Table 4. Description of the Maturation Stage and Contextual Factors Relevant for Establishing a Policy Support Organization .

Description of the Stage	Contextual Factors Acting as Mechanisms of Influence on Stages of Establishment	Link to the Other Stages
The maturation stage reflects the organization’s stability where it can be considered as sustainable in the long term. The following are some of the features identified as being important for ensuring sustainability: • Institutionalization of PSO within a pre-existing institutional structure to facilitate the ability to overcome challenges.39,41,42,44,45,47,51,59,64 • Having a formal legal mandate (ie, legislation, ministerial order, term of reference) to reduce duplication of effort, maximize productivity and enhance understanding of stakeholder needs.43,47,51 • Having a sustainable source of funding to reduce the threat of ending some or all of the organization’s activities when one or more sources for external funding stops.39,47,59 • Having mechanisms to retain needed capacities (eg, providing financial and/or non-financial incentives).39,62	Political system – Availability of resource • Anchoring a PSO to a pre-existing institutional structure facilitates its establishment by pooling needed financial and human resources, sharing infrastructure, and helping to foster support from policy-makers, stakeholders and researchers. For these reasons, institutionalizing the PSO within a pre-existing structure is important even if initially started as an independent project.39,51,52,54,60,63,64,70,76 However, the impact of this is influenced by the strength of the anchored organization’s infrastructure, governance, and ability to mobilize the resources to fund and implement programs and projects.39,44,50,55 • To ensure the sustainability of PSO, the payment scheme should be attractive enough to retain staff.39,50-52,68,70 • The conceptualization of the length and cost of EIPM processes by policy-makers and stakeholders influences their commitment to providing needed supports and resources in the long-term,20 which makes it important to demonstrate the potential effectiveness of the PSO in improving resource allocation and other aspects of providing health services. Political system – Trust between researchers and policy-makers • Trust between policy-makers and researchers increases the commitment and support of policy-makers from within the government, which influences the PSO sustainability because there support increases the likelihood of the organization being institutionalized and gaining support from other local and international organizations.19,39,44,50,51 Political system – Ideas about EIPM •PSO sustainability is enhanced when policy-makers and stakeholders value the role of research in policy-making, which in turn helps build increased awareness among policy-makers about the services offered.42,44,51,54 Research system – Availability of resources • Weak productivity of research (particularly local evidence) due to financial or human resources challenges would influence the sustainability of PSO.50,68,70 Research system – Trust between researchers and policy-makers • Maintaining a trusting relationship between policy-makers and researchers is important for PSO sustainability because it forms the foundation of all PSO activities, builds stronger inter-organizational links over time, and ensures credibility and neutrality of the PSO.43,46,68 Health system – Trust between researchers and policy-makers • Highly qualified managers with a research background within the MOH is important for sustaining the value placed on using research in decision-making, which can enhance the sustainability of PSO as it supports ongoing demanding for and use of PSO services.44,54 Health system – Availability of resources • Having a focus on evidence-to-policy processes within a government’s mandate facilitates PSO sustainability because of the pressure the mandate can create on policy-makers to utilize research and developing evidence-informed policies (and to draw on the PSO’s services in the process).46	Stage 2 – Development Strong leadership • Institutional leadership is important to avoid organizational collapse if/when the key people leave.42,46,70 Clearly defined organizational structure • The PSO governance approach, clarity of its legal mandates, and its location are critical to defining organization sustainability.43,47,51,63,72 Sustainable funding • Lack of sustained funding can slow the development process,39,59,64,71 and jeopardize the organization’s sustainability.47,52,64 Capable human resources • Any issues with low salaries, high workload, and job insecurity should be resolved to retain the qualified staff in order to ensure long-term sustainability.26,52,64,65,68,70

Abbreviation: PSO, policy support organization.