A Scoping Review of Evidence-based Decision-making in Health Financing Reforms: Conceptual Frameworks and Experiences to Inform Health Policy in Cameroon

Abstract

Evidence-informed decision-making is increasingly recognized as essential for health financing reforms. It can improve effectiveness, equity, and accountability while supporting progress towards Universal Health Coverage (UHC). However, its integration into decision-making to inform health policy processes remains uneven across different contexts. This review aims to synthesise the available knowledge on the use of evidence in health financing decision-making, including international experiences and lessons learned from Cameroon. A scoping review was conducted using the Arksey and O’Malley framework, later refined by Levac et al. Reporting followed the PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, and Web of Science, as well as in institutional sources such as WHO and the World Bank. Studies published between 2000 and 2025 in English or French were considered. Eligible studies included empirical and conceptual work on the use of evidence in health financing policies. Data were extracted using a standardized template and analysed thematically. A supplementary analysis of the case of Cameroon was carried out. Twenty-eight studies were included. The use of evidence appears to be multidimensional, encompassing quantitative, qualitative and economic data. Four main types of use were identified: instrumental, conceptual, strategic and interactive. High-income countries showed more institutionalized processes. In contrast, low- and middle-income countries faced fragmented practices, often influenced by external actors. The main determinants include governance structures, stakeholder interests, institutional capacities and the political context. Reforms were generally associated with improved access to care and financial protection, with varying effects on equity and quality. The use of evidence in health financing reforms is progressing but remains uneven. To accelerate progress towards Universal Health Coverage, policymakers should institutionalize evidence-informed decision-making. They should also strengthen national health information and financing data systems, invest in local analytical capacity, and promote transparent multi-stakeholder governance mechanisms. In low- and middle-income settings, reducing dependency on externally driven agendas and aligning reforms with national priorities will be critical to achieving equitable, efficient and sustainable health financing outcomes.