Evidence-informed health policy making contributes to improved health outcomes by strengthening health systems. In addition, health policy decisions should take into consideration the needs and priorities of users of healthcare services. However, little research has been done to find best ways to facilitate evidence-informed and participatory health policymaking, particularly in low- and middle-income countries. This thesis is written based on three studies done in Ethiopia to fill this knowledge gap. In the first study, we examined whether, how and under what conditions evidence was used and service-users participated during the agenda-setting and policy formulation phases of selected policies in the ‘prevention of mother-to-child transmission of HIV’ program in Ethiopia using a multiple-case study design. In the second study, we identified strategies to facilitate evidence-informed health policy making using an online survey. In the third study, we identified strategies to facilitate participatory health policy making using a combined paper-based and Internet-based Delphi approach. The thesis does not have direct theoretical contribution. However, it will draw on two theoretical frameworks, namely Kingdon’s framework and the 3I+E framework. and use them in a setting from where they were originally developed. This thesis has two substantive and three methodological contributions. Substantively, the first study provides empirical evidence about the current practice of evidence-informed and participatory health policy making in a low-income, ‘revolutionary’ democratic country (Ethiopia). In addition, the studies have identified strategies to concretize the constitutional and policy provisions for evidence-informed and participatory health policy making in Ethiopia. The thesis has the following three methodological contributions. First, the studies explored the use of Kingdon’s multiple-streams framework and the 3I+E framework in predicting factors influencing agenda-setting and policy formulation phases, respectively, and in explaining the use of research evidence in informing these two phases in a ‘revolutionary’ democratic country where they have not previously been used. Second, the thesis has shown that paper-based and Internet-based Delphi could be combined in contexts with limited resources. Third, the thesis has demonstrated the possibility of training service-users as ‘peer’ researchers to collect and analyze data to inform their participation and maximize their contribution in surveys, forming a pyramid of participation. / Thesis / Doctor of Philosophy (PhD) / Evidence-informed health policy making can contribute to improved health outcomes by strengthening health systems. In addition, health policy decisions ultimately affect users of healthcare services. Thus, such decisions should take into consideration their needs and priorities. However, little research has been done to find best ways to facilitate evidence-informed and participatory health policymaking, particularly in low- and middle-income countries. This thesis is written based on three studies done in Ethiopia. In the first study, we examined whether, how and under what conditions evidence was used and service-users participated in the ‘prevention of mother-to-child transmission of HIV’ program in Ethiopia. In the second and third studies, we identified strategies to facilitate evidence-informed and participatory health policy making. In addition, we explored the possibility of combining Internet- and paper-based methods for consensus-building among policymakers, program managers, researchers, healthcare providers and service-users in settings with limited resources.

This case study focuses on Ontario higher education policy and the Colleges of Applied Arts and Technology (CAATs). A sequence of policy shifts occurred during the last decade of the twentieth century and the early years of the new millennium. By 2002, the Government of Ontario had reviewed its position with regard to baccalaureate degree credentials being the exclusive domain of publicly supported universities. Governance arrangements for the CAATs had also changed. The new policy framework was set with two pieces of legislation, the Postsecondary Education Choice and Excellence Act, 2000, and the Ontario Colleges of Applied Arts and Technology Act, 2002. The purpose of this case study is to explain why these policy changes occurred. To facilitate inquiry, John W. Kingdon’s Multiple Streams Model was used as a platform and lens to guide data collection and organize the findings. For Kingdon, policy is the outcome of a complex pre-decision process that requires the ‘coupling’ of the problem, policy, and political streams at the time of an open policy window. A qualitative approach was adopted, and primary and secondary documents covering the period 1990 to 2002 were collected. In addition, in-depth semi-structured interviews were conducted with key policy actors and policy entrepreneurs.  The study found evidence to support the Multiple Streams Model's contention of streams of processes. However, with respect to this study, two types of policy problems were found flowing in the problem stream: macro-structural policy problems shaped conditions and the scope of options available with respect to policy goals and policy solutions; and micro-specific policy problems were localized, actor identified, constructed, and linked to specific interests. The study also found that historical institutional structures, and intermediate institutions, had a significant impact on policy development. The policy changes occurred as the result of two open policy windows, and in both instances, policy entrepreneurs were able to couple the policy streams to effect change. In view of the findings, a Structured Dynamics Model of Policy Development is offered as an explanation of the policy changes and for consideration in future inquiry.

This case study focuses on Ontario higher education policy and the Colleges of Applied Arts and Technology (CAATs). A sequence of policy shifts occurred during the last decade of the twentieth century and the early years of the new millennium. By 2002, the Government of Ontario had reviewed its position with regard to baccalaureate degree credentials being the exclusive domain of publicly supported universities. Governance arrangements for the CAATs had also changed. The new policy framework was set with two pieces of legislation, the Postsecondary Education Choice and Excellence Act, 2000, and the Ontario Colleges of Applied Arts and Technology Act, 2002. The purpose of this case study is to explain why these policy changes occurred. To facilitate inquiry, John W. Kingdon’s Multiple Streams Model was used as a platform and lens to guide data collection and organize the findings. For Kingdon, policy is the outcome of a complex pre-decision process that requires the ‘coupling’ of the problem, policy, and political streams at the time of an open policy window. A qualitative approach was adopted, and primary and secondary documents covering the period 1990 to 2002 were collected. In addition, in-depth semi-structured interviews were conducted with key policy actors and policy entrepreneurs.  The study found evidence to support the Multiple Streams Model's contention of streams of processes. However, with respect to this study, two types of policy problems were found flowing in the problem stream: macro-structural policy problems shaped conditions and the scope of options available with respect to policy goals and policy solutions; and micro-specific policy problems were localized, actor identified, constructed, and linked to specific interests. The study also found that historical institutional structures, and intermediate institutions, had a significant impact on policy development. The policy changes occurred as the result of two open policy windows, and in both instances, policy entrepreneurs were able to couple the policy streams to effect change. In view of the findings, a Structured Dynamics Model of Policy Development is offered as an explanation of the policy changes and for consideration in future inquiry.

The theme of the diploma thesis is the policy-making process, specifically the process of making of the National Action Plan for Positive Ageing for the Period 2013 - 2017. It's about exploring its creation from the viewpoint of active members of the Government Council for Seniors and Population Ageing, who was discussing it at meetings. The theoretical framework - Multiple Streams Framework deals with the aspect of policy entrepreneurs. Using qualitative, semi-structured interviews and then analysis of qualitative data, it was possible to explore the means, used by policy entrepreneurs to promote their ideas at meetings. This diploma thesis does not only study the creation of an action plan, but also the identification of policy entrepreneurs, through document analysis. After that were analysed primary data from interviews with members of the Government Council for Seniors and Population Ageing, who had been appointed by The Ministry of labour and social affairs. The studied, strategic document is the answer to the demographic ageing phenomenon the population of the Czech Republic.