Measuring evidence-informed decision-making processes in low- and middle-income countries

In recent years there has been increased attention to and investment in evidence-informed decision-making (EIDM) in the international development sector and by some national governments. This brief focuses on health policy and characterises the evidence base on EIDM, identifies specific measurement challenges and discusses considerations for the design of future assessments.

Key messages

• The evidence base on the practice of EIDM in international development is limited. Previous work has identified multiple roles that evidence could play; principles and desirable decision-making practices; and individual, interpersonal, organisational and contextual factors thought to influence the interpretation of evidence and decisions. Despite a proliferation of frameworks and guidance, there is a relative dearth of research on the extent to which and how they are applied in practice, at what cost and with what effects.
• EIDM faces measurement challenges, including investigation into largely undocumented and sometimes unobservable processes, multi-finality and equifinality (multiple pathways to multiple outcomes) and extended time horizons, in addition to difficulties establishing counterfactuals.
• In the health sector, current indicators tend to cluster around two ends of a long change pathway: tracking upstream activities and immediate outputs, and downstream changes in health coverage and outcomes.
• Building on existing systems, future efforts could be directed at the ‘missing middle’ in measurement, filling notable gaps in defining what constitute high-quality EIDM processes, minimising biases in measuring these processes and investigating how evidence-informed recommendations make their way through the policy process.