1
|
Kim S, Rochette A, Ahmed S, Archambault PS, Auger C, Battaglini A, Freeman AR, Kehayia E, Kinsella EA, Larney E, Letts L, Nugus P, Raymond MH, Salbach NM, Sinnige D, Snider L, Swaine B, Tousignant-Laflamme Y, Thomas A. Creating synergies among education/research, practice, and policy environments to build capacity for the scholar role in occupational therapy and physiotherapy in the Canadian context. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1169-1198. [PMID: 38015277 DOI: 10.1007/s10459-023-10298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023]
Abstract
Scholarly practice (SP) is considered a key competency of occupational therapy and physiotherapy. To date, the three sectors-education/research, practice, and policy/regulation-that support SP have been working relatively independently. The goals of this project were to (a) understand how representatives of the three sectors conceptualize SP; (b) define each sector's individual and collective roles in supporting SP; (c) identify factors influencing the enactment of SP and the specific needs of how best to support SP; and (d) co-develop goals and strategies to support SP across all sectors. We used interpretive description methodology. Consistent with an integrated knowledge translation approach, partners representing the three sectors across Canada recruited individuals from each sector, developed the content and questions for three focus groups, and collected and analyzed the data. Inspired by the Consolidated Framework for Implementation Research, we developed the questions for the second focus group. We analyzed the data using an inductive thematic analysis method. Thirty-nine participants from the three sectors participated. Themes related to participants' conceptualization of SP included (a) ongoing process, (b) reflective process, (c) broad concept, and (d) collective effort. Themes describing factors influencing and supporting SP were (a) recognition, (b) appropriate conceptualization, (c) social network, (d) accessibility to resources, and (e) forces outside of practitioners' effort. Goals to support SP included (a) further recognizing SP, (b) sustaining SP competency, and (c) ensuring access to information. SP requires collaborative and integrated intersectoral support and further recognition of its importance through the collaboration of multiple stakeholders.
Collapse
Affiliation(s)
- Sungha Kim
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada
- Clinical Epidemiology, Center for Outcome Research and Evaluation (CORE), McGill University Health Center Research Institute, Montréal, QC, Canada
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Montréal, QC, Canada
| | - Alex Battaglini
- Directorate of University Teaching and Research, CISSS de Laval, Laval, QC, Canada
- l'École de Santé Publique de l'Université de Montréal, Montréal, QC, Canada
| | - Andrew R Freeman
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM: Centre de Recherche en Santé Durable, Québec, QC, Canada
| | - Eva Kehayia
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada
| | - Elizabeth Anne Kinsella
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Elinor Larney
- Association of Canadian Occupational Therapy Regulatory Organizations and College of Occupational Therapists of Ontario, Toronto, ON, Canada
| | - Lori Letts
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Peter Nugus
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Marie-Hélène Raymond
- Institut National d'Excellence en Santé et en Services Sociaux, Montréal, QC, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Diana Sinnige
- Canadian Alliance of Physiotherapy Regulators, Toronto, ON, Canada
| | - Laurie Snider
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada
| | - Bonnie Swaine
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Montréal, QC, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montréal, QC, Canada.
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.
| |
Collapse
|
2
|
Arbaein TJ, Alharbi KK, Alfahmi AA, Alharthi KO, Monshi SS, Alzahrani AM, Alkabi S. Makkah healthcare cluster response, challenges, and interventions during COVID-19 pandemic: A qualitative study. J Infect Public Health 2024; 17:975-985. [PMID: 38631067 DOI: 10.1016/j.jiph.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The global COVID-19 crisis has underscored the critical role of effective decision-making in healthcare systems. Saudi Arabia has shown resilience by implementing comprehensive testing, tracing, and vaccination measures. Given the unique cultural and religious characteristics of Makkah, specific challenges have prompted efforts to uncover local pandemic responses. This qualitative assessment aims to delineate the challenges faced by decision-makers during COVID-19 in Makkah and identify key interventions implemented by the Makkah healthcare cluster to manage and coordinate care. METHOD Utilizing a purposive sampling approach, executive leaders within the Makkah Healthcare Cluster were invited for semi-structured interviews during the COVID-19 period. Thematic analysis was carried out in five steps, ensuring rigor and trustworthiness through multiple checks, and employing a critical and collaborative approach. RESULT Throughout the COVID-19 outbreak in Makkah, participants revealed Several factors that have hindered healthcare organizations' ability to effectively manage the pandemic, including testing difficulties, resource shortages, vaccination misconceptions, continuity of care issues, infections among healthcare workers, and the need for consistent protocols. The participant leaders in Makkah's healthcare cluster specified implemented strategies that helped in overcoming the encountered challenges, such as adopting new technologies, enhancing communication, managing supply and demand, and improving workforce adaptability and development. Their experience in managing Hajj and Umrah provided valuable insights for handling the pandemic effectively. CONCLUSION The study emphasizes the significance of technology adoption, effective communication, supply management, workforce development, and lessons from managing religious events. Its findings have implications for healthcare systems globally, emphasizing the importance of preparedness, response, and resilience in diverse cultural contexts.
Collapse
Affiliation(s)
- Turky J Arbaein
- Department of Health Administration and Hospital, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Khulud K Alharbi
- Department of Health Administration and Hospital, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Afrah A Alfahmi
- Department of Health Administration and Hospital, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khawlah O Alharthi
- Department of Health Administration and Hospital, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sarah S Monshi
- Department of Health Administration and Hospital, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ali M Alzahrani
- Department of Health Administration and Hospital, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sanaa Alkabi
- Department of Health Administration and Hospital, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| |
Collapse
|
3
|
Tiendrebeogo J, Arnold B, Ouedraogo Y, Haws R, Garane LP, Ouedraogo V, Gouem M, Coulibaly A, Bougma M. Mobilizing stakeholders for implant removals in Burkina Faso using landscape assessment data. BMC Womens Health 2024; 24:301. [PMID: 38769558 PMCID: PMC11104007 DOI: 10.1186/s12905-024-03121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Successful efforts to encourage uptake of subdermal contraceptive implants, with a lifespan of three to five years, necessitate planning to ensure that quality removal services are available when desired. In Burkina Faso, implant use has tripled over the past 8 years and now comprises almost half of the contraceptive method mix. Population Monitoring for Action (PMA) surveys identified barriers to obtaining quality removal when desired, particularly when the implant is not palpable, or providers lack needed skills or supplies. The Expanding Family Planning Choices (EFPC) project supported ministries of health in four countries with evaluation and strengthening of implant removal services. METHODS An implant removal landscape assessment was conducted at 24 health facilities in three regions of Burkina Faso with high implant use that included provider observations of implant removal, interviews with providers and health facility managers, and facility readiness surveys. The project used landscape data to mobilize stakeholders through a series of participatory workshops to develop a collaborative roadmap and commit to actions supporting quality implant removals. RESULTS Landscape findings revealed key gaps in provision of quality removal services, including high levels of provider confidence for implant insertion and removal (82% and 71%, respectively), low competence performing simple and difficult removals (19.2% and 11.1%, respectively), inadequate supplies and equipment (no facilities had all necessary materials for removal), lack of difficult removal management systems, and a lack of standard data collection tools for removal. Exposure to the data convinced stakeholders to focus on removals rather than expanding insertion services. While not all roadmap commitments were achieved, the process led to critical investments in quality implant removals. CONCLUSION Landscape data revealed that facilities lack needed supplies and equipment, and providers lack skills needed to perform quality implant removals, limiting client reproductive choice. Disseminating this data enabled stakeholders to identify and commit to evidence-based priority actions. Stakeholders have since capitalized on program learnings and the roadmap, including following MOH guidance for implant removal supplies and health provider training. Our experience in Burkina Faso offers a replicable model of how data can direct collective action to improve quality of contraceptive implant removals.
Collapse
Affiliation(s)
| | | | | | - Rachel Haws
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Maria Gouem
- Jhpiego Burkina Faso, Ouagadougou, Burkina Faso
| | | | - Mathieu Bougma
- Ministère de la Santé [Ministry of Health] Burkina Faso, Ouagadougou, Burkina Faso
| |
Collapse
|
4
|
Fujioka M, Okamoto R, Miyamoto K, Koide K, Kageyama M, Saeki K, Hirokane K, Nagano F, Takemura S. Best practice transfer by public health nurses in Japan: actual conditions and related factors. BMC Nurs 2024; 23:253. [PMID: 38649995 PMCID: PMC11034165 DOI: 10.1186/s12912-024-01800-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/14/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors. METHODS An anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis. RESULTS One hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice. CONCLUSIONS Through a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research.
Collapse
Affiliation(s)
- Mana Fujioka
- Former Division of Health Sciences, Osaka University Graduate School of Medicine , Yamadaoka 1-7, 565-0871, Suita-city, Osaka, Japan
| | - Reiko Okamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita-city, Japan.
| | - Keiko Miyamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Keiko Koide
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Masako Kageyama
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita-city, Japan
| | - Kazuko Saeki
- Faculty of Nursing, Toyama Prefectural University, Nishi-nagae 2-2-78, 930-0975, Toyama-city, Toyama, Japan
| | - Kazue Hirokane
- Faculty of Nursing, Hyogo Medical University, Minatojima 1-3-6, Chuo-ku, 650-8530, Kobe-city, Hyogo, Japan
| | - Fusami Nagano
- Faculty of Nursing, Fukuyama Heisei University, Kamiiwanari-syoto 117-1, Miyuki-town, 720-0001, Fukuyama-city, Hiroshima, Japan
| | - Shinji Takemura
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako-city-minami 2-3-6, 351-0197, Wako-city, Saitama, Japan
| |
Collapse
|
5
|
Buss VH, Shahab L, Bauld L, Kock L, Cheeseman H, Brown J. 'Stopping the start': support for proposed tobacco control policies - a population-based survey in Great Britain 2021-2023. Tob Control 2024:tc-2023-058571. [PMID: 38609176 DOI: 10.1136/tc-2023-058571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES This study assessed public support for four proposed tobacco control policies in Great Britain: (1) Raising the sales age of tobacco by 1 year every year (Smokefree Generation); (2) Raising the sales age of tobacco from 18 years to 21 years; (3) Providing prescription e-cigarettes as smoking cessation aids to adults who smoke; (4) Restricting e-cigarette advertising to prevent youth uptake. DESIGN Repeat cross-sectional population-based survey weighted to match the population of Great Britain. SETTING The survey was conducted in England, Scotland and Wales in September 2021, October 2022 and October 2023. PARTICIPANTS 6541 adults living in Great Britain. MAIN OUTCOME MEASURES Support for each policy and year and prevalence ratios (PRs) comparing support between years and subgroups. RESULTS The most popular policy each year was restricting e-cigarette advertising (74%/79%/85%), followed by raising the sales age to 21 years (50%/58%/64%), providing prescription e-cigarettes (45%/44%/47%) and Smokefree Generation (34%/44%/49%). The largest increases were for policies about the age of sale (Smokefree Generation: 2021/2022 PR=1.28, 95% CI 1.18 to 1.40, 2022/2023 PR=1.12, 95% CI 1.04 to 1.20; raising the age to 21 years: 2021/2022 PR=1.16, 95% CI 1.09 to 1.23, 2022/2023 PR=1.11, 95% CI 1.05 to 1.17). Only 30% opposed Smokefree Generation in 2023 down from 41% in 2021. CONCLUSIONS Support for each policy increased each year, except for providing prescription e-cigarettes. Restricting e-cigarette advertising was the most popular policy, while support for age of sale policies, in particular for a Smokefree Generation, grew most. TRIAL REGISTRATION The study protocol was published on the Open Science Framework (https://osf.io/46z2c/) prior to starting the analysis.
Collapse
Affiliation(s)
- Vera Helen Buss
- Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Lion Shahab
- Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Linda Bauld
- SPECTRUM Consortium, Edinburgh, UK
- Usher Institute and UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Loren Kock
- Behavioural Science and Health, University College London, London, UK
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
| | - Hazel Cheeseman
- SPECTRUM Consortium, Edinburgh, UK
- Action on Smoking and Health, London, UK
| | - Jamie Brown
- Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| |
Collapse
|
6
|
Jabali SH, Yazdani S, Pourasghari H, Maleki M. From bench to policy: a critical analysis of models for evidence-informed policymaking in healthcare. Front Public Health 2024; 12:1264315. [PMID: 38596514 PMCID: PMC11002157 DOI: 10.3389/fpubh.2024.1264315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background The use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations. Method A systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars' perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations. Result Nine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations. Conclusion The reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.
Collapse
Affiliation(s)
- Seyyed Hadi Jabali
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Nabyonga-Orem J, Kataika E, Rollinger A, Weatherly H. Research-to-Policy Partnerships for Evidence-Informed Resource Allocation in Health Systems in Africa: An Example Using the Thanzi Programme. Value Health Reg Issues 2024; 39:24-30. [PMID: 37976774 DOI: 10.1016/j.vhri.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Empirical data on the impact of research-to-policy interventions are scant, with the few attempts mainly focusing on ensuring policymakers' timely access to evidence and evidence-informed dialogs. METHODS This article reflects on how the Thanzi Programme cultivates an approach of research-to-policy engagement in health economics. The program is structured around 3 interrelated pillars comprising research evidence generation, capacity and capability building, and research-and-policy engagement. Each pillar is described and examples from the Thanzi Programme are given, including illustrating how each pillar informs the other. Limitations and challenges of the approach are discussed, with examples of a way forward. RESULTS This program supports health system strengthening through addressing gaps identified by program partners. This includes providing health economics training and research and strengthened partnerships between in-country researchers and health policymakers, as well as between national and international researchers. Platforms bringing together researchers and policymakers to shape the research agenda, disseminate evidence, and foster an evidence-based dialog are institutionalized at country and regional levels. Health Economics and Policy Units have been established, which sit between the Ministries of Health and Universities, to augment policymakers and health economics researchers' engagements on priority health policy matters and determine researchable policy questions. The establishment of the Health Economics Community of Practice as a substantive expert committee under the East Central and Southern Africa Health Community bolsters the contribution of health economics evidence in policy processes at the regional level. CONCLUSIONS The Thanzi Programme is an example of how a research-and-policy partnership framework is being used to support evidence-informed health resource allocation decisions in Africa. It uses a combination of high-quality multidisciplinary research, sustained research and policymakers' engagement and capacity strengthening to use research evidence to guide and support policy makers more effectively.
Collapse
Affiliation(s)
- Juliet Nabyonga-Orem
- Office of the Regional Director/Public Health coordinator, WHO Africa Regional Office, Harare, Zimbabwe; Centre for Health Professions Education/Professor, North-West University-Potchefstroom Campus, Potchefstroom, South Africa.
| | - Edward Kataika
- East Central and Southern Africa Health Community/Technical officer, East African Community, Arusha, Tanzania
| | - Alexandra Rollinger
- Centre for Health Economics/Researcher, University of York, York, England, UK
| | - Helen Weatherly
- Centre for Health Economics/Researcher, University of York, York, England, UK
| |
Collapse
|
8
|
Semahegn A, Manyazewal T, Hanlon C, Getachew E, Fekadu B, Assefa E, Kassa M, Hopkins M, Woldehanna T, Davey G, Fekadu A. Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review. Health Res Policy Syst 2023; 21:131. [PMID: 38057873 PMCID: PMC10699029 DOI: 10.1186/s12961-023-01084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND An estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review. METHODS The scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question. RESULTS A total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms. CONCLUSION Important barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.
Collapse
Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | | | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
| |
Collapse
|
9
|
Sell K, Jessani NS, Mesfin F, Rehfuess EA, Rohwer A, Delobelle P, Balugaba BE, Schmidt BM, Kedir K, Mpando T, Niyibizi JB, Osuret J, Bayiga-Zziwa E, Kredo T, Mbeye NM, Pfadenhauer LM. Developing, implementing, and monitoring tailored strategies for integrated knowledge translation in five sub-Saharan African countries. Health Res Policy Syst 2023; 21:91. [PMID: 37667309 PMCID: PMC10478471 DOI: 10.1186/s12961-023-01038-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Integrated knowledge translation (IKT) through strategic, continuous engagement with decision-makers represents an approach to bridge research, policy and practice. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA +), comprising research institutions in Ethiopia, Malawi, Rwanda, South Africa, Uganda and Germany, developed and implemented tailored IKT strategies as part of its multifaceted research on prevention and care of non-communicable diseases and road traffic injuries. The objective of this article is to describe the CEBHA + IKT approach and report on the development, implementation and monitoring of site-specific IKT strategies. METHODS We draw on findings derived from the mixed method IKT evaluation (conducted in 2020-2021), and undertook document analyses and a reflective survey among IKT implementers. Quantitative data were analysed descriptively and qualitative data were analysed using content analysis. The authors used the TIDieR checklist to report results in a structured manner. RESULTS Preliminary IKT evaluation data (33 interviews with researchers and stakeholders from policy and practice, and 31 survey responses), 49 documents, and eight responses to the reflective survey informed this article. In each of the five African CEBHA + countries, a site-specific IKT strategy guided IKT implementation, tailored to the respective national context, engagement aims, research tasks, and individuals involved. IKT implementers undertook a variety of IKT activities at varying levels of engagement that targeted a broad range of decision-makers and other stakeholders, particularly during project planning, data interpretation, and output dissemination. Throughout the project, the IKT teams continued to tailor IKT strategies informally and modified the IKT approach by responding to ad hoc engagements and involving non-governmental organisations, universities, and communities. Challenges to using systematic, formalised IKT strategies arose in particular with respect to the demand on time and resources, leading to the modification of monitoring processes. CONCLUSION Tailoring of the CEBHA + IKT approach led to the inclusion of some atypical IKT partners and to greater responsiveness to unexpected opportunities for decision-maker engagement. Benefits of using systematic IKT strategies included clarity on engagement aims, balancing of existing and new strategic partnerships, and an enhanced understanding of research context, including site-specific structures for evidence-informed decision-making.
Collapse
Affiliation(s)
- Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | - Nasreen S Jessani
- Centre for Evidence-Based Healthcare, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Firaol Mesfin
- Non-Communicable Diseases Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Anke Rohwer
- Centre for Evidence-Based Healthcare, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter Delobelle
- Chronic Diseases Initiative for Africa, University of Cape Town, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bonny E Balugaba
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kiya Kedir
- Non-Communicable Diseases Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Talitha Mpando
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Jean Berchmans Niyibizi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jimmy Osuret
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Esther Bayiga-Zziwa
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics and Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nyanyiwe Masingi Mbeye
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| |
Collapse
|
10
|
Korri R, Ivanova O. A series of workshops to present research findings and fill knowledge gap among adolescent girls and young women on sexual and reproductive health in Lebanon: An example of active knowledge dissemination. J Glob Health 2023; 13:03044. [PMID: 37655369 PMCID: PMC10472200 DOI: 10.7189/jogh.13.03044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
- Rayan Korri
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| |
Collapse
|
11
|
Ngwira MM, Gadama LA, Shanmugalingam R, Makris A, Hennessy A. Health Care Workers and Key Policy Informant’s Knowledge of the use of Calcium and Low Dose Aspirin for Prevention of Preeclampsia in Malawian Women. Pregnancy Hypertens 2022; 30:221-225. [DOI: 10.1016/j.preghy.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
|
12
|
Jaeger L, Devi T, Barbazza E, Neufeld M, Franz C, Marten R, Tello JE. Describing and mapping scientific articles on alcohol globally for the period 2010-2021: a bibliometric analysis. BMJ Open 2022; 12:e063365. [PMID: 36127108 PMCID: PMC9490636 DOI: 10.1136/bmjopen-2022-063365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To describe and map scientific literature related to alcohol consumption, its determinants, governance, harm and control policies by publication output, author affiliations, funding, countries of study and research themes. DESIGN Bibliometric analysis using performance analysis and science mapping techniques. DATA SOURCES Scientific articles. ELIGIBILITY CRITERIA Indexed scientific articles published between 1 January 2010 and 31 December 2021 with an English abstract focused on alcohol consumption, its determinants, harms, governance and control policies. DATA EXTRACTION AND SYNTHESIS Searches were run in Web of Science and PubMed. Performance metrics were analysed using descriptive statistics. Keywords were used for science mapping in a deductive approach to cluster articles by five main research themes. The 'policy response' theme was further analysed by six subthemes. RESULTS 4553 articles were included in the analysis. Three out of four articles (3479/4553, 76.4%) were authored solely by authors affiliated with HIC institutions. One in five articles (906/4553, 19.9%) had at least one author affiliated to an institution from an upper-middle-income, middle-income or low-income country context. Governments, followed by research institutions, were the predominant funding source. Half (53.1%) studied a single country and, of these, 77.0% were high-income countries (HICs). Australia, USA and UK were the most studied countries, together accounting for 44.9% (975/2172) of country-specific articles. Thematically, 'consumption' was most studied, and 'alcohol determinants', least. 'Policy response' articles were predominately conducted in HIC contexts. CONCLUSIONS Although the attributable harm of alcohol is known to affect more significantly lower-income and middle-income countries, scientific publications primarily report on HIC contexts by authors from HICs. Research themes reflect known cost-effective policy actions, though skewed towards HICs and a focus on consumption. The implementation of context-specific alcohol control policies requires addressing the determinants of the uneven geographical and thematic distribution of research.
Collapse
Affiliation(s)
| | - Tanmay Devi
- Data Analysis, CPC Analytics, Berlin, Germany
| | - Erica Barbazza
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Neufeld
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | | | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Juan E Tello
- Department of Health Promotion, World Health Organization, Geneve, Switzerland
| |
Collapse
|
13
|
Verboom B, Baumann A. Mapping the Qualitative Evidence Base on the Use of Research Evidence in Health Policy-Making: A Systematic Review. Int J Health Policy Manag 2022; 11:883-898. [PMID: 33160295 PMCID: PMC9808178 DOI: 10.34172/ijhpm.2020.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/06/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The use of research evidence in health policy-making is a popular line of inquiry for scholars of public health and policy studies, with qualitative methods constituting the dominant strategy in this area. Research on this subject has been criticized for, among other things, disproportionately focusing on high-income countries; overemphasizing 'barriers and facilitators' related to evidence use to the neglect of other, less descriptive concerns; relying on descriptive, rather than in-depth explanatory designs; and failing to draw on insights from political/policy studies theories and concepts. We aimed to comprehensively map the global, peer-reviewed qualitative literature on the use of research evidence in health policy-making and to provide a descriptive overview of the geographic, temporal, methodological, and theoretical characteristics of this body of literature. METHODS We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched nine electronic databases, hand-searched 11 health- and policy-related journals, and systematically scanned the reference lists of included studies and previous reviews. No language, date or geographic limitations were imposed. RESULTS The review identified 319 qualitative studies on a diverse array of topics related to the use of evidence in health policy-making, spanning 72 countries and published over a nearly 40 year period. A majority of these studies were conducted in high-income countries, but a growing proportion of the research output in this area is now coming from low- and middle-income countries, especially from sub-Saharan Africa. While over half of all studies did not use an identifiable theory or framework, and only one fifth of studies used a theory or conceptual framework drawn from policy studies or political science, we found some evidence that theory-driven and explanatory (eg, comparative case study) designs are becoming more common in this literature. Investigations of the barriers and facilitators related to evidence use constitute a large proportion but by no means a majority of the work in this area. CONCLUSION This review provides a bird's eye mapping of the peer reviewed qualitative research on evidence-to-policy processes, and has identified key features of - and gaps within - this body of literature that will hopefully inform, and improve, research in this area moving forward.
Collapse
Affiliation(s)
- Ben Verboom
- Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK
| | - Aron Baumann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
14
|
Asamani JA, Nabyonga-Orem J. Knowledge translation in Africa: are the structures in place? Implement Sci Commun 2020; 1:111. [PMID: 33308316 PMCID: PMC7729704 DOI: 10.1186/s43058-020-00101-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background Contextualised evidence to generate local solutions on the progressive path to universal health coverage is essential. However, this evidence must be translated into action. Knowledge translation (KT) experts have highlighted the plausible mechanisms to foster the uptake of evidence. The objective of this study was to assess the extent to which structures are in place to boost uptake of evidence, in countries of the WHO African Region. Methods Employing a cross-sectional survey, we collected data on the availability of structures to foster the uptake of evidence into policy in 35 out of the 47 member states of the WHO African Region. Data were analysed using a simple counting of the presence or absence of such structures. Results Less than half of the countries had evidence collation and synthesis mechanisms. The lack of such mechanisms presents a missed opportunity to identify comprehensive solutions that can respond to health sector challenges. Close to 50% of the countries had KT platforms in place. However, the availability of these was in several forms, as an institution-based platform, as an annual event to disseminate evidence and as a series of conferences at the national level. In some countries, KT was mainstreamed into routine health sector performance review processes. Several challenges impacted the functionality of the KT platforms including inadequate funding and lack of dedicated personnel. Regarding dissemination of evidence, sharing reports, scientific publications and one-off presentations in meetings were the main approaches employed. Conclusion The availability of KT platforms in the WHO African countries can be described as at best and non-existent at the worst. The current structures, where these exist, cannot adequately foster KT. Knowledge translation platforms need to be viewed as sector-wide platforms and mainstreamed in routine health sector performance reviews and policymaking processes. Funds for their functionality must be planned for as part of the health sector budget. Dissemination of evidence needs to be viewed differently to embrace the concept of “disseminate for impact”. Further, funding for dissemination activities needs to be planned for as part of the evidence generation plan.
Collapse
Affiliation(s)
- James Avoka Asamani
- Inter-Country Support Team for Eastern & Southern Africa, Universal Health Coverage - Life Course Cluster, World Health Organization, P.O Box CY 348, 82-86 Enterprise/Glenara Roads, Highlands, Causeway, Harare, Zimbabwe
| | - Juliet Nabyonga-Orem
- Inter-Country Support Team for Eastern & Southern Africa, Universal Health Coverage - Life Course Cluster, World Health Organization, P.O Box CY 348, 82-86 Enterprise/Glenara Roads, Highlands, Causeway, Harare, Zimbabwe.
| |
Collapse
|
15
|
Strengthening health policy development and management systems in low- and middle- income countries: South Africa's approach. HEALTH POLICY OPEN 2020. [DOI: 10.1016/j.hpopen.2020.100010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
16
|
Biermann O, Tran PB, Viney K, Caws M, Lönnroth K, Sidney Annerstedt K. Active case-finding policy development, implementation and scale-up in high-burden countries: A mixed-methods survey with National Tuberculosis Programme managers and document review. PLoS One 2020; 15:e0240696. [PMID: 33112890 PMCID: PMC7592767 DOI: 10.1371/journal.pone.0240696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) stresses the importance of active case-finding (ACF) for early detection of tuberculosis (TB), especially in the 30 high-burden countries that account for almost 90% of cases globally. OBJECTIVE To describe the attitudes of National TB Programme (NTP) managers related to ACF policy development, implementation and scale-up in the 30 high-burden countries, and to review national TB strategic plans. METHODS This was a mixed-methods study with an embedded design: A cross-sectional survey with NTP managers yielded quantitative and qualitative data. A review of national TB strategic plans complemented the results. All data were analyzed in parallel and merged in the interpretation of the findings. RESULTS 23 of the 30 NTP managers (77%) participated in the survey and 22 (73%) national TB strategic plans were reviewed. NTP managers considered managers in districts and regions key stakeholders for both ACF policy development and implementation. Different types of evidence were used to inform ACF policy, while there was a particular demand for local evidence. The NSPs reflected the NTP managers' unanimous agreement on the need for ACF scale-up, but not all included explicit aims and targets related to ACF. The NTP managers recognized that ACF may decrease health systems costs in the long-term, while acknowledging the risk for increased health system costs in the short-term. About 90% of the NTP managers declared that financial and human resources were currently lacking, while they also elaborated on strategies to overcome resource constraints. CONCLUSION NTP managers stated that ACF should be scaled up but reported resource constraints. Strategies to increase resources exist but may not yet have been fully implemented, e.g. generating local evidence including from operational research for advocacy. Managers in districts and regions were identified as key stakeholders whose involvement could help improve ACF policy development, implementation and scale-up.
Collapse
Affiliation(s)
- Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Phuong Bich Tran
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | |
Collapse
|
17
|
Head MG, Brown RJ, Newell ML, Scott JAG, Batchelor J, Atun R. The allocation of USdollar;105 billion in global funding from G20 countries for infectious disease research between 2000 and 2017: a content analysis of investments. LANCET GLOBAL HEALTH 2020; 8:e1295-e1304. [PMID: 32971052 PMCID: PMC7505652 DOI: 10.1016/s2214-109x(20)30357-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Each year, billions of US$ are spent globally on infectious disease research and development. However, there is little systematic tracking of global research and development. We present research on investments into infectious diseases research from funders in the G20 countries across an 18-year time period spanning 2000-17, comparing amounts invested for different conditions and considering the global burden of disease to identify potential areas of relative underfunding. METHODS The study examined research awards made between 2000 and 2017 for infectious disease research from G20-based public and philanthropic funders. We searched research databases using a range of keywords, and open access data were extracted from funder websites. Awards were categorised by type of science, specialty, and disease or pathogen. Data collected included study title, abstract, award amount, funder, and year. We used descriptive statistics and Spearman's correlation coefficient to investigate the association between research investment and disease burden, using Global Burden of Disease 2017 study data. FINDINGS The final 2000-17 dataset included 94 074 awards for infectious disease research, with a sum investment of $104·9 billion (annual range 4·1 billion to 8·4 billion) and a median award size of $257 176 (IQR 62 562-770 661). Pre-clinical research received $61·1 billion (58·2%) across 70 337 (74·8%) awards and public health research received $29·5 billion (28·1%) from 19 197 (20·4%) awards. HIV/AIDS received $42·1 billion (40·1%), tuberculosis received $7·0 billion (6·7%), malaria received $5·6 billion (5·3%), and pneumonia received $3·5 billion (3·3%). Funding for Ebola virus ($1·2 billion), Zika virus ($0·3 billion), influenza ($4·4 billion), and coronavirus ($0·5 billion) was typically highest soon after a high-profile outbreak. There was a general increase in year-on-year investment in infectious disease research between 2000 and 2006, with a decline between 2007 and 2017. Funders based in the USA provided $81·6 billion (77·8%). Based on funding per 2017 disability-adjusted life years (DALYs), HIV/AIDS received the greatest relative investment ($772 per DALY), compared with tuberculosis ($156 per DALY), malaria ($125 per DALY), and pneumonia ($33 per DALY). Syphilis and scabies received the least relative investment (both $9 per DALY). We observed weak positive correlation (r=0·30) between investment and 2017 disease burden. INTERPRETATION HIV research received the highest amount of investment relative to DALY burden. Scabies and syphilis received the lowest relative funding. Investments for high-threat pathogens (eg, Ebola virus and coronavirus) were often reactive and followed outbreaks. We found little evidence that funding is proactively guided by global burden or pandemic risk. Our findings show how research investments are allocated and how this relates to disease burden and diseases with pandemic potential. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Michael G Head
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Rebecca J Brown
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marie-Louise Newell
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - James Batchelor
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| |
Collapse
|
18
|
Wu S, Khan M, Legido-Quigley H. What steps can researchers take to increase research uptake by policymakers? A case study in China. Health Policy Plan 2020; 35:665-675. [PMID: 32386212 DOI: 10.1093/heapol/czaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2020] [Indexed: 11/14/2022] Open
Abstract
Empirical analysis of the connections between research and health policymaking is scarce in middle-income countries. In this study, we focused on a national multidrug-resistant tuberculosis (TB) healthcare provider training programme in China as a case study to examine the role that research plays in influencing health policy. We specifically focused on the factors that influence research uptake within the complex Chinese policymaking process. Qualitative data were collected from 34 participants working at multilateral organizations, funding agencies, academia, government agencies and hospitals through 14 in-depth interviews and 2 focus group discussions with 10 participants each. Themes were derived inductively from data and grouped based on the 'Research and Policy in Developing countries' framework developed by the Overseas Development Institute. We further classified how actors derive their power to influence policy decisions following the six sources of power identified by Sriram et al. We found that research uptake by policymakers in China is influenced by perceived importance of the health issues addressed in the research, relevance of the research to policymakers' information needs and government's priorities, the research quality and the composition of the research team. Our analysis identified that international donors are influential in the TB policy process through their financial power. Furthermore, the dual roles of two government agencies as both evidence providers and actors who have the power to influence policy decisions through their technical expertise make them natural intermediaries in the TB policy process. We concluded that resolving the conflict of interests between researchers and policymakers, as suggested in the 'two-communities theory', is not enough to improve evidence use by policymakers. Strategies such as framing research to accommodate the fast-changing policy environment and making alliances with key policy actors can be effective to improve the communication of research findings into the policy process, particularly in countries undergoing rapid economic and political development.
Collapse
Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore
| | - Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore 117549, Singapore.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK
| |
Collapse
|
19
|
Votruba N, Grant J, Thornicroft G. The EVITA framework for evidence-based mental health policy agenda setting in low- and middle-income countries. Health Policy Plan 2020; 35:424-439. [PMID: 32040175 PMCID: PMC7195852 DOI: 10.1093/heapol/czz179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 01/23/2023] Open
Abstract
The burden of mental illness is excessive, but many countries lack evidence-based policies to improve practice. Mental health research evidence translation into policymaking is a 'wicked problem', often failing despite a robust evidence base. In a recent systematic review, we identified a gap in frameworks on agenda setting and actionability, and pragmatic, effective tools to guide action to link research and policy are needed. Responding to this gap, we developed the new EVITA 1.1 (EVIdence To Agenda setting) conceptual framework for mental health research-policy interrelationships in low- and middle-income countries (LMICs). We (1) drafted a provisional framework (EVITA 1.0); (2) validated it for specific applicability to mental health; (3) conducted expert in-depth interviews to (a) validate components and mechanisms and (b) assess intelligibility, functionality, relevance, applicability and effectiveness. To guide interview validation, we developed a simple evaluation framework. (4) Using deductive framework analysis, we coded and identified themes and finalized the framework (EVITA 1.1). Theoretical agenda-setting elements were added, as targeting the policy agenda-setting stage was found to lead to greater policy traction. The framework was validated through expert in-depth interviews (n = 13) and revised. EVITA 1.1 consists of six core components [advocacy coalitions, (en)actors, evidence generators, external influences, intermediaries and political context] and four mechanisms (capacity, catalysts, communication/relationship/partnership building and framing). EVITA 1.1 is novel and unique because it very specifically addresses the mental health research-policy process in LMICs and includes policy agenda setting as a novel, effective mechanism. Based on a thorough methodology, and through its specific design and mechanisms, EVITA has the potential to improve the challenging process of research evidence translation into policy and practice in LMICs and to increase the engagement and capacity of mental health researchers, policy agencies/planners, think tanks, NGOs and others within the mental health research-policy interface. Next, EVITA 1.1 will be empirically tested in a case study.
Collapse
Affiliation(s)
- Nicole Votruba
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Jonathan Grant
- Policy Institute at King’s, King’s College London, 1st Floor, Virginia Woolf Building, 22 Kingsway, London WC2B 6LE, UK
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| |
Collapse
|
20
|
Zych MM, Berta WB, Gagliardi AR. Conceptualising the initiation of researcher and research user partnerships: a meta-narrative review. Health Res Policy Syst 2020; 18:24. [PMID: 32070367 PMCID: PMC7029453 DOI: 10.1186/s12961-020-0536-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Integrated knowledge translation refers to researcher and research user partnerships to co-generate and implement knowledge. This type of partnership may be critical to success in increasing knowledge use and impact, but the conceptualisation of its initiation has not been fully developed. Initiating this type of partnership has proven to be challenging but crucial to its success. The purpose of this study was to conduct a meta-narrative review of partnership initiation concepts, processes, enablers, barriers and outcomes in the disciplines of healthcare and social sciences where examples of researcher and research user partnerships were found. Methods Seven research traditions were identified. Three were in the discipline of social sciences (including psychology, education and business) and five were in the discipline of healthcare (including medicine, nursing, public health, health services research). Searches were conducted in MEDLINE, EMBASE, CINAHL, ABI Inform, ERIC, PsychInfo and the Cochrane Library on June 9, 2017. Fifty titles and abstracts were screened in triplicate; data were extracted from three records in duplicate. Narratives comprised of study characteristics and conceptual and empirical findings across traditions were tabulated, summarised and compared. Results A total of 7779 unique results were identified and 17 reviews published from 1998 to 2017 were eligible. All reviews identified a partnership initiation phase referred to as ‘early’ or ‘developmental’, or more vaguely as ‘fuzzy’, across six traditions – integrated knowledge translation, action research, stakeholder engagement, knowledge transfer, team initiation and shared mental models. The partnership initiation processes, enablers, barriers and outcomes were common to multiple narratives and summarised in a Partnership Initiation Conceptual Framework. Our review revealed limited use or generation of theory in most included reviews, and little empirical evidence testing the links between partnership initiation processes, enablers or barriers, and outcomes for the purpose of describing successful researcher and research user partnership initiation. Conclusions Narratives across multiple research traditions revealed similar integrated knowledge translation initiation processes, enablers, barriers and outcomes, which were captured in a conceptual framework that can be employed by researchers and research users to study and launch partnerships. While partnership initiation was recognised, it remains vaguely conceptualised despite lengthy research in several fields of study. Ongoing research of partnership initiation is needed to identify or generate relevant theory, and to empirically establish outcomes and the determinants of those outcomes.
Collapse
Affiliation(s)
- Maria Maddalena Zych
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.
| | - Whitney B Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada
| | - Anna R Gagliardi
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.,Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, Ontario, M5G 2C4, Canada
| |
Collapse
|
21
|
Koon AD, Windmeyer L, Bigdeli M, Charles J, El Jardali F, Uneke J, Bennett S. A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries. Health Res Policy Syst 2020; 18:7. [PMID: 31959208 PMCID: PMC6971874 DOI: 10.1186/s12961-019-0522-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/20/2019] [Indexed: 12/21/2022] Open
Abstract
There is growing interest in how different forms of knowledge can strengthen policy-making in low- and middle-income country (LMIC) health systems. Additionally, health policy and systems researchers are increasingly aware of the need to design effective institutions for supporting knowledge utilisation in LMICs. To address these interwoven agendas, this scoping review uses the Arskey and O’Malley framework to review the literature on knowledge utilisation in LMIC health systems, using eight public health and social science databases. Articles that described the process for how knowledge was used in policy-making, specified the type of knowledge used, identified actors involved (individual, organisation or professional), and were set in specific LMICs were included. A total of 53 articles, from 1999 to 2016 and representing 56 countries, were identified. The majority of articles in this review presented knowledge utilisation as utilisation of research findings, and to a lesser extent routine health system data, survey data and technical advice. Most of the articles centered on domestic public sector employees and their interactions with civil society representatives, international stakeholders or academics in utilising epistemic knowledge for policy-making in LMICs. Furthermore, nearly all of the articles identified normative dimensions of institutionalisation. While there is some evidence of how different uses and institutionalisation of knowledge can strengthen health systems, the evidence on how these processes can ultimately improve health outcomes remains unclear. Further research on the ways in which knowledge can be effectively utilised and institutionalised is needed to advance the collective understanding of health systems strengthening and enhance evidence-informed policy formulation.
Collapse
Affiliation(s)
- Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States of America. .,International Development Division, Abt Associates Inc, Rockville, MD, United States of America.
| | - Lauren Windmeyer
- Upstream USA, Oakland, CA, United States of America.,John F Kennedy School of Government, Harvard University, Cambridge, MA, United States of America
| | | | - Jodi Charles
- Office of Health Systems, United States Agency for International Development, Washington, D.C, United States of America
| | | | | | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
| |
Collapse
|
22
|
Turner S, Sharp CA, Sheringham J, Leamon S, Fulop NJ. Translating academic research into guidance to support healthcare improvement: how should guidance development be reported? BMC Health Serv Res 2019; 19:1000. [PMID: 31881964 PMCID: PMC6935180 DOI: 10.1186/s12913-019-4792-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/29/2019] [Indexed: 11/15/2022] Open
Abstract
Background There is interest internationally in improving the uptake of research evidence to inform health care quality and safety. This article focusses on guidance development from research studies as one method for improving research uptake. While we recognise that implementation strategies on the ´demand´ side for encouraging the uptake of research are important, e.g. knowledge brokers and university-practice collaborations, this article focusses on the ´production´ aspect of how guidance development is reported and the consequent influence this may have on end-users´ receptivity to evidence, in addition to other demand-side processes. Main text The article considers the following question: how is guidance developed and what are the implications for reporting? We address this question by reviewing examples of guidance development reporting from applied health research studies, then describe how we produced guidance for a national study of evidence use in decision-making on adopting innovations. The starting point for reflecting on our experiences is a vignette of the guidance ´launch´ event at a national conference. Conclusions Implications for reporting guidance development and supporting improvement are discussed. These include the need to (a) produce reporting standards for the production of guidance to match reporting standards for other research methods, (b) acknowledge the ´informal´ or emergent aspects of producing guidance and its role within a wider knowledge mobilization strategy, (c) consider guidance development from projects as part of a wider knowledge mobilization strategy, and (d) encourage a receptive environment for guidance development and use, including researcher training, durable funding to support impact, and closer relations between research and practice.
Collapse
Affiliation(s)
- Simon Turner
- School of Management, University of Los Andes, Edificio Santo Domingo, Cl. 21 #1 20, Bogotá, Colombia.
| | - Charlotte A Sharp
- Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - Shaun Leamon
- The Health Foundation, 8 Salisbury Square, London, EC4Y 8AP, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| |
Collapse
|
23
|
Scalway T, Otmani Del Barrio M, Ramirez B. Research on vector-borne diseases: implementation of research communication strategies. Infect Dis Poverty 2019; 8:101. [PMID: 31806008 PMCID: PMC6896314 DOI: 10.1186/s40249-019-0610-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/14/2019] [Indexed: 12/02/2022] Open
Abstract
Background Effective communication of research findings on vector-borne diseases in Africa is challenging for a number of reasons. Following the experiences of a number of researchers over the life of a project, this article looks for lessons that can be shared with the wider research community. Main body Between 2014 and 2017, a set of five inter-disciplinary teams from seven African countries collaborated on a project focusing on vector-borne diseases in the context of climate change. A central objective of this work was to influence policy and programming with relevant research findings. This article examines how principles of research communication, derived from the literature and current guidelines, can be applied in practice. Several challenges and lessons are highlighted, showing that research communication takes place within difficult constraints and in complex, fluid institutional and political environments. The processes of communication between policymakers and researchers including stakeholder mapping, defining research communication plans and tailoring communication products are discussed. Conclusions The article concludes that while guidelines and frameworks for research communication are helpful, they should not detract from the ability of local teams to adapt to circumstances. Of key importance are the relationships and networks of local research teams.
Collapse
Affiliation(s)
| | - Mariam Otmani Del Barrio
- Unit on Vectors, Environment and Society, The UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Bernadette Ramirez
- Unit on Vectors, Environment and Society, The UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
24
|
Jakobsen MW, Eklund Karlsson L, Skovgaard T, Aro AR. Organisational factors that facilitate research use in public health policy-making: a scoping review. Health Res Policy Syst 2019; 17:90. [PMID: 31752899 PMCID: PMC6869261 DOI: 10.1186/s12961-019-0490-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 09/23/2019] [Indexed: 01/08/2023] Open
Abstract
Background Although important syntheses and theoretical works exist in relation to understanding the organisational factors that facilitate research use, these contributions differ in their scope and object of study as well as their theoretical underpinnings. Therefore, from an exploratory angle, it may be useful to map out the current literature on organisational factors of research use in public health policy-making when revisiting existing theories and frameworks to gain further theoretical insights. Methods Herein, a scoping review technique and thematic content analysis were used to bring together findings from both synthesised and empirical studies of different types to map out the organisational factors that facilitate research use in public health policy-making. Results A total of 14 reviews and 40 empirical studies were included in the analysis. These were thematically coded and the intra-organisational factors reported as enabling research use were examined. Five main categories of organisational factors that advance research use in policy organisations – (1) individual factors, (2) the management of research integration, (3) organisational systems and infrastructures of research use, (4) institutional structures and rules for policy-making, and (5) organisational characteristics – were derived as well as 18 subcategories and a total of 64 specific factors, where 27 factors were well supported by research. Conclusions Using a scoping review methodology, the intra-organisational factors influencing research use in policy-making (including individual factors) were systematically mapped and the theories applied in this area of research were assessed. The review findings confirm the importance of an intra-organisational perspective when exploring research use, showing that many organisational factors are critical facilitators of research use but also that many factors and mechanisms are understudied. The synthesis shows a lack of studies on politicians and the need for more theoretically founded research. Despite increased efforts to update the existing evidential and theoretical basis of research use, we still need frameworks that combine different approaches and theories to help us grasp the complex organisational mechanisms that facilitate research use in policy settings.
Collapse
Affiliation(s)
- Mette Winge Jakobsen
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700, Esbjerg, Denmark.
| | - Leena Eklund Karlsson
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700, Esbjerg, Denmark
| | - Thomas Skovgaard
- Department of Sports Science and Clinical Biomechanics, Research and Innovation Centre for Human Movement and Learning and Research Unit for Active Living, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - Arja R Aro
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700, Esbjerg, Denmark
| |
Collapse
|
25
|
Grimmer K, Louw Q, Dizon JM, Brown SM, Ernstzen D, Wiysonge CS. A South African experience in applying the Adopt-Contextualise-Adapt framework to stroke rehabilitation clinical practice guidelines. Health Res Policy Syst 2019; 17:56. [PMID: 31170992 PMCID: PMC6554990 DOI: 10.1186/s12961-019-0454-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/16/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Clinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to increasingly sophisticated methods for CPG developers and implementers. Despite this, there remains a lack of practical support for end-users in terms of effectively and efficiently implementing CPG recommendations into local practice. This paper describes South African experiences in implementing international CPG recommendations for best practice stroke rehabilitation into local contexts, using a purpose-build approach. METHODS Composite recommendations were synthesised from 16 international CPGs to address end-user questions about best practice rehabilitation for South African stroke survivors. End-user representatives on the project team included methodologists, policy-makers, clinicians, managers, educators, researchers and stroke survivors. The Adopt-Contextualise-Adapt model was applied as a decision-guide to streamline discussions on endorsement and development of implementation strategies. Where recommendations required contextualisation to address local barriers before they could be effectively implemented, prompts were provided to identify barriers and possible solutions. Where recommendations could not be implemented without additional local evidence (adaptation), options were identified to establish new evidence. FINDINGS The structured implementation process was efficient in terms of time, effort, resources and problem solving. The process empowered the project team to make practical decisions about local uptake of international recommendations, develop local implementation strategies, and determine who was responsible, for what and when. Different implementation strategies for the same recommendation were identified for different settings, to address different barriers. CONCLUSION The South African evidence translation experience could be useful for evidence implementers in other countries, when translating CPG recommendations developed elsewhere, into local practice.
Collapse
Affiliation(s)
- Karen Grimmer
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
- Clinical Teaching and Education Centre, College of Nursing and Health Sciences, Flinders University, Daw Park, 5041, South Australia.
| | - Quinette Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Janine M Dizon
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, Adelaide, 5000, Australia
| | - Sjan-Mari Brown
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
- Hong Kong Polytechnic University, Hong Kong, Kowloon, Hong Kong
| | - Dawn Ernstzen
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
| |
Collapse
|
26
|
Akhnif E, Macq J, Meessen B. The place of learning in a universal health coverage health policy process: the case of the RAMED policy in Morocco. Health Res Policy Syst 2019; 17:21. [PMID: 30791925 PMCID: PMC6383252 DOI: 10.1186/s12961-019-0421-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To progress towards universal health coverage (UHC), each country will have to develop its systemic learning capacity. This study aims at documenting how, across time, learning can feed into a UHC policy process, and how the latter can itself strengthen (or not) the learning capacity of the health system. It specifically focuses on the development of a major health financing policy aligned with the UHC goal in Morocco, the RAMED, a health financing scheme covering hospital costs for the poorest segment of the population. METHODS We conducted a retrospective analysis of the RAMED policy for the period between 1997 and 2018, along with a case study design. For the data collection and analysis, we developed a framework combining Garvin's learning organisation framework and the heuristic health policy analysis framework. We gathered data from key informants and document reviews. RESULTS The study confirmed the importance of learning during the different stages of the RAMED policy process. There is evidence of a leadership encouraging learning, the introduction and adoption of knowledge management processes, and the start of a transformation of the administrative culture. Yet, our study also showed some major shortcomings, especially the lack of structure of the learning, and insufficient effort to systemise and sustain a transformation of practices within the health administration. Our study also confirms that the learning changes in nature across the different stages of the policy process. CONCLUSION The policy decisions and the implementation strategy create a learning dynamic, though not structured in all cases. Despite the positive interaction between learning and the RAMED policy, the opportunity to push forward a more structural transformation towards a learning system has not been fully seized. Hierarchical logics still largely prevail in the Moroccan health administration. The impact of future health policies for both the target beneficiaries and the health system will be bigger if their design integrates purposeful and structured actions in favour of organisational learning. This recommendation probably applies beyond Morocco.
Collapse
Affiliation(s)
- E. Akhnif
- School of Public Health, Rue Lamfadel Cherkaoui, Madinat Al Irfane, BP-6329 Rabat, Morocco
- IRSS - Clos Chapelle-aux-champs 30 bte B1.30.13 à 1200 Woluwe-Saint-Lambert, Université Catholique de Louvain (UCL) Ottignies-Louvain-la-Neuve, Brussels, Belgium
- Institute of Tropical Medicine, Antwerp, Belgium
| | - J. Macq
- IRSS - Clos Chapelle-aux-champs 30 bte B1.30.13 à 1200 Woluwe-Saint-Lambert, Université Catholique de Louvain (UCL) Ottignies-Louvain-la-Neuve, Brussels, Belgium
| | - Bruno Meessen
- Institute of Tropical Medicine, Antwerp, Belgium
- Community of Practice ‘Performance-Based Financing’, Antwerp, Belgium
| |
Collapse
|
27
|
Edwards A, Zweigenthal V, Olivier J. Evidence map of knowledge translation strategies, outcomes, facilitators and barriers in African health systems. Health Res Policy Syst 2019; 17:16. [PMID: 30732634 PMCID: PMC6367796 DOI: 10.1186/s12961-019-0419-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/20/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The need for research-based knowledge to inform health policy formulation and implementation is a chronic global concern impacting health systems functioning and impeding the provision of quality healthcare for all. This paper provides a systematic overview of the literature on knowledge translation (KT) strategies employed by health system researchers and policy-makers in African countries. METHODS Evidence mapping methodology was adapted from the social and health sciences literature and used to generate a schema of KT strategies, outcomes, facilitators and barriers. Four reference databases were searched using defined criteria. Studies were screened and a searchable database containing 62 eligible studies was compiled using Microsoft Access. Frequency and thematic analysis were used to report study characteristics and to establish the final evidence map. Focus was placed on KT in policy formulation processes in order to better manage the diversity of available literature. RESULTS The KT literature in African countries is widely distributed, problematically diverse and growing. Significant disparities exist between reports on KT in different countries, and there are many settings without published evidence of local KT characteristics. Commonly reported KT strategies include policy briefs, capacity-building workshops and policy dialogues. Barriers affecting researchers and policy-makers include insufficient skills and capacity to conduct KT activities, time constraints and a lack of resources. Availability of quality locally relevant research was the most reported facilitator. Limited KT outcomes reflect persisting difficulties in outcome identification and reporting. CONCLUSION This study has identified substantial geographical gaps in knowledge and evidenced the need to boost local research capacities on KT practices in low- and middle-income countries. Evidence mapping is also shown to be a useful approach that can assist local decision-making to enhance KT in policy and practice.
Collapse
Affiliation(s)
- Amanda Edwards
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Virginia Zweigenthal
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Western Cape Government Health, Cape Town, South Africa
| | - Jill Olivier
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| |
Collapse
|
28
|
Malla C, Aylward P, Ward P. Knowledge translation for public health in low- and middle- income countries: a critical interpretive synthesis. Glob Health Res Policy 2018; 3:29. [PMID: 30377666 PMCID: PMC6196454 DOI: 10.1186/s41256-018-0084-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Effective knowledge translation allows the optimisation of access to and utilisation of research knowledge in order to inform and enhance public health policy and practice. In low- and middle- income countries, there are substantial complexities that affect the way in which research can be utilised for public health action. This review attempts to draw out concepts in the literature that contribute to defining some of the complexities and contextual factors that influence knowledge translation for public health in low- and middle- income countries. Methods A Critical Interpretive Synthesis was undertaken, a method of analysis which allows a critical review of a wide range of heterogeneous evidence, through incorporating systematic review methods with qualitative enquiry techniques. A search for peer-reviewed articles published between 2000 and 2016 on the topic of knowledge translation for public health in low- and middle – income countries was carried out, and 85 articles were reviewed and analysed using this method. Results Four main concepts were identified: 1) tension between ‘global’ and ‘local’ health research, 2) complexities in creating and accessing evidence, 3) contextualising knowledge translation strategies for low- and middle- income countries, and 4) the unique role of non-government organisations in the knowledge translation process. Conclusion This method of review has enabled the identification of key concepts that may inform practice or further research in the field of knowledge translation in low- and middle- income countries. Electronic supplementary material The online version of this article (10.1186/s41256-018-0084-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Catherine Malla
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042 Australia
| | - Paul Aylward
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042 Australia
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042 Australia
| |
Collapse
|
29
|
Grimmer K, Louw Q, Dizon JM, van Niekerk SM, Ernstzen D, Wiysonge C. Standardising evidence strength grading for recommendations from multiple clinical practice guidelines: a South African case study. Implement Sci 2018; 13:117. [PMID: 30157898 PMCID: PMC6114483 DOI: 10.1186/s13012-018-0803-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Significant resources are required to write de novo clinical practice guidelines (CPGs). There are many freely-available CPGs internationally, for many health conditions. Developing countries rarely have the resources for de novo CPGs, and there could be efficiencies in using CPGs developed elsewhere. This paper outlines a novel process developed and tested in a resource-constrained country (South Africa) to synthesise findings from multiple international CPGs on allied health (AH) stroke rehabilitation. METHODS Methodologists, policy-makers, content experts and consumers collaborated to describe the pathway of an 'average' stroke patient through the South African public healthcare system and pose questions about best-practice stroke rehabilitation along this pathway. A comprehensive search identified international guidance documents published since January 2010. These were scanned for relevance to the South African AH stroke rehabilitation questions and critically appraised for methodological quality. Recommendations were extracted from guidance documents for each question. Strength of the body of evidence (SoBE) gradings underpinning recommendations were standardised, and composite recommendations were developed using qualitative synthesis. An algorithm was developed to guide assignment of overall SoBE gradings to composite recommendations. RESULTS Sixteen CPGs were identified, and all were included, as they answered different project questions differently. Methodological quality varied and was unrelated to currency. Seven clusters, outlining 20 composite recommendations were proposed (organise for best practice rehabilitation, operationalise strategies for best practice communication throughout the patient journey, admit to an acute hospital, refer to inpatient rehabilitation, action inpatient rehabilitation, discharge from inpatient rehabilitation and longer-term community-based rehabilitation). CONCLUSION The methodological development process, tested by writing a South African AH stroke rehabilitation guideline from existing evidence sources, took 9 months. The process was efficient, collaborative, effective, rewarding and positive. Using the proposed methods, similar synthesis of existing evidence could be conducted in shorter time periods, in other resource-constrained countries, avoiding the need for expensive and time-consuming de novo CPG development.
Collapse
Affiliation(s)
- K. Grimmer
- Clinical Teaching and Education Centre, College of Nursing and Health Sciences, Flinders University, Daw Park, Adelaide, South Australia 5041 Australia
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - Q. Louw
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - J. M. Dizon
- International Centre for Allied Health Evidence, University of South Australia, City East Campus, Adelaide, 5000 Australia
| | - S-M van Niekerk
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - D. Ernstzen
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
| | - C. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505 South Africa
| |
Collapse
|
30
|
Nabyonga-Orem J, Nabukalu BJ, Andemichael G, Khosi-Mthetwa R, Shaame A, Myeni S, Quinto E, Dovlo D. Moving towards universal health coverage: The need for a strengthened planning process. Int J Health Plann Manage 2018; 33:1093-1109. [PMID: 30074277 DOI: 10.1002/hpm.2585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/29/2018] [Indexed: 11/08/2022] Open
Abstract
As countries embrace the ambitious universal health coverage (UHC) agenda whose major tenents include reaching everyone with the needed good quality services, strengthening the planning process to work towards a common objective is paramount. Drawing from country experiences-Swaziland and Zanzibar, we reviewed strategic planning processes to assess the extent to which they impact on realising alignment towards a collective health sector objective. Employing qualitative approaches, we reviewed strategic plans under implementation in the health sector and using an interview guide consisting of open-ended questions, interviewed key informants at the national and district level. Results showed that strategic plans are too many with majority of program strategies not well aligned to the health sector strategic plan, are not costed, and there overlaps in objectives among the several strategies addressing the same program. Weaknesses in the development process, perceived poor quality of the strategies, limited capacity, high staff turnover, and inadequate funding were the identified challenges that abate the utility of the strategic plans. Moving towards UHC starts with a robust planning process that rallies all actors and all available resources around a common objective. The planning process should be strengthened through ensuring participatory processes, evidence informed prioritisation, MoH institutional capacity to lead the process, and consideration for implementation feasibility. Flexibility to take into consideration emerging evidence and new developments in global health needs consideration.
Collapse
Affiliation(s)
- Juliet Nabyonga-Orem
- Health Systems and Services Cluster, Inter-Country Support Team for Eastern and Southern Africa; World Health Organization, Harare, Zimbabwe
| | | | | | | | - Attiye Shaame
- Ministry of Health, Directorate of Policy, Planning, and Research, Ministry of Health, Zanzibar, United Republic of Tanzania
| | - Sebentile Myeni
- Ministry of Health, Swaziland, Monitoring and Evaluation Unit, Mbabane, Swaziland
| | - Ebony Quinto
- Ministry of Health Headquarters, Kampala, Uganda
| | - Delanyo Dovlo
- World Health Organization Regional Office for Africa, Health Systems and Services Cluster, Brazzaville, Republic of Congo
| |
Collapse
|
31
|
Jessani NS, Siddiqi SM, Babcock C, Davey-Rothwell M, Ho S, Holtgrave DR. Factors affecting engagement between academic faculty and decision-makers: learnings and priorities for a school of public health. Health Res Policy Syst 2018; 16:65. [PMID: 30045730 PMCID: PMC6060478 DOI: 10.1186/s12961-018-0342-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background Schools of public health (SPHs) are increasingly being recognised as important contributors of human, social and intellectual capital relevant to health policy and decision-making. Few studies within the implementation science literature have systematically examined knowledge exchange experiences within this specific organisational context. The purpose of this study was therefore to elicit whether documented facilitators and barriers to engaging with government decision-makers resonates within an academic SPH context. We sought to understand the variations in such experiences at four different levels of government decision-making. Furthermore, we sought to elicit intervention priorities as identified by faculty. Methods Between May and December 2016, 211 (34%) of 627 eligible full-time faculty across one SPH in the United States of America participated in a survey on engagement with decision-makers at the city, state, federal and global government levels. Surveys were administered face-to-face or via Skype. Descriptive data as well as tests of association and logistic regression analyses were conducted using STATA. Results Over three-quarters of respondents identified colleagues with ties to decision-makers, institutional affiliation and conducting policy-relevant research as the highest facilitators. Several identified time constraints, academic incentives and financial support as important contributors to engagement. Faculty characteristics, such as research areas of expertise, career track and faculty rank, were found to be statistically significantly associated with facilitators. The top three intervention priorities that emerged were (1) creating incentives for engagement, (2) providing funding for engagement and (3) inculcating an institutional culture around engagement. Conclusions The data suggest that five principal categories of factors – individual characteristics, institutional environment, relational dynamics, research focus and funder policies – affect the willingness and ability of academic faculty to engage with government decision-makers. This study suggests that SPHs could enhance the relevance of their role in health policy decision-making by (1) periodically measuring engagement with decision-makers; (2) enhancing individual capacity in knowledge translation and communication, taking faculty characteristics into account; (3) institutionalising a culture that supports policies and practices for engagement in decision-making processes; and (4) creating a strategy to expand and nurture trusted, relevant networks and relationships with decision-makers.
Collapse
Affiliation(s)
- Nasreen S Jessani
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America.
| | - Sameer M Siddiqi
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| | - Carly Babcock
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| | - Melissa Davey-Rothwell
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| | - Shirley Ho
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| | - David R Holtgrave
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, United States of America
| |
Collapse
|
32
|
Ellen ME, Lavis JN, Horowitz E, Berglas R. How is the use of research evidence in health policy perceived? A comparison between the reporting of researchers and policy-makers. Health Res Policy Syst 2018; 16:64. [PMID: 30029647 PMCID: PMC6053732 DOI: 10.1186/s12961-018-0345-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/22/2018] [Indexed: 12/18/2022] Open
Abstract
Background The use of health policy and systems research (HPSR) to inform health policy-making is an international challenge. Incorporating HPSR into decision-making primarily involves two groups, namely researchers (knowledge producers) and policy-makers (knowledge users). The purpose of this study was to compare the perceptions of Israeli health systems and policy researchers and health services policy-makers regarding the role of HPSR, factors influencing its uses and potential facilitators and barriers to HPSR, and implementation of knowledge transfer and exchange (KTE) activities. Methods A cross-sectional survey was administered to researchers and policy-makers in Israel. The survey consisted of seven closed questions. Descriptive analyses were carried out for closed-ended questions and comparative analysis were conducted between groups using the χ2 test. Results A total of 37 researchers and 32 policy-makers responded to the survey. While some views were in alignment, others showed differences. More policy-makers than researchers perceived that the use of HPSR in policy was hindered by practical implementation constraints, whereas more researchers felt that its use was hindered by a lack of coordination between knowledge producers and users. A larger percentage of policy-makers, as compared to researchers, reported that facilitators to the KTE process are in place and a larger percentage of researchers perceived barriers within the KTE environment. A larger percentage of policy-makers perceived KTE activities were in place as compared to researchers. Results also showed large differences in the perceptions of the two groups regarding policy formulation and which organisations they perceived as exerting strong influence on policy-making. Conclusions This research demonstrated that there are differences in the perceptions of knowledge producers and users about the process of KTE. Future work should focus on minimising the challenges highlighted here and implementing new KTE activities. These activities could include making the researchers aware of the most effective manner in which to package their results, providing training to policy-makers and assuring that policy-makers have technical access to appropriate databases to search for HPSR. These results underscore the need for the groups to communicate and clarify to each other what they can offer and what they require. Electronic supplementary material The online version of this article (10.1186/s12961-018-0345-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Moriah E Ellen
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel. .,McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S-4L6, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON, L8S-4L6, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, ON, L8S-4L6, Canada.,Department of Political Science, McMaster University, 1280 Main Street West, Hamilton, ON, L8S-4L6, Canada.,Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States of America
| | - Einav Horowitz
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel
| | | |
Collapse
|
33
|
Tricco AC, Zarin W, Rios P, Nincic V, Khan PA, Ghassemi M, Diaz S, Pham B, Straus SE, Langlois EV. Engaging policy-makers, health system managers, and policy analysts in the knowledge synthesis process: a scoping review. Implement Sci 2018; 13:31. [PMID: 29433543 PMCID: PMC5809959 DOI: 10.1186/s13012-018-0717-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/25/2018] [Indexed: 01/03/2023] Open
Abstract
Background It is unclear how to engage a wide range of knowledge users in research. We aimed to map the evidence on engaging knowledge users with an emphasis on policy-makers, health system managers, and policy analysts in the knowledge synthesis process through a scoping review. Methods We used the Joanna Briggs Institute guidance for scoping reviews. Nine electronic databases (e.g., MEDLINE), two grey literature sources (e.g., OpenSIGLE), and reference lists of relevant systematic reviews were searched from 1996 to August 2016. We included any type of study describing strategies, barriers and facilitators, or assessing the impact of engaging policy-makers, health system managers, and policy analysts in the knowledge synthesis process. Screening and data abstraction were conducted by two reviewers independently with a third reviewer resolving discrepancies. Frequency and thematic analyses were conducted. Results After screening 8395 titles and abstracts followed by 394 full-texts, 84 unique documents and 7 companion reports fulfilled our eligibility criteria. All 84 documents were published in the last 10 years, and half were prepared in North America. The most common type of knowledge synthesis with knowledge user engagement was a systematic review (36%). The knowledge synthesis most commonly addressed an issue at the level of national healthcare system (48%) and focused on health services delivery (17%) in high-income countries (86%). Policy-makers were the most common (64%) knowledge users, followed by healthcare professionals (49%) and government agencies as well as patients and caregivers (34%). Knowledge users were engaged in conceptualization and design (49%), literature search and data collection (52%), data synthesis and interpretation (71%), and knowledge dissemination and application (44%). Knowledge users were most commonly engaged as key informants through meetings and workshops as well as surveys, focus groups, and interviews either in-person or by telephone and emails. Knowledge user content expertise/awareness was a common facilitator (18%), while lack of time or opportunity to participate was a common barrier (12%). Conclusions Knowledge users were most commonly engaged during the data synthesis and interpretation phases of the knowledge synthesis conduct. Researchers should document and evaluate knowledge user engagement in knowledge synthesis. Registration details Open Science Framework (https://osf.io/4dy53/). Electronic supplementary material The online version of this article (10.1186/s13012-018-0717-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada. .,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College St, Toronto, Ontario, M5T 3M7, Canada.
| | - Wasifa Zarin
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Patricia Rios
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Paul A Khan
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Marco Ghassemi
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Sanober Diaz
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Ba' Pham
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - Sharon E Straus
- Department of Geriatric Medicine, Faculty of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| |
Collapse
|
34
|
Kim C, Wilcher R, Petruney T, Krueger K, Wynne L, Zan T. A research utilisation framework for informing global health and development policies and programmes. Health Res Policy Syst 2018; 16:9. [PMID: 29426325 PMCID: PMC5807737 DOI: 10.1186/s12961-018-0284-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 01/11/2018] [Indexed: 12/02/2022] Open
Abstract
A shift in the culture and practice of health and development research is required to maximise the real-world use of evidence by non-academic or non-research-oriented audiences. Many frameworks have been developed to guide and measure the research utilisation process, yet none have been widely applied. Some frameworks are simplified to an unrealistic linear representation while others are rendered overly complex and unusable in an attempt to capture all aspects of the research utilisation process. Additionally, many research utilisation frameworks have focused on the policy development process or within a clinical setting, with less application of the translation process at the programme level. In response to this gap – and drawing from over a decade of experience implementing research utilisation strategies – we developed a simple, four-phase framework to guide global health and development efforts that seek to apply evidence to policies and programmes. We present a detailed description of each phase in our framework, with examples of its relevance and application illustrated through our own case study experiences in global health. We believe the utility of this framework extends beyond the health sector and is relevant for maximising use of evidence to achieve the Sustainable Development Goals.
Collapse
Affiliation(s)
- Christine Kim
- Gillings School of Global Public Health, Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States of America
| | | | | | | | - Leigh Wynne
- FHI 360, Durham, NC, United States of America
| | - Trinity Zan
- FHI 360, Durham, NC, United States of America.
| |
Collapse
|
35
|
Head MG, Goss S, Gelister Y, Alegana V, Brown RJ, Clarke SC, Fitchett JRA, Atun R, Scott JAG, Newell ML, Padmadas SS, Tatem AJ. Global funding trends for malaria research in sub-Saharan Africa: a systematic analysis. LANCET GLOBAL HEALTH 2017; 5:e772-e781. [PMID: 28668230 PMCID: PMC5567191 DOI: 10.1016/s2214-109x(17)30245-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/26/2017] [Accepted: 06/01/2017] [Indexed: 12/21/2022]
Abstract
Background Total domestic and international funding for malaria is inadequate to achieve WHO global targets in burden reduction by 2030. We describe the trends of investments in malaria-related research in sub-Saharan Africa and compare investment with national disease burden to identify areas of funding strength and potentially neglected populations. We also considered funding for malaria control. Methods Research funding data related to malaria for 1997–2013 were sourced from existing datasets, from 13 major public and philanthropic global health funders, and from funding databases. Investments (reported in US$) were considered by geographical area and compared with data on parasite prevalence and populations at risk in sub-Saharan Africa. 45 sub-Saharan African countries were ranked by amount of research funding received. Findings We found 333 research awards totalling US$814·4 million. Public health research covered $308·1 million (37·8%) and clinical trials covered $275·2 million (33·8%). Tanzania ($107·8 million [13·2%]), Uganda ($97·9 million [12·0%]), and Kenya ($92·9 million [11·4%]) received the highest sum of research investment and the most research awards. Malawi, Tanzania, and Uganda remained highly ranked after adjusting for national gross domestic product. Countries with a reasonably high malaria burden that received little research investment or funding for malaria control included Central African Republic (ranked 40th) and Sierra Leone (ranked 35th). Congo (Brazzaville) and Guinea had reasonably high malaria mortality, yet Congo (Brazzaville) ranked 38th and Guinea ranked 25th, thus receiving little investment. Interpretation Some countries receive reasonably large investments in malaria-related research (Tanzania, Kenya, Uganda), whereas others receive little or no investments (Sierra Leone, Central African Republic). Research investments are typically highest in countries where funding for malaria control is also high. Investment strategies should consider more equitable research and operational investments across countries to include currently neglected and susceptible populations. Funding Royal Society of Tropical Medicine and Hygiene and Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Michael G Head
- Global Health Research Institute and Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Sian Goss
- Global Health Research Institute and Faculty of Medicine, University of Southampton, Southampton, UK; WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Yann Gelister
- Global Health Research Institute and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Victor Alegana
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Rebecca J Brown
- Global Health Research Institute and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Stuart C Clarke
- Global Health Research Institute and Faculty of Medicine, University of Southampton, Southampton, UK; Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK
| | - Joseph R A Fitchett
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie-Louise Newell
- Global Health Research Institute and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sabu S Padmadas
- Department of Social Statistics and Demography and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK; Flowminder Foundation, Stockholm, Sweden
| |
Collapse
|
36
|
Ellen ME, Horowitz E, Vaknin S, Lavis JN. Views of health system policymakers on the role of research in health policymaking in Israel. Isr J Health Policy Res 2016; 5:24. [PMID: 27330738 PMCID: PMC4915086 DOI: 10.1186/s13584-016-0088-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background The use of research evidence in health policymaking is an international challenge. Health systems, including that of Israel, are usually characterized by scarce resources and the necessity to make rapid policy decisions. Knowledge transfer and exchange (KTE) has emerged as a paradigm to start bridging the “know-do” gap. The purpose of this study was to explore the views of health system policymakers and senior executives involved in the policy development process in Israel regarding the role of health systems and policy research (HSPR) in health policymaking, the barriers and facilitators to the use of evidence in the policymaking process, and suggestions for improving the use of HSPR in the policymaking process. Methods A survey and an interview were verbally administered in a single face-to-face meeting with health system policymakers and senior executives involved in the policy development process in Israel. The data collection period was from July to October 2014. The potential participants included members of Knesset, officials from Israel’s Ministry of Health, Ministry of Finance, health services organizations, and other stakeholder organizations (i.e., National Insurance Institute). The close-ended questions were based on previous surveys that had been conducted in this field. Interviews were tape recorded and transcribed. Descriptive statistics were conducted for close ended survey-questions and thematic analysis was conducted for open-ended interview questions. Results There were 32 participants in this study. Participants felt that the use of HSPR helps raise awareness on policy issues, yet the actual use of HSPR was hindered for many reasons. Facilitators do exist to support the use of HSPR in the policymaking process, such as a strong foundation of relationships between researchers and policymakers. However, many barriers exist such as the lack of relevance and timeliness of much of the currently available research to support decision-making and the paucity of funding to support research use. Suggestions to improve the use of HSPR focused on improving dissemination of research findings and ensuring that the research was more relevant and timely. Conclusions This research demonstrated that health systems policymakers in Israel perceive having strong relationships and collaborations with researchers however there is room for improvement, e.g. partnering in research projects to ensure relevance and use. Furthermore, health system policymakers seem to be interested in receiving relevant research in a more useable format and are open to using research in decision making.
Collapse
Affiliation(s)
- Moriah E Ellen
- Jerusalem College of Technology, Ha-Va'ad ha-Le'umi St 21, Jerusalem, 93721 Israel ; Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel ; McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L6 Canada ; Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6 Canada
| | - Einav Horowitz
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - Sharona Vaknin
- Israeli Center for Technology Assessment in Health Care, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - John N Lavis
- McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L6 Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Department of Political Science, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, CRL 209, Hamilton, ON L8S 4K1 Canada ; Department of Global Health and Population, Harvard School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115-6018 USA
| |
Collapse
|
37
|
Owusu-Addo E, Cross R, Sarfo-Mensah P. Evidence-based practice in local public health service in Ghana. CRITICAL PUBLIC HEALTH 2016. [DOI: 10.1080/09581596.2016.1182621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
Mbachu CO, Onwujekwe O, Chikezie I, Ezumah N, Das M, Uzochukwu BSC. Analysing key influences over actors' use of evidence in developing policies and strategies in Nigeria: a retrospective study of the Integrated Maternal Newborn and Child Health strategy. Health Res Policy Syst 2016; 14:27. [PMID: 27067540 PMCID: PMC4828804 DOI: 10.1186/s12961-016-0098-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background Evidence-informed policymaking has been promoted as a means of ensuring better outcomes. However, what counts as evidence in policymaking lies within a spectrum of expert knowledge and scientifically generated information. Since not all forms of evidence share an equal validity or weighting for policymakers, it is important to understand the key factors that influence their preferences for different types of evidence in policy and strategy development. Method A retrospective study was carried out at the national level in Nigeria using a case-study approach to examine the Nigerian Integrated Maternal Newborn and Child Health (IMNCH) strategy. Two frameworks were used for conceptualization and data analysis, namely (1) to analyse the role of evidence in policymaking and (2) the policy triangle. They were used to explore the key contextual and participatory influences on choice of evidence in developing the IMNCH strategy. Data was collected through review of relevant national documents and in-depth interviews of purposively selected key policy and strategic decision makers. Thematic analysis was applied to generate information from collected data. Results The breadth of evidence used was wide, ranging from expert opinions to systematic reviews. The choice of different types of evidence was found to overlap across actor categories. Key influences over actors’ choice of evidence were: (1) perceived robustness of evidence – comprehensive, representative, recent, scientifically sound; (2) roles in evidence process, i.e. their degree and level of participation in evidence generation and dissemination, with regards to their role in the policy process; and (3) contextual factors such as global agenda and influence, timeline for strategy development, availability of resources for evidence generation, and lessons learnt from previous unsuccessful policies/plans. Conclusion Actors’ preferences for different types of evidence for policy are influenced not only by the characteristics of evidence itself, but on actors’ roles in the evidence process, their power to influence the policy, and the context in which evidence is used. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0098-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Chinyere O Mbachu
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria.
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria
| | - Ifeanyi Chikezie
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria.,Department of Sociology, University of Nigeria Nsukka campus, Nsukka, Nigeria
| | - Mahua Das
- Nuffield Center for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Benjamin S C Uzochukwu
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria
| |
Collapse
|
39
|
Langlois EV, Becerril Montekio V, Young T, Song K, Alcalde-Rabanal J, Tran N. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches. Health Res Policy Syst 2016; 14:20. [PMID: 26983405 PMCID: PMC4794922 DOI: 10.1186/s12961-016-0089-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings. METHODS The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals' abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a 'buddying' process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design. RESULTS In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge. CONCLUSIONS The collaborative evidence-to-policy approaches underline the importance of iterations and continuity in the engagement of researchers and policymakers/programme managers, in order to account for swift evolutions in health policy planning and implementation. In developing and supporting evidence-to-policy interventions, due consideration should be given to fit-for-purpose approaches, as different needs in policymaking cycles require adapted processes and knowledge. Greater consideration should be provided to approaches embedding the use of research in real-world policymaking, better suited to the complex adaptive nature of health systems.
Collapse
Affiliation(s)
- Etienne V. Langlois
- />Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
| | - Victor Becerril Montekio
- />Center for Health Systems Research, National Institute of Public Health - Instituto Nacional de Salud Pública, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán Cerrada Los Pinos y Caminera C.P., 62100 Cuernavaca, Morelos Mexico
| | - Taryn Young
- />Centre for Evidence-based Health Care, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
- />Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Kayla Song
- />Health Systems Performance Research Network, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6 Canada
| | - Jacqueline Alcalde-Rabanal
- />Center for Health Systems Research, National Institute of Public Health - Instituto Nacional de Salud Pública, Av. Universidad No. 655 Colonia Santa María Ahuacatitlán Cerrada Los Pinos y Caminera C.P., 62100 Cuernavaca, Morelos Mexico
| | - Nhan Tran
- />Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
| |
Collapse
|
40
|
Nsabagasani X, Hansen E, Mbonye A, Ssengooba F, Muyinda H, Mugisha J, Ogwal-Okeng J. Explaining the slow transition of child-appropriate dosage formulations from the global to national level in the context of Uganda: a qualitative study. J Pharm Policy Pract 2015. [PMID: 26203358 PMCID: PMC4511518 DOI: 10.1186/s40545-015-0039-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2007, the Sixtieth World Health Assembly (WHA) passed a resolution entitled "Better medicines for children" and subsequently the World Health Organization (WHO) recommended the inclusion of child-appropriate dosage formulations in the essential medicines lists of member countries. However, child-appropriate dosage formulations are not highlighted in the Essential Medicines and Health Supplies List of Uganda (EMHSLU) 2012 and they are still limited in availability in public health facilities. Several stakeholders influenced the status of child-appropriate dosage formulations in the EMHSLU 2012. OBJECTIVE To explore stakeholders' views about the relevance of the globally recommended child-appropriate dosage formulations in the context of Uganda. METHODS The findings derive from thirty three in-depth interviews with stakeholder representatives and the results of a follow up validation meeting where preliminary findings were shared with stakeholders. Policy analysis and policy transfer theories were used to guide a deductive analysis for manifest and latent content. RESULTS According to stakeholders, the transition to the globally recommended child-appropriate dosage formulations has been slow in Uganda due to a number of factors. These factors include resource constraints at the global and national levels, lack of Ministry of Health (MOH) formal commitment to the adoption of the child-appropriate dosage formulations policy and a lack of consensus between those who advocated for the availability of liquid oral dosage formulations for easy administration and effectiveness and those who were more convinced by economic arguments and preferred the procurement of solid oral dosage formulations intended for adults. CONCLUSIONS The global policy for child-appropriate dosage formulations still remains to be implemented in Uganda and other low income countries. This has been due to lack of resources that hindered formal transfer of the policy from the global to the local level. To achieve this transfer there is a need for resource mobilisation at both the international and local levels, together with the revitalisation of UMTAC to enable it to take on a leadership role of the coalitions supporting child-appropriate dosage formulations.
Collapse
Affiliation(s)
- Xavier Nsabagasani
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - Ebba Hansen
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | - Anthony Mbonye
- Ministry of Health Uganda and Department of Health, Uganda Christian University, Kampala, Uganda
| | - Freddie Ssengooba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Herbert Muyinda
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - James Mugisha
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - Jasper Ogwal-Okeng
- Departments of Pharmacology and Therapeutics, Gulu University, Gulu, Uganda
| |
Collapse
|
41
|
Pratt B, Hyder AA. Global justice and health systems research in low- and middle-income countries. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:143-161. [PMID: 25846045 DOI: 10.1111/jlme.12202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Scholarship focusing on how international research can contribute to justice in global health has primarily explored requirements for the conduct of clinical trials. Yet health systems research in low- and middle-income countries (LMICs) has increasingly been identified as vital to the reduction of health disparities between and within countries. This paper expands an existing ethical framework based on the health capability paradigm - research for health justice - to externally-funded health systems research in LMICs. It argues that a specific form of health systems research in LMICs is required if the enterprise is to advance global health equity. "Research for health justice" requirements for priority setting, research capacity strengthening, and post-study benefits in health systems research are derived in light of the field's distinctive characteristics. Specific obligations are established for external research actors, including governments, funders, sponsors, and investigators. How these framework requirements differ from those for international clinical research is discussed.
Collapse
Affiliation(s)
- Bridget Pratt
- Research fellow in the Department of International Health at Johns Hopkins Bloomberg School of Public Health and at the Johns Hopkins Berman Institute of Bioethics
| | | |
Collapse
|
42
|
El-Jardali F, Fadlallah R. A call for a backward design to knowledge translation. Int J Health Policy Manag 2015; 4:1-5. [PMID: 25584357 DOI: 10.15171/ijhpm.2015.10] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 12/29/2014] [Indexed: 11/09/2022] Open
Abstract
Despite several calls to support evidence-informed policy-making, variations in uptake of evidence into policy persist. This editorial brings together and builds on previous Knowledge Translation (KT) frameworks and theories to present a simple, yet, holistic approach for promoting evidence-informed policies. The proposed conceptual framework is characterized by its impact-oriented approach and its view of KT as a continuum from the evidence synthesis stage to uptake and evaluation, while highlighting capacity and resource requirement at every step. A practical example is given to guide readers through the different steps of the framework. With a growing interest in strengthening evidence-informed policy-making, there is a need to continuously develop theories to understand and improve the science of KT and its implementation within the field of policy-making.
Collapse
Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. ; Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon. ; Center for Systematic Reviews in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon. ; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Racha Fadlallah
- Center for Systematic Reviews in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| |
Collapse
|
43
|
Shayo EH, Våga BB, Moland KM, Kamuzora P, Blystad A. Challenges of disseminating clinical practice guidelines in a weak health system: the case of HIV and infant feeding recommendations in Tanzania. Int Breastfeed J 2014; 9:188. [PMID: 25606050 PMCID: PMC4300161 DOI: 10.1186/s13006-014-0024-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 12/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical guidelines aim to improve patient outcomes by providing recommendations on appropriate healthcare for specific clinical conditions. Scientific evidence produced over time leads to change in clinical guidelines, and a serious challenge may emerge in the process of communicating the changes to healthcare practitioners and getting new practices adopted. There is very little information on the major barriers to implementing clinical guidelines in low-income settings. Looking at how continual updates to clinical guidelines within a particular health intervention are communicated may shed light on the processes at work. The aim of this paper is to explore how the content of a series of diverging infant feeding guidelines have been communicated to managers in the Prevention of Mother to Child Transmission of HIV Programme (PMTCT) with the aim of generating knowledge about both barriers and facilitating factors in the dissemination of new and updated knowledge in clinical guidelines in the context of weak healthcare systems. METHODS A total of 22 in-depth interviews and two focus group discussions were conducted in 2011. All informants were linked to the PMTCT programme in Tanzania. The informants included managers at regional and district levels and health workers at health facility level. RESULTS The informants demonstrated partial and incomplete knowledge about the recommendations. There was lack of scientific reasoning behind various infant feeding recommendations. The greatest challenges to the successful communication of the infant feeding guidelines were related to slowness of communication, inaccessible jargon-ridden English language in the manuals, lack of summaries, lack of supportive supervision to make the guidelines comprehensible, and the absence of a reading culture. CONCLUSION The study encountered substantial gaps in knowledge about the diverse HIV and infant feeding policies. These gaps were partly related to the challenges of communicating the clinical guidelines. There is a need for caution in assuming that important changes in guidelines for clinical practice can easily be translated to and implemented in local programme settings, not least in the context of weak healthcare systems.
Collapse
Affiliation(s)
- Elizabeth H Shayo
- />Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway
- />National Institute for Medical Research, PO Box 9653, Dar-es-Salaam, Tanzania
| | - Bodil Bø Våga
- />Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway
- />Department of Health Studies, University of Stavanger, 4036 Stavanger, Norway
| | - Karen Marie Moland
- />Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Peter Kamuzora
- />Institute of Development Studies, University of Dar-es-Salaam, PO Box 35169, Dar-es- Salaam, Tanzania
| | - Astrid Blystad
- />Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| |
Collapse
|
44
|
Nabyonga-Orem J, Ssengooba F, Mijumbi R, Tashobya CK, Marchal B, Criel B. Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda. BMC Health Serv Res 2014; 14:639. [PMID: 25560092 PMCID: PMC4310169 DOI: 10.1186/s12913-014-0639-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Several countries in Sub Saharan Africa have abolished user fees for health care but the extent to which such a policy decision is guided by evidence needs further exploration. We explored the barriers and facilitating factors to uptake of evidence in the process of user fee abolition in Uganda and how the context and stakeholders involved shaped the uptake of evidence. This study builds on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitating factors for knowledge translation (KT). Application of the MRT to the case of abolition of user fees contributes to its refining. Methods Employing a theory-driven inquiry and case study approach given the need for in-depth investigation, we reviewed documents and conducted interviews with 32 purposefully selected key informants. We assessed whether evidence was available, had or had not been considered in policy development and the reasons why and; assessed how the actors and the context shaped the uptake of evidence. Results Symbolic, conceptual and instrumental uses of evidence were manifest. Different actors were influenced by different types of evidence. While technocrats in the ministry of health (MoH) relied on formal research, politicians relied on community complaints. The capacity of the MoH to lead the KT process was weak and the partnerships for KT were informal. The political window and alignment of the evidence with overall government discourse enhanced uptake of evidence. Stakeholders were divided, seemed to be polarized for various reasons and had varying levels of support and influence impacting the uptake of evidence. Conclusion Evidence will be taken up in policy development in instances where the MoH leads the KT process, there are partnerships for KT in place, and the overall government policy and the political situation can be expected to play a role. Different actors will be influenced by different types of evidence and their level of support and influence will impact the uptake of evidence. In addition, the extent to which a policy issue is contested and, whether stakeholders share similar opinions and preferences will impact the uptake of evidence. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0639-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Juliet Nabyonga-Orem
- WHO Regional Office for Africa, Health systems and services cluster, P.O Box 6, Brazaville, Congo.
| | - Freddie Ssengooba
- Makerere University, School of Public Health, P.O. Box 7072, Kampala, Uganda.
| | - Rhona Mijumbi
- Regional East African Community Health (REACH) policy initiative, Uganda, College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | | | - Bruno Marchal
- Institute of Tropical Medicine Antwerp-Belgium, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Bart Criel
- Institute of Tropical Medicine Antwerp-Belgium, Nationalestraat 155, 2000, Antwerp, Belgium.
| |
Collapse
|
45
|
Nabyonga-Orem J, Nanyunja M, Marchal B, Criel B, Ssengooba F. The roles and influence of actors in the uptake of evidence: the case of malaria treatment policy change in Uganda. Implement Sci 2014; 9:150. [PMID: 25294279 PMCID: PMC4193992 DOI: 10.1186/s13012-014-0150-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uganda changed its malaria treatment policy in response to evidence of resistance to commonly used antimalarials. The use of evidence in policy development--also referred to as knowledge translation (KT)--is crucial, especially in resource-limited settings. However, KT processes occur amidst a complex web of stakeholder interactions. Stakeholder involvement in evidence generation and in KT activities is essential. In the present study, we explored how stakeholders impacted the uptake of evidence in the malaria treatment policy change in Uganda. METHODS We employed a qualitative case study methodology involving interviews with key informants and review of documents. A timeline of events was developed, which guided the purposive sampling of respondents and identification of relevant documents. Data were analysed using inductive content analysis techniques. RESULTS Stakeholders played multiple roles in evidence uptake in the malaria treatment policy change. Donors, the Ministry of Health (MoH), service providers, and researchers engaged in the role of evidence generation. The MoH, parliamentarians, and opinion leaders at the national and local levels engaged in dissemination of evidence. The donors, MoH, researchers, and service providers engaged in the uptake of evidence in policy development and implementation. Stakeholders exerted varying levels of support and influence for different reasons. It is noteworthy that all of the influential stakeholders were divided regarding the best antimalarial alternative to adopt. CONCLUSION Our results showed a diverse group of stakeholders who played multiple roles, with varying levels of support and influence on the uptake of evidence in the malaria treatment policy change. For a given KT processes, mapping the relevant stakeholders and devising mechanism for their engagement and for how to resolve conflicts of interest and disagreements a priori will enhance uptake of evidence in policy development.
Collapse
|
46
|
Mijumbi RM, Oxman AD, Panisset U, Sewankambo NK. Feasibility of a rapid response mechanism to meet policymakers' urgent needs for research evidence about health systems in a low income country: a case study. Implement Sci 2014; 9:114. [PMID: 25208522 PMCID: PMC4172950 DOI: 10.1186/s13012-014-0114-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 08/21/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Despite the recognition of the importance of evidence-informed health policy and practice, there are still barriers to translating research findings into policy and practice. The present study aimed to establish the feasibility of a rapid response mechanism, a knowledge translation strategy designed to meet policymakers' urgent needs for evidence about health systems in a low income country, Uganda. Rapid response mechanisms aim to address the barriers of timeliness and relevance of evidence at the time it is needed. METHODS A rapid response mechanism (service) designed a priori was offered to policymakers in the health sector in Uganda. In the form of a case study, data were collected about the profile of users of the service, the kinds of requests for evidence, changes in answers, and courses of action influenced by the mechanism and their satisfaction with responses and the mechanism in general. RESULTS We found that in the first 28 months, the service received 65 requests for evidence from 30 policymakers and stakeholders, the majority of whom were from the Ministry of Health. The most common requests for evidence were about governance and organization of health systems. It was noted that regular contact between the policymakers and the researchers at the response service was an important factor in response to, and uptake of the service. The service seemed to increase confidence for policymakers involved in the policymaking process. CONCLUSION Rapid response mechanisms designed to meet policymakers' urgent needs for research evidence about health systems are feasible and acceptable to policymakers in low income countries.
Collapse
Affiliation(s)
- Rhona M Mijumbi
- />College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew D Oxman
- />Norwegian Knowledge Center for the Health Services, St Olavs plass, Oslo, 0130 Norway
| | - Ulysses Panisset
- />World Health Organization, Avenue Appia 20, Geneva 27, 1211 Switzerland
| | | |
Collapse
|
47
|
Nabyonga-Orem J, Ssengooba F, Macq J, Criel B. Malaria treatment policy change in Uganda: what role did evidence play? Malar J 2014; 13:345. [PMID: 25179532 PMCID: PMC4164770 DOI: 10.1186/1475-2875-13-345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/26/2014] [Indexed: 01/22/2023] Open
Abstract
Background Although increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. The present study explores the role of evidence, barriers, and factors facilitating the uptake of evidence in the change in malaria treatment policy in Uganda, building on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitatory factors for KT. Application of the MRT to a health policy case will contribute to refining it. Methods Using a case study approach and mixed methods, perceptions of respondents on whether evidence was available, had been considered and barriers and facilitatory factors to the uptake of evidence were explored. In addition, the respondents’ rating of the degree of consistency between the policy decision and available evidence was assessed. Data collection methods included key informant interviews and document review. Qualitative data were analysed using content thematic analysis, whereas quantitative data were analysed using Excel spreadsheets. The two data sets were eventually triangulated. Results Evidence was used to change the malaria treatment policy, though the consistency between evidence and policy decisions varied along the policy development cycle. The availability of high-quality and contextualized evidence, including effective dissemination, Ministry of Health institutional capacity to lead the KT process, intervention of the WHO and a regional professional network, the existence of partnerships for KT with mutual trust and availability of funding, tools, and inputs to implement evidence, were the most important facilitatory factors that enhanced the uptake of evidence. Among the barriers that had to be overcome were resistance from implementers, the health system capacity to implement evidence, and financial sustainability. Conclusion The results agree with facilitatory factors identified in the earlier developed MRT, though additional factors emerged. These results refine the earlier MRT stating that high-quality and contextualized evidence will be taken up in policies, leading to evidence-informed policies when the MoH leads the KT process, partnerships are in place for KT, the WHO and regional professional bodies play a role, and funding, tools, and required inputs for implementing evidence are available. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-345) contains supplementary material, which is available to authorized users.
Collapse
|
48
|
Imani-Nasab MH, Seyedin H, Majdzadeh R, Yazdizadeh B, Salehi M. Development of evidence-based health policy documents in developing countries: a case of Iran. Glob J Health Sci 2014; 6:27-36. [PMID: 24762343 PMCID: PMC4825355 DOI: 10.5539/gjhs.v6n3p27] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/19/2014] [Indexed: 11/12/2022] Open
Abstract
Background: Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. Methods: In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policymaking. Results: 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Conclusion: Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior.
Collapse
Affiliation(s)
| | - Hesam Seyedin
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences.
| | | | | | | |
Collapse
|
49
|
Orem JN, Mafigiri DK, Nabudere H, Criel B. Improving knowledge translation in Uganda: more needs to be done. Pan Afr Med J 2014; 17 Suppl 1:14. [PMID: 24624247 PMCID: PMC3946259 DOI: 10.11694/pamj.supp.2014.17.1.3482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/09/2013] [Indexed: 11/16/2022] Open
Abstract
Introduction Meeting the health-related Millennium Development Goals in Africa calls for better access to and higher utilisation of quality evidence. The mechanisms through which research evidence can effectively guide public health policy and implementation of health programmes are not fully understood. Challenges to the use of evidence to inform policy and practice include the lack of a common understanding of what constitutes evidence and limited insight on the effectiveness of different research uptake activities. Available Knowledge Translation (KT) models have mainly been developed in high income countries and may not be directly applicable in resource-limited settings. In this study we examine the uptake of evidence in public health policy making in Uganda. Methods We conducted a cross-sectional qualitative study consisting of in-depth interviews with 17 purposively-selected health policy makers and researchers. The study explored respondents’ perceptions of the role of evidence in public health policy development, their understanding of KT and their views on the appropriateness of different KT activities that are currently implemented in Uganda. Results Although all respondents stated that evidence should inform health policies and programmes, they noted that this occurred infrequently. We noted a lack of conceptual clarity about KT and what precisely constitutes evidence. Respondents reported having been involved in different KT activities, including partnerships and platforms created for knowledge sharing between researchers and end users, but with very mixed results. Conclusion There is need for conceptual clarity on the notion of KT and an understanding of the most appropriate KT strategies in low-income settings.
Collapse
Affiliation(s)
- Juliet Nabyonga Orem
- WHO Uganda office, Health Systems and Services Cluster P. O. Box 24578, Kampala, Uganda
| | | | - Harriet Nabudere
- Regional East African Community Health (REACH) Policy Initiative, Uganda and Support the Use of Research Evidence (SURE) for Policy in African Health Systems Project; College of Health Sciences, Makerere University Medical School, P.O. Box 7072 Kampala, Uganda
| | - Bart Criel
- Institute of Tropical Medicine Antwerp-Belgium; Nationalestraat 155; 2000 Antwerp; Belgium
| |
Collapse
|
50
|
El-Jardali F, Lavis J, Moat K, Pantoja T, Ataya N. Capturing lessons learned from evidence-to-policy initiatives through structured reflection. Health Res Policy Syst 2014; 12:2. [PMID: 24438365 PMCID: PMC3904410 DOI: 10.1186/1478-4505-12-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge translation platforms (KTPs), which are partnerships between policymakers, stakeholders, and researchers, are being established in low- and middle-income countries (LMICs) to enhance evidence-informed health policymaking (EIHP). This study aims to gain a better understanding of the i) activities conducted by KTPs, ii) the way in which KTP leaders, policymakers, and stakeholders perceive these activities and their outputs, iii) facilitators that support KTP work and challenges, and the lessons learned for overcoming such challenges, and iv) factors that can help to ensure the sustainability of KTPs. Methods This paper triangulated qualitative data from: i) 17 semi-structured interviews with 47 key informants including KTP leaders, policymakers, and stakeholders from 10 KTPs; ii) document reviews, and iii) observation of deliberations at the International Forum on EIHP in LMICs held in Addis Ababa in August 2012. Purposive sampling was used and data were analyzed using thematic analysis. Results Deliberative dialogues informed by evidence briefs were identified as the most commendable tools by interviewees for enhancing EIHP. KTPs reported that they have contributed to increased awareness of the importance of EIHP and strengthened relationships among policymakers, stakeholders, and researchers. Support from policymakers and international funders facilitated KTP activities, while the lack of skilled human resources to conduct EIHP activities impeded KTPs. Ensuring the sustainability of EIHP initiatives after the end of funding was a major challenge for KTPs. KTPs reported that institutionalization within the government has helped to retain human resources and secure funding, whereas KTPs hosted by universities highlighted the advantage of autonomy from political interests. Conclusions The establishment of KTPs is a promising development in supporting EIHP. Real-time lesson drawing from the experiences of KTPs can support improvements in the functioning of KTPs in the short term, while making the case for sustaining their work in the long term. Lessons learned can help to promote similar EIHP initiatives in other countries.
Collapse
Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut 1107 2020, Lebanon.
| | | | | | | | | |
Collapse
|