Strengthening health systems: Adapting guidance to local policy contexts

Alvarez, E. & Lavis, J. (2016). Implementing health systems guidance: A workbook to support the contextualization of recommendations at the national or subnational level. Hamilton, Canada: McMaster Health Forum.


The Implementing Health Systems Guidance Workbook provides an eight-step process to adapt guidelines to the local context and circumstances in which recommendations will be prioritized, planned and implemented. The workbook incorporates a health policy and systems research perspective. The purpose is to address contextual factors during the policy development process to facilitate decision making. The use of the workbook has been evaluated in two countries, Peru and Uganda. This is an updated version based on findings through these evaluations, and can be used for any health systems or public health systems topic.

Steps for Using Method/Tool

The workbook prompts users with key questions and evidence for consideration when transferring findings to the national or subnational level. The broad health policy and health systems questions can be posed across different health system arrangements and sociocultural and political systems. Throughout the workbook, evidence prompts are labelled according to the level of evidence (e.g., systematic reviews, systematically collected global data, national data and research evidence) to ensure that the best available and most appropriate global and local evidence are included in the policy decision-making process.

The steps for the health systems guidance contextualization framework are:

  1. selecting the topic, identifying the venue for decision making, and clarifying the problem and its causes;
  2. framing options for addressing the problem;
  3. identifying implementation considerations;
  4. considering the broader health system context;
  5. considering the broader political system context;
  6. refining the statement of the problem, options and implementation considerations in light of health system and political system factors;
  7. anticipating monitoring and evaluation needs; and lastly,
  8. making national or subnational policy recommendations or decisions and developing advocacy and dissemination strategies.

The workbook provides a suite of tools (i.e., worksheets) to accompany each step in the process.


The use of the workbook has been evaluated in two countries, Peru and Uganda. This version of the workbook is an update based on feedback from global guidance developers, users at the country level, and a critical interpretive literature search from a variety of fields.

These summaries are written by the NCCMT to condense and to provide an overview of the resources listed in the Registry of Methods and Tools and to give suggestions for their use in a public health context. For more information on individual methods and tools included in the review, please consult the authors/developers of the original resources.

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