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Table 2 Key messages

From: Countdown to 2015 country case studies: systematic tools to address the “black box” of health systems and policy assessment

Key messages
1. “Black box” of health system and policy (HSP) assessment: This paper presents a standard set of tools to systematically describe policy formulation for reproductive, maternal, newborn and child health and assess changes in programmes and implementation within and across countries, and over time. We adapted the tools from the ‘stages heuristic’ of the policy process (i.e. agenda setting, policy formulation, policy implementation and evaluation).
2. National and subnational change: To date, these tools have been mainly applied at national level to assess HSP change over time and by programme, but HSP assessment would be even more valuable and needs further development at subnational level, particularly to better understand variation in health outcomes.
3. Implementation strength: Metrics to track strength of implementation need more work to develop, particularly to be comparable between programmes and across geographies. These metrics would be especially valuable if linked to GIS data and considering finance, human resources and domains for service readiness.
4. Research gaps: Presentation of data using consistent visualisations may help with interpretation of complex policy changes, but further assessment of perceptions and use of such visualisations would be valuable. Future research should also include analyses of power, partnerships and governance to complement the HSP tools’ outputs by providing a deeper understanding of how and why policy change took place.