Building on the Health Policy Analysis Triangle: Elucidation of the Elements

The health policy triangle first presented in the 20th century by Walt and Gilson has been extensively used at local, national, regional, and international levels to assess health policies related to communicable and non-communicable diseases, physical and mental health, antenatal and postnatal care, and human resources, services, and systems. However, the framework lacks intricate details for the four pillars in the triangle viz: ‘content,’ ‘context’, ‘actors’, and ‘processes. We propose a checklist of elements to be considered for each pillar; to ease and enhance the process of policy analyses for researchers and policymakers across the globe, including low- and middle-income countries. We suggest using Leichter’s categorization of situational, structural, cultural, and environmental factors for comprehensive contextual assessment. Kingdon’s multiple streams framework can be applied to determine the ‘window of opportunity’ allowing the politics, policy, and problem streams to unite, giving birth to the formulation of policies. Lastly, stakeholders’ analyses expounding the power, influence, interest, and involvement of intrinsic, extrinsic, implicit, and explicit players should be applied to explore the ‘actors’ in policy analyses. Robust policy analyses for generating evidence are of paramount importance for policymakers for informed decision-making. Our approach of dis-entangling and elaborating the pillars of the triangle will be helpful for health systems researchers at sub-national, national, regional and global levels to serve as a basis for evidence-based informed decision-making.