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The Importance of Context: Context Analysis

In this lecture, Yodi Mahendradhata explain the importance of context and how to conduct context anlaysis. (Step 3.13)
YODI MAHENDRADHATA: The Importance of Context– Context Analysis. Let’s go back again to the health policy triangle. The triangle suggests, again, that policies are influenced by policy content, process, stakeholders, and contexts. This highlights that when it comes to policy support and ownership context really matters. Sometimes contextual elements become clear as the program evolves. What works in one place may not work in another place. In Afghanistan, for example, as the polio program progressed, policymakers realized explicit political support from the government was often counterproductive. So, clearly, the effectiveness of policies is influenced by their implementation in a given context. Health policies are often implemented in complex, multifaceted, and dynamic environments.
So the same policy would rarely work in the same way in different contexts. While the tools and strategies used to implement a policy are important, the context of implementation equally matters. Understanding context is crucial for successful implementation of a program. Understanding contextual factors as much as possible at the outset in particular would be really, really helpful in the long run. Now here we have guidance to help us do a proper context analysis, basically viewing seven contextual domains, which have been shown to be important for policy engagement. So, first, we have geographical. This refers to the broader physical environment, landscapes and resources, both natural and transformed by humans, for example, infrastructure. And then we have epidemiological.
This refers to the distribution of diseases or conditions, the attributable burden of disease, as well as determinants of needs in populations, including demographics. Then we have sociocultural contexts, which comprises explicit and implicit behavior patterns, including their embodiment in symbols and artifacts. The essential core of culture consists of historically derived and selected ideas and values that are shared among members of a group. Next, we have the socioeconomic context, which comprises the social and economic resources of a community and the access of a population to these resources. Then related to that, we have the ethical context, which is about reflections of morality, which encompasses norms, rules, standards of conduct, and principles that guide the decisions and behaviors of individuals and institutions.
And then we have the legal context. This is about rules and regulations that have been established to protect a population’s right and societal interests. Now, formally, this has to be passed by a competent legislative body like a parliament. Legal norms can mostly be enforced with order and compulsion, which distinguish them from ethical and social norms. At the end, we have the political contexts, which focus on the distribution of power, assets, and interests within a population, as well as the range of organizations involved, their interests and the formal and informal rules that govern interactions between them. Now context analysis, of course, should not just be an academic exercise.
The analysis can be and should be used to support policy development and policy implementations. For the purpose of policy development, context analysis can inform or adapt policy content, can also be used to improve policy participation or improve communication of stakeholders in the context of policy implementations. Context analysis can help. Continuous engagement with stakeholders. It can also provide feedback to address the gaps in policy implementations, promoting institutionalization, and provision of programs, services, resources, or information. By now, you should be ready to try to do a context analysis. So what I would like to ask you to do now is first go back to the program summary for an overview of the context key player challenges.
And then try to do a rapid conducts analysis based on the seven domains we discussed. This, again, should take you no more than 20 minutes. Again, if you are following this course individually, you can do this mini exercise as a thought process on your own. If you are following this as a group, then you could actually simulate a more realistic context analysis exercise by doing it with others. In any case, I am sure by the end of this exercise you would have a better grasp of what it takes to do a proper context analysis. Good luck.

Yodi Mahendradhata, MD, MSc, PhD, FRSPH Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia

In conducting policy engagement, context is king! What works in one place may not work in another – the effectiveness of policies is critically influenced by the contexts they are implemented in, which are often complex and dynamic.

After you complete the lecture, please take a moment to review the the reading Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework

In the next activity, you will be invited to conduct your own Context analysis.

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