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A: The decision-making environment (macro-level and health sector)
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Review
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Policy dialogue
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Absence of long-term plans and directors' lack of commitment to such plans
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*
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Organizational, social, and political pressure in decision-making and the dominance of pressure groups over scientific evidence in policy-making
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*
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Lack of communication between different sectors of the MOHME in the development and implementation of health policies
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*
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Short tenure of policy-makers and their rapid replacement
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*
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Directors are not chosen based on meritocracy
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*
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Time limitations in organizational decision-making
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*
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Personal interpretations of enforceable laws
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*
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Directors and policy-makers act based on their personal preferences
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*
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Evidence is exploited to approve a predetermined mental framework
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*
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Decision-makers' politicization
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*
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B: The health decision-making/policy-making process
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Lack of universality and institutionalization of the HTA process
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*
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Absence of a specific criterion for prioritization and decision-making
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*
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Policies and programmes are not evaluated, and improvement is not made based on evaluation
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*
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No attention is paid to the contextualization of interventions
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*
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Panels of experts are used instead of research, and the panels are not held properly
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*
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Solutions are presented without complete and comprehensive data backup
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*
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C: Supportive processes and structures
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Lack of supervision, rules, and regulations regarding the development and implementation of guidelines
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*
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Structural, financial, and legislative limitations in ordering the research needed
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*
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Lack of processes that enforce the use of evidence in decision-making
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*
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Lack of support of senior policy-makers (e.g. Parliament representatives) by scientific groups
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*
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Shortage of skilled human resources for evidence utilization
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*
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D: Incentive system
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D1: Organizational and individual goals and values
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Absence of political support for evidence utilization in decision-making
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*
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Policy-makers' inappropriate perceptions of the need for evidence utilization/ Decision-makers do not feel the need to utilize scientific evidence
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*
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The health ministry's health decision-makers' preference to produce evidence themselves
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*
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Giving priority to personal or organizational preferences over evidence
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*
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Lack of health decision-makers' trust in the local research evidence
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*
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Lack of commitment to evidence utilization in decision-making
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*
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Policy-makers' inappropriate perceptions of the real outcomes of policy execution
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*
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The perception of evidence utilization as a luxurious tool rather than strengthening and improving the health system
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*
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Lack of decision-maker transparency and accountability
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*
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D2: Individual capacities and capabilities
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Policy-makers' lack of awareness and skills in the analysis and rapid utilization of evidence
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*
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Inappropriateness of individuals' skill and knowledge for policy-making and management; absence of strategic thinking among decision-makers
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*
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Superficial and simplistic knowledge regarding issues, problems, and solutions
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*
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D3: Performance evaluation and reward programmes
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Inappropriateness of indices for managers' performance evaluations (there's a quantitative approach, and the number of decisions is important); There is no criterion for evidence utilization in the managers' evaluation
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*
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*
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The supervision and evaluation system of decision-makers is not evidence-based
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*
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The noncompetitive advantage of evidence utilization among policy-makers and managers and negative attitude towards policy-makers and managers who utilize evidence
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*
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