![]() ![]() Rather than being an afterthought, contextual analysis enables the meaning and inner workings of our main variable of interest to be better illuminated (Collins et al., 1999). Context, according to the Oxford dictionary, is defined as “the circumstances that form the setting for an event, statement, or idea, and in terms of which it can be fully understood and assessed” (OED, 2014). To further such understanding, in this article we explore how context is understood in health systems and policy research (HPSR) and from that basis present findings from our literature review on HC contextual factors.Įmphasis on understanding context in HPSR (Walt and Gilson, 1994) is part of what distinguishes it as a social science subject (Sheikh et al., 2011). One part of unlocking their potential to engage communities and improve health care quality and coverage lies in better understanding their contextual location within health systems and societies. Despite their widespread prevalence, their contributions vary due to their diversity in formation, roles, resources and mandates. In many countries, they are a familiar fixture of health systems, and can be effective in improving quality and coverage of health care, as well as improving health (McCoy et al., 2012). Health committees (HCs) are one of the better documented mechanisms in an incipient empirical evidence base on community accountability in health systems (Molyneux et al., 2012). Such an understanding of context points to its contingent and malleable nature, links it to theorizing in HPSR, and clarifies areas for investigation and action. While reforms focus on tangible HC inputs and outputs (training, guidelines, number of meetings held), our review of contextual factors highlights the dynamic relationships and broader structural elements that facilitate and/or hinder the role of health committees in health systems. ![]() In addition, our review found that contextual elements are dynamic and porous in nature, influencing HCs but also being influenced by them due to the permeability of HCs. By doing so, our review distinguishes between contextual elements that are relatively well understood and those that are not. While many attempts at describing context in HPSR result in empty arenas, generic lists or amorphous detail, we suggest anchoring an understanding of context to a conceptual framework specific to the phenomena of interest. Through an iterative process of exploring previous attempts at understanding context in health policy and systems research (HPSR) and the HC literature, we developed a conceptual framework that delineates these contextual factors into four overlapping spheres (community, health facilities, health administration, society) with cross-cutting issues (awareness, trust, benefits, resources, legal mandates, capacity-building, the role of political parties, non-governmental organizations, markets, media, social movements and inequalities). After screening with inclusion and exclusion criteria, we focused on 44 articles. We found 390 English language articles from journals and grey literature since 1996 on health committees, councils and boards. We undertook a narrative review to better understand the contextual features relevant to HCs, drawing from Scopus and the internet. ![]() Despite their widespread prevalence, HC functions vary due to their diversity and complexity, not least because of their context specific nature. Health committees, councils or boards (HCs) mediate between communities and health services in many health systems. ![]()
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