Developments in the field of health policy analysis in low- and middle-income countries: a review of published literature 2008-2023.

This review maps the development of health policy analysis (HPA) in low- and middle-income countries (LMICs) since 2008, when Gilson and Raphaely (Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007. Health Policy Plan 2008;23:294-307. https://doi.org/10.1093/heapol/czn019) published a review clarifying the state of the field and tracing its evolution. Subsequent years have seen some progress in capacity strengthening for HPA in LMICs, but the extent of development of the field has not been formally assessed since that time. We used a combination of bibliometric, thematic, and narrative analysis to better understand the nature of the research being undertaken, identify weaknesses in the evidence base, and gauge maturation of the field. Despite the relatively restrictive focus of this review, we identified 629 articles reporting empirical studies of LMIC policy experiences, revealing substantial growth in the volume of published HPA since 2008. However, significant imbalances in knowledge production remain, with low-income country experiences, and those of North Africa and Central Asia still neglected, and with the dominance of HIC authors persisting despite efforts to strengthen the field in LMICs. At the same time, the review finds evidence of maturation, reflected in deeper theoretical engagement, greater methodological diversity, the use of comparative approaches to enable causal explanation and cross-context learning, and the emergence of robust bodies of work on specific health policy issues. Taken together, the findings point to a field that has grown in scale, scope and analytic sophistication, but still requires deliberate nurturing. Purposeful efforts by researchers, funders, and institutions are needed to ensure that HPA realizes its full potential and contributes to progressive policy change. Improving domestic and regional funding, supporting LMIC institutions and researchers, deepening theoretical engagement, and encouraging analytical HPA that enables explanation and cross-context learning are essential to sustaining the development of the field and ensuring that it continues to generate rigorous, relevant insights and contributes to progressive policy change.