Strengthening health systems: Adapting guidance to local policy contexts

A Summary of

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.

Access the Method

Format of the Method




On-line Access



Using the Method

Time for Participation/Completion

Information not available

Additional Resources and/or Skills Needed for Implementation


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.

Who is involved

While policymakers and policy advisors are primarily responsible for leading the contextualization process, they may work in conjunction with researchers who are skilled in conducting literature searches and in knowledge translation methods, and they may seek the views and opinions of public health/health care recipients, health workers and managers in organizations, among others.

Conditions for Use

© 2016 McMaster University

Evaluation of the Method


Has been evaluated.

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.


Not applicable


Not applicable

Methodological Rating

Not applicable

Development of the Method


Elizabeth Alvarez

Method of Development

The workbook builds upon previously published content in the PLoS Med ‘guidance for evidence-informed policies about health systems’ series, in particular article number 2 of 3, and the ‘SUPPORT tools for evidence-informed health policymaking’ articles. This work was at least in part informed by issues raised during meetings of the World Health Organization’s (WHO) Task Force on Developing Health Systems Guidance.

Release Date


Contact Person/Source

Elizabeth Alvarez
McMaster Health Forum’s Impact Lab
1280 Main St W
Hamilton, ON L8S 4K1
Phone: (905) 525-9140 ext. 22521

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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