Review Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries Asha George a , Kerry Scott a, b, * , Surekha Garimella b , Shinjini Mondal b , Rajani Ved c , Kabir Sheikh b a Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA b Public Health Foundation of India, New Delhi, India c National Health Systems Resource Centre, New Delhi, India article info Article history: Available online 28 March 2015 Keywords: Context Health committee Community Health facility Health administration Society Low and middle income countries abstract Health committees, councils or boards (HCs) mediate between communities and health services in many health systems. Despite their widespread prevalence, HC functions vary due to their diversity and complexity, not least because of their context specific nature. We undertook a narrative review to better understand the contextual features relevant to HCs, drawing from Scopus and the internet. We found 390 English language articles from journals and grey literature since 1996 on health committees, councils and boards. After screening with inclusion and exclusion criteria, we focused on 44 articles. Through an iterative process of exploring previous attempts at understanding context in health policy and systems research (HPSR) and the HC literature, we developed a conceptual framework that delineates these contextual factors into four overlapping spheres (community, health facilities, health administration, society) with cross-cutting issues (awareness, trust, benefits, resources, legal mandates, capacity- building, the role of political parties, non-governmental organizations, markets, media, social move- ments and inequalities). While many attempts at describing context in HPSR result in empty arenas, generic lists or amorphous detail, we suggest anchoring an understanding of context to a conceptual framework specific to the phenomena of interest. By doing so, our review distinguishes between contextual elements that are relatively well understood and those that are not. In addition, our review found that contextual elements are dynamic and porous in nature, influencing HCs but also being influenced by them due to the permeability of HCs. While reforms focus on tangible HC inputs and outputs (training, guidelines, number of meetings held), our review of contextual factors highlights the dynamic relationships and broader structural elements that facilitate and/or hinder the role of health committees in health systems. Such an understanding of context points to its contingent and malleable nature, links it to theorizing in HPSR, and clarifies areas for investigation and action. © 2015 Published by Elsevier Ltd. 1. Introduction Health committees (HCs) are one of the better documented mechanisms in an incipient empirical evidence base on community accountability in health systems (Molyneux et al., 2012). In many countries, they are a familiar fixture of health systems, and can be effective in improving quality and coverage of health care, as well as improving health (McCoy et al., 2012). Despite their widespread prevalence, their contributions vary due to their diversity in for- mation, roles, resources and mandates. One part of unlocking their potential to engage communities and improve health care quality and coverage lies in better understanding their contextual location within health systems and societies. To further such understanding, in this article we explore how context is understood in health systems and policy research (HPSR) and from that basis present findings from our literature review on HC contextual factors. Emphasis on understanding context in HPSR (Walt and Gilson, 1994) is part of what distinguishes it as a social science subject * Corresponding author. Health Governance Hub, Public Health Foundation of India, Sector 44, Plot 47, Gurgaon, Haryana 122003, India. E-mail address: kerry.e.scott@gmail.com (K. Scott). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed http://dx.doi.org/10.1016/j.socscimed.2015.03.049 0277-9536/© 2015 Published by Elsevier Ltd. Social Science & Medicine 133 (2015) 159e167