Why does EBP matter for developing countries?
We are convinced that that EBP approaches have the potential to have even greater impact on socioeconomic outcomes in developing countries. This is because EBP tends to be less well established in developing countries than in developed ones. Indeed, better use of evidence in policy and practice could help dramatically reduce poverty and improve economic performance in developing countries. Two cases highlight the value of EBP in developing countries - one where evidence dramatically improved lives, the other where the lack of an evidence-based response has caused widespread devastation. In the first case, the government of Tanzania has implemented a process of health service reforms informed by the results of household disease surveys; this contributed to an over 40% reduction in infant mortality between 2000 and 2003 in the two pilot districts. On the other hand, the HIV/AIDS crisis has deepened in some countries because governments have ignored the evidence regarding what causes the disease and how to prevent it spreading.

Translation of EBP to developing country contexts
Increasing the use of evidence-based policy approaches in developing countries undoubtedly introduces new challenges. It is important to note that there is considerable diversity in terms of cultural, economic and political contexts, which makes it difficult to make valid generalisations here. Below, however, we try to highlight a few of the key differences that exist across the developing world and that would affect the effective use of EBP approaches (as based on Court, 2005).

A few of the issues that may matter in some countries include:

• Weaker economic conditions: resources for research and policy are scarcer.
  
• Difficult political environments: there are many places where political freedoms are limited and public accountability systems are weak, even in countries where elections occur (Hyden, Court and Mease, 2004). Political volatility tends to have a negative impact on the use of evidence in policy processes.
  
• It is often in the implementation component of policy processes that barriers to evidence use are largest. Many commentators note problems with accountability, participation, corruption and lack of incentives/capacity to draw in evidence in policy implementation.
  
• Academic freedom, media freedom and civil society strength matter for effective EBP. This is also a key factor in communicating ideas into policy and practice.
  
• Capacity is more limited with regards to generating rigorous evidence and formulating policy.
  
• Conditions of conflict: civil wars or low intensity conflicts limit the application of evidence-based policy.

As a result of research on Sri Lanka, Hornby and Perera (2002) argue that there are a number of factors that make using EBP in developing countries more challenging. These include the lack of performance management within many developing countries; the lack of indicators at the political level or which monitor service provision; the lack of institutional mechanisms; and the lack of ongoing evaluation.

These factors affect evidence-based policy on both the supply and demand side, as well as the relationship between the two. In terms of the supply of evidence, stable and open political systems allow evidence to be freely gathered, assessed and communicated. In terms of demand, democracies imply a greater accountability of governments and therefore a greater incentive to improve policy and performance. Democratic contexts also imply the existence of more open entry-points into the policymaking process and there are fewer constraints on communication. In contrast, autocratic regimes often tend to limit the gathering and communication of evidence and have weak accountability mechanisms. For example, a case study from Uruguay charted the negative effect the dictatorship had on the use of research in health policy (Salvatella, Muzio and Sánchez, 2000: 67-76).

It is clear that in some contexts, the real challenge is not about evidence-based policymaking but instead about the general challenges of a troubled political context. In an increasing number of countries, however, the context is improving. And in many, there are thresholds that have been reached which merit a greater focus on evidence-based policy. Chile, for example, in many ways provides an 'ideal' case, where research and local technical expertise often contribute to improving policy frameworks within the context of a democratic polity. This is also the case in Tanzania, which has often used the evidence base to improve policy and practice despite its very low income (one good example is mentioned above). In such contexts, many of the tools and approaches we propose are worth considering. These would, of course, need to be adapted to make them relevant to local context.

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