This study explored macro, meso and micro-level influences on the role of evidence in the development of six health policies in India and Nigeria. Macro-level influences included adoption of international agreements, movement towards evidence-informed policymaking, committed country leadership and resource environment. At meso level, national actors drove policy processes with support from the international actors. Micro-level influences included individual values, interests and evidence preferences. Factors at three levels are interrelated. Greater understanding of contextual influences can provide a platform for adapting to, or managing, these influences to improve the evidence-informed nature of health policymaking.