Barrier | Source | |
---|---|---|
A: The decision-making environment (macro-level and health sector) | Review | Policy dialogue |
 Absence of long-term plans and directors' lack of commitment to such plans | * |  |
 Organizational, social, and political pressure in decision-making and the dominance of pressure groups over scientific evidence in policy-making | * |  |
 Lack of communication between different sectors of the MOHME in the development and implementation of health policies | * |  |
 Short tenure of policy-makers and their rapid replacement | * |  |
 Directors are not chosen based on meritocracy | * |  |
 Time limitations in organizational decision-making | * |  |
 Personal interpretations of enforceable laws |  | * |
 Directors and policy-makers act based on their personal preferences |  | * |
 Evidence is exploited to approve a predetermined mental framework |  | * |
 Decision-makers' politicization |  | * |
B: The health decision-making/policy-making process | ||
 Lack of universality and institutionalization of the HTA process | * |  |
 Absence of a specific criterion for prioritization and decision-making |  | * |
 Policies and programmes are not evaluated, and improvement is not made based on evaluation |  | * |
 No attention is paid to the contextualization of interventions |  | * |
 Panels of experts are used instead of research, and the panels are not held properly |  | * |
 Solutions are presented without complete and comprehensive data backup |  | * |
C: Supportive processes and structures | ||
 Lack of supervision, rules, and regulations regarding the development and implementation of guidelines | * |  |
 Structural, financial, and legislative limitations in ordering the research needed | * |  |
 Lack of processes that enforce the use of evidence in decision-making |  | * |
 Lack of support of senior policy-makers (e.g. Parliament representatives) by scientific groups |  | * |
 Shortage of skilled human resources for evidence utilization |  | * |
D: Incentive system | Â | Â |
 D1: Organizational and individual goals and values | ||
  Absence of political support for evidence utilization in decision-making | * |  |
  Policy-makers' inappropriate perceptions of the need for evidence utilization/ Decision-makers do not feel the need to utilize scientific evidence | * |  |
  The health ministry's health decision-makers' preference to produce evidence themselves | * |  |
  Giving priority to personal or organizational preferences over evidence | * |  |
  Lack of health decision-makers' trust in the local research evidence | * |  |
  Lack of commitment to evidence utilization in decision-making |  | * |
  Policy-makers' inappropriate perceptions of the real outcomes of policy execution |  | * |
  The perception of evidence utilization as a luxurious tool rather than strengthening and improving the health system |  | * |
  Lack of decision-maker transparency and accountability |  | * |
 D2: Individual capacities and capabilities | ||
  Policy-makers' lack of awareness and skills in the analysis and rapid utilization of evidence | * |  |
  Inappropriateness of individuals' skill and knowledge for policy-making and management; absence of strategic thinking among decision-makers |  | * |
  Superficial and simplistic knowledge regarding issues, problems, and solutions |  | * |
 D3: Performance evaluation and reward programmes | ||
  Inappropriateness of indices for managers' performance evaluations (there's a quantitative approach, and the number of decisions is important); There is no criterion for evidence utilization in the managers' evaluation | * | * |
  The supervision and evaluation system of decision-makers is not evidence-based |  | * |
  The noncompetitive advantage of evidence utilization among policy-makers and managers and negative attitude towards policy-makers and managers who utilize evidence |  | * |