Using Evidence in a Highly Fragmented Legislature: The Case of Colombia’s Health System Reform

Abstract

This chapter examines how evidence is used in major policy health policy initiatives in a highly contested political context. Through a case study of legislation proposed in the context of Colombia's ongoing health systems reformed process, it explores how such use is affected by the specific role played by the legislature within a highly fragmented polity. We use an institutionalist framework to identify three concentric layers of fragmentation: at the social, political and administrative levels. The former refers to macro levels social structures and factors shaping Colombian society and politics, including the ongoing armed conflict as associated social cleavages which have loomed over Colombian society for decades. At the second level, Colombian politics is characterised by deep divisions and political cleavages along party lines, coupled with weak party structures. This results in a highly fluid political terrain in which new parties may