative/Kenya

Drivers: strong government leadership, strong partnership, strong stakeholder engagements

Alignment with political priorities

Decentralization of the context to identify specific community needs

The policy development was guided by research and evidence

Community health strategic plan

National health sector strategic plan,

Successful policy development

The various contributing factors to the successful policy development are useful lessons for other similar jurisdictions. However, the successful implementation of the policy will depend the sustained political interest and consistency in financing sources

(Jacobs & George, 2022)

Youth participation in the formulation of the Adolescent and Youth Health Policy was examined

Qualitative/South Africa

Barriers: donor politics and segmented donor priorities, fragmented among actors on how to embrace diversity and difference and how to handle power relations

Drivers: opening of a good policy window, consensus between policy actors, youth participation

Adolescent and Youth Health Policy

The opportunity for youth to participate in the policy development was a great achievement. However, there is the need to ensure proper representation of the youth in all the concerns them. This is a fundamental human right

(Kagaha & Manderson, 2021)

Explored the role of power operations in setting priorities for maternal healthcare

Qualitative (ethnography and discourse analysis)/Uganda

Moral and legal restrictions

Government priorities

Abortion care policy

(Kielmann et al., 2021)

Assess health systems readiness to implement a new policy in resource constrained settings

Qualitative/South Africa

Facilitators: interventions to address staffing issues were addressed, infrastructure redesign and equipment arrangements

Policy on drug-resistant TB management

The programme was implemented successfully

Healthcare workers were willing to deliberately go the extra mile to do things that would ease the implementation of the policy

(Koduah et al., 2018)

Understand decision-making processes that influence policy agenda

Qualitative/Ghana

Understanding and agreeing on the context, stakeholder interactions, ideas and framing of issues

Maternal health policies

Effective use of power to convince final decision makers moves the decision into a specified direction

Interconnectedness of policy drivers is such as the context, actors and their powers crucial in the policy process

(Koon et al., 2020)

Providing social explanation to the president’s decision not to sign a policy

Qualitative/Kenya

Actors’ preferences influenced their judgement. Decisions were not evidence informed but were informed by the values of the actors. There was no understanding of how to finance the policy among actors

National Social Health Insurance law

The president refused to sign the document into law

The Ngilu Bill did not fail, but rather was fragmented into several smaller policy positions, some of which have recently been legislated

(Kumwenda et al., 2021)

Explored factors that influenced development, adoption and implementation of ART policies

Qualitative/Malawi, Tanzania and South Africa

Weak health systems, suboptimal care

Pressures from different stakeholders to accelerate or slow implementation

Donor financing facilitated the process but skewed the power balance

Anti-retroviral therapy policies

Donor influence interfered with local innovative solutions to address specific local health system issues

Donors should be more focused on comprehensive health systems strengthening to achieve more effective results

(Mac-Seing et al., 2022)

Explored policy actors’ perceptions of pro-disability laws, barriers to SRH services for people with disabilities and recommendations for addressing inequities

Qualitative/Uganda

Legislation and policy implementation faced technical and financial challenges, with disability issues lacking prioritization. People with disabilities encountered various barriers accessing SRH services, including physical, attitudinal, communication, and structural obstacles

Sexual and reproductive health (SRH) policy

There is proof of the complex challenges individuals with disabilities encounter when accessing SRH services, alongside the struggles in implementing disability-focused policies in Uganda

Policy actors identified and proposed concrete solutions to mitigate health inequities for people with disabilities

(Masefield et al., 2021)

Explored how local stakeholders perceive their involvement in shaping the National Health Policy II (NHP II) and Health Sector Strategic Plan II (HSSP II)

Qualitative/Malawi

Tokenistic involvement, stakeholder hierarchy, mutual distrust, preferred stakeholders, no culture of engagement

National Health Plan II (NHP II) and Health Sector Strategic Plan II (HSSP II)

After18 months of policy implementation, stakeholders observe minimal improvement in governance and lack confidence in the government’s ability to achieve Universal Health Coverage (UHC)

Stakeholders expressed that both top-down and bottom-up pressures were lacking, resulting in superficial consultations with local stakeholders. As a consequence, these stakeholders felt powerless to influence health policy-making in a manner that aligns more effectively with the needs of their respective communities

More inclusive top-down efforts are needed for effective stakeholder engagement

(Mauti et al., 2022)

Assess how the adoption of the HiAP approach can leverage on SDGs implementation in Kenya

Mixed method/Kenya

Strong political commitment

Draw on existing structures

Funding strategy was not captured the framework

Health in all Policies

Multisectoral approach is a prerequisite for a successful comprehensive policy. Fragmentation of the various sectors will be a disadvantage to policy development and implementation

(Modisenyane et al., 2017)

Understand how South Africa integrates domestic health policy into its foreign policy

Qualitative/South Africa

Social, political, economic and institutional factors influence the integration process

The integration process was driven by national and external developments, stakeholder interests and advocacy and collaborative efforts from civil society as well as global advocacy movement

Antiretroviral Policy

Global pressures to make access to antiretroviral treatment a fundamental human right compelled the local health system to prioritize the ARV policy

Global and transnational systems can influence local policy focus by changing policy priorities

(Mukuru et al., 2021)

Examine the roles of policy elites and how their interests drove maternal health policies

Qualitative/Uganda

The policies were driven by senior MoH officials, cabinet members, health development partners

Maternal Health Policies

The policies were skewed towards elite personal political and economic interests rather than reducing maternal mortality

The policies on maternal health in Uganda were informed by the personal interest of elites and not by the aim of reducing maternal mortality

(Murray & Rutland, 2022)

Tests hypotheses from public health policy-making literature concerning the influence of medical, political, social, economic and external factors on African countries’ issuance of Stay-at-Home Orders (SAHOs) in response to the early COVID-19 pandemic

Quantitative/54 African countries

The analysis indicates that medical factors and external influences significantly shaped decisions, whereas political factors had minimal impact. Social and economic factors did not appear to play a significant role

Stay-at-Home Orders (SAHOs) in response to the COVID-19 pandemic

While effective in curbing disease transmission, these measures have considerably disrupted social and economic structures

African leaders balanced competing factors during the initial phases of a public health crisis

(Mwisongo et al., 2016)

Understand the how power influences policy processes

Qualitative/Cabo Verde, Chad, Guinea, Liberia and Togo

Different types of power were used

Positive or negative power, transitive, disproportional and structural power

National policies

When negatively applied, can influence and slow down the entire process as well as change its focus

Power could positively or negatively influence the policy process, at various stages of the process

(Novignon et al., 2021)

Document the political path to the establishment of the Ghana National Health Insurance Scheme (NHIS)

Qualitative/Ghana

Drivers: an open policy window

Government’s political will (manifesto promise)

Strong collaboration between the actors on financing the policy

Massive interest and support from development partners

Politics cut across the entire policy process

External actor politics, beneficiary politics, interest groups, leadership politics, budget politics, bureaucratic politics

NHIS

The strong politic interest of the sitting government and the opposition facilitated the development of the policy without unnecessary delays

Ghana’s NHIS policy development and implementation benefited from a good political atmosphere and leadership drive to achieve a manifesto promise. In addition, the engagement and collaboration between the internal and external actors was crucial to its success. Finally, the willingness of stakeholders to manage fragmentations to arrive at compromises easily facilitated the process

(Okedo-Alex et al., 2021)

Assessment of the status of domestic funding and advocacy Strategies for improving funding of Health Policy and Systems Research (HPSR)

Qualitative/Nigeria

Barriers of domestic funding of HPSR are political and policy transition, corruption and bureaucratic bottlenecks

Health policies

Lack of domestic funding of HPSR is affecting the generation of strong evidence base data to inform and guide policy

Improved private sector involvement, continuous advocacy, multi-stakeholder coalitions for advocacy and researcher skill building on advocacy were suggested as the way forwards

(Oraro et al., 2020)

Examined actor values and interest that influence agenda setting in health financing

Qualitative/Kenya

Lack of strategic leadership

Fragmentation of stakeholders

Understanding and interpretation of context by stakeholders

Universal Healthcare Policy

Conflicts in priorities of key actors threatens smooth progress towards the expansion of healthcare coverage as well us financing it

Properly contextualizing the competing health needs and prioritizing them in the policy arena is a more practical way of achieving results

(Parkhurst et al., 2021)

Explore the impact of national and global network and related politics on malaria control in sub-Saharan Africa

Qualitative/sub-Saharan Africa

Balancing global goals with local realities

Managing expectations and coordination of non-state stakeholders

Peculiar NMCP institutionalized systems, structures and processes capable of influencing local capacity building

Although NMCPs are very well structured and adequately resourced by global partners and Ministries of Health, the programme can not be isolated from the local contexual realities

(Ridde & Faye, 2022)

Understand how the COVID-19 response policy was formulated in Senegal

Qualitative/Senegal

Leadership and coordination conflicts

Inadequate community participation and engagement with scientific community

Power dominance by international donor

COVID-19 policy

The highly centralized and biomedical processes employed in the development of this policy, with very little intersectoral involvement and contribution from the scientific community, resulted in challenges with implementation

Policy-making should be guided by evidence and context, not only politics

(Ruhara et al., 2021)

Described the policy landscape, identify and analyse the facilitators of and barriers to strengthening taxation on sugar-sweetened beverages

Qualitative/Rwanda

Government commitment to boosting sugar production

Failure of existing policy to identify sugar as a risk factor for noncommunicable diseases

Tax to reduce the consumption of sugary beverages

The setting for sugar-sweetened beverage tax strengthening is a very complex

There are several impediments as well as facilitators in the policy environment to strengthen the existing tax

(Sambala & Manderson, 2017)

Examine the public health policy perspectives on vaccination to prevent the spread of infection under post-pandemic conditions

Qualitative/Ghana and Malawi

The programme was motivated by policy-makers own financial incentives as well as government and foreign policy conditionalities

Policy on influenza virus vaccination

Confusion about the targets and the coverage among the policy actors. For some policy-makers the process was successful, but others think otherwise

The vaccination intervention was problematic, its implementation was too late

(Omar et al., 2010)

This paper delves into the formulation of suitable mental health policies and their successful execution

Qualitative/

Ghana, South Africa, Uganda and Zambia

Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services

Mental health policy

Health policy processes frequently lack strength and adequate resources, especially in the realm of mental health. This deficiency often leads to bureaucratic delays and under-utilization of available evidence

More work is needed to improve mental health policy processes in African countries. Involving a wider range of stakeholders is crucial due to the diverse nature of mental health issues

(Seddoh & Akor, 2012)

Conceptualize the various levers of policy formulation

Qualitative/Ghana

Various stakeholders, that is technical expects, civil society, academicians and politicians, had their various interests

NHIS

During the policy process, it is important that the actors consider the content as well as the context to appreciate the viewpoints of others

(Shiroya et al., 2019)

Presents Kenya’s experience of translating the UN declaration to national policies for diabetes prevention and control

Qualitative/Kenya

Open policy windows, political drive triggered by diabetes community,

Scant local evidence

Policy for noncommunicable diseases

Suboptimal gains due to poor engagement with and participation of non-healthy sector players, fragmented health governance and week monitoring systems

Contrary to global recommendations, the policy process was largely driven by the health sector without the involvement of other sectors. Efforts to achieve population-wide impart will be enhanced when other sector players are brought on board

(Simen-Kapeu et al., 2021)

Examined the process of developing community health policies to extract insights from Liberia’s efforts to strengthen its health system after the Ebola Virus Disease (EVD) crisis

Mixed method/Liberia

Establishing a coordination mechanism and harnessing partnership support, adopting a systemic approach to better guide policy changes, enhancing community involvement and conducting planning based on evidence to advise policy-makers

Community health policy

The policy was completed and at implementation stage

To enhance resilience against future shocks and bolster primary healthcare (PHC), community-based systems should assume a more significant role. This necessitates viewing communities not merely as recipients of health services but as

(Thow et al., 2021)

Examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana

Qualitative/Ghana

Poor integration of nutrition into existing food policies

Existing food policies overly focused on food production, creating employment and economic returns at the expense of nutrition sensitive food supply

Food and nutrition policy

(Wanjohi et al., 2021)

Assess the policy and stakeholder landscape relevant to nutrition related noncommunicable diseases and sugar-sweetened beverage taxation

Qualitative/Kenya

The role of nutrition in noncommunicable disease prevention is not a priority for policy-makers

Government has competing roles such as growing the sugar and feed processing industries

The dangers of sugar-sweetened beverages have not gained national consensus

Sugar-sweetened beverages tax policy

Taxation of sugar-sweetened beverages is not a policy priority

There is the need for local advocacy in favour of sugary beverage taxation

Public and policy-maker education to understand the dangers of sugary beverages and refined foods

(Zulu et al., 2022)

Examined the events, actors, and contexts behind the withdrawal of Zambia’s Community Health Strategy

Qualitative/Zambia

Divided perspectives of actors

Numerous international partners with various interests

Shifted locus of the strategy at the MoH

No service provider and community participation in the policy process

Community Health Strategy

The policy development process was highly political and characterized by fraught external

This led to its abrupt termination

Interaction between events, actors and context in policy development cannot be overlooked. The success of these interactions in the driving force behind any successful policy