Assessment of capacity of the Ministry of Health to conduct health policy processes in the Republic of Tajikistan

The widely-recognised importance of robust health policy processes suggests the need for capacity to ensure these. Whilst research exists on capacity or policy processes, little is known about how these two are related. This study starts to fill this gap by developing a conceptual framework and testing in the Republic of Tajikistan, where independence reinforced the need for Ministry of Health's (MOH) capacity to conduct country-level policy processes.

The following overarching research question guided this qualitative study: What are the key elements of, and main effects on, MOH capacity to conduct health policy processes in RT and how has this capacity changed since independence? Data was collected using semi-structured interviews, document reviews and observations of policy event. A framework approach was used for analysis, drawing on the conceptual framework.

An understanding of what constitutes robust health policy processes is important and six characteristics were identified: holistic, evidence-informed, efficient, effective, feasible and sustainable. The conceptual framework distinguishes five components: MOH capacity to conduct policy processes (comprising elements of policy cycle, use of evidence, leadership and governance, and resources), actors, context, policy contents and policy results. This study explored the MOH capacity related to its management or response to the first three components.

Though positive changes since independence were identified, the study found that MOH capacity is lacking in all following areas: recognising and managing stages of policy cycle, considering wider context, managing involvement of policy actors, ensuring evidence-informed policy processes, applying good governance and effective leadership, and establishing and effectively using resources.

Each area is dynamic, interrelated with others and involves intra-relationships, with implications for overall MOH capacity. Two underlying issues are important: the need for both ability and willingness and the inter-relationships and interdependence between different capacity levels. As a result of the study a revised framework was developed.