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Fadlallah R, El-Jardali F, Chidiac N, Daher N, Harb A. Analysis of funding landscape for health policy and systems research in the Eastern Mediterranean Region: A scoping review of the literature over the past decade. Health Res Policy Syst 2024; 22:70. [PMID: 38915031 PMCID: PMC11194879 DOI: 10.1186/s12961-024-01161-3] [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: 07/19/2023] [Accepted: 06/08/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Health policy and systems research (HPSR) can strengthen health systems and improve population health outcomes. In the Eastern Mediterranean Region (EMR), there is limited recognition of the importance of HPSR and funding remains the main challenge. This study seeks to: (1) assess the reporting of funding in HPSR papers published between 2010 and 2022 in the EMR, (2) examine the source of funding in the published HPSR papers in the EMR and (3) explore variables influencing funding sources, including any difference in funding sources for coronavirus disease 2019 (COVID-19)-related articles. METHODS We conducted a rapid scoping review of HPSR papers published between 2010 and 2022 (inclusively) in the EMR, addressing the following areas: reporting of funding in HPSR papers, source of funding in the published HPSR papers, authors' affiliations and country of focus. We followed the Joanna Briggs Institute (JBI) guidelines for conducting scoping reviews. We also conducted univariate and bivariate analyses for all variables at 0.05 significance level. RESULTS Of 10,797 articles screened, 3408 were included (of which 9.3% were COVID-19-related). More than half of the included articles originated from three EMR countries: Iran (n = 1018, 29.9%), the Kingdom of Saudi Arabia (n = 595, 17.5%) and Pakistan (n = 360, 10.6%). Approximately 30% of the included articles did not report any details on study funding. Among articles that reported funding (n = 1346, 39.5%), analysis of funding sources across all country income groups revealed that the most prominent source was national (55.4%), followed by international (41.7%) and lastly regional sources (3%). Among the national funding sources, universities accounted for 76.8%, while governments accounted for 14.9%. Further analysis of funding sources by country income group showed that, in low-income and lower-middle-income countries, all or the majority of funding came from international sources, while in high-income and upper-middle-income countries, national funding sources, mainly universities, were the primary sources of funding. The majority of funded articles' first authors were affiliated with academia/university, while a minority were affiliated with government, healthcare organizations or intergovernmental organizations. We identified the following characteristics to be significantly associated with the funding source: country income level, the focus of HPSR articles (within the EMR only, or extending beyond the EMR as part of international research consortia), and the first author's affiliation. Similar funding patterns were observed for COVID-19-related HPSR articles, with national funding sources (78.95%), mainly universities, comprising the main source of funding. In contrast, international funding sources decreased to 15.8%. CONCLUSION This is the first study to address the reporting of funding and funding sources in published HPSR articles in the EMR. Approximately 30% of HPSR articles did not report on the funding source. Study findings revealed heavy reliance on universities and international funding sources with minimal role of national governments and regional entities in funding HPSR articles in the EMR. We provide implications for policy and practice to enhance the profile of HPSR in the region.
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Affiliation(s)
- Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Health Systems Global Society, London, UK
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - 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.
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Ottawa, ON, Canada.
| | - Nesrin Chidiac
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Najla Daher
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Aya Harb
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
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Lai PS, Lam NL, Gallery B, Lee AG, Adair-Rohani H, Alexander D, Balakrishnan K, Bisaga I, Chafe ZA, Clasen T, Díaz-Artiga A, Grieshop A, Harrison K, Hartinger SM, Jack D, Kaali S, Lydston M, Mortimer KM, Nicolaou L, Obonyo E, Okello G, Olopade C, Pillarisetti A, Pinto AN, Rosenthal JP, Schluger N, Shi X, Thompson C, Thompson LM, Volckens J, Williams KN, Balmes J, Checkley W, Ozoh OB. Household Air Pollution Interventions to Improve Health in Low- and Middle-Income Countries: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2024; 209:909-927. [PMID: 38619436 DOI: 10.1164/rccm.202402-0398st] [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] [Indexed: 04/16/2024] Open
Abstract
Background: An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners.Methods: We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method.Results: The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes.Conclusions: HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.
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Isah MB, Muhammad Z, Lawan MM, Alkhamis AI, Goni BW, Oakley SS, Marshall K, Hartig R, Raouf ISA, Yoshimatsu T, Chagas AM, Maina MB. Setting up a state-of-the-art laboratory in resource limited settings: A case study of the biomedical science research and training centre in Northeast Nigeria. Eur J Neurosci 2024; 59:1681-1695. [PMID: 38311832 DOI: 10.1111/ejn.16260] [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: 09/17/2023] [Revised: 12/25/2023] [Accepted: 01/07/2024] [Indexed: 02/06/2024]
Abstract
African science has substantial potential, yet it grapples with significant challenges. Here we describe the establishment of the Biomedical Science Research and Training Centre (BioRTC) in Yobe State, Northeast Nigeria, as a case study of a hub fostering on-continent research and describe strategies to overcome current barriers. We detail the steps taken to establish BioRTC, emphasising the critical importance of stakeholder engagement, community involvement, resource optimisation and collaborations. With its state-of-the-art facilities and commitment to training African scientists, BioRTC is poised to significantly advance neuroscience research and training in the region. Although we are in the early stages of our journey, our model, emphasizing open access and inclusivity, offers a replicable blueprint for neuroscience research development in similar resource-limited settings, promising to enrich the global neuroscience community. We invite the support and collaboration of those who share our vision and believe in our potential.
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Affiliation(s)
- Murtala Bindawa Isah
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Department of Biochemistry, Umaru Musa Yar'adua University, Katsina, Nigeria
| | - Zaid Muhammad
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton, UK
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Department of Human Physiology, College of Medical Sciences, Yobe State University, Damaturu, Yobe State, Nigeria
| | - Mohammed Musa Lawan
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Department of Chemistry, Yobe State University, Damaturu, Nigeria
| | - Abdulrahman Idris Alkhamis
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Department of Human Physiology, College of Medical Sciences, Yobe State University, Damaturu, Yobe State, Nigeria
- Department of Human Physiology, Faculty of Basic Medical Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Baba Waru Goni
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Yobe State University Teaching Hospital, Damaturu, Yobe State, Nigeria
- Department of Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Sebastian Scott Oakley
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton, UK
| | - Karen Marshall
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton, UK
| | - Renée Hartig
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Issa Sabi-Abdoul Raouf
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Maintenance of the Nervous System & Behaviour, Brain Plasticity Unit, CNRS, ESPCI Paris, PSL Research University, Paris, France
- Laboratoire de Biologie et Modélisation de la Cellule, ENS de Lyon, Lyon, France
| | - Takeshi Yoshimatsu
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton, UK
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - André Maia Chagas
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton, UK
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
| | - Mahmoud Bukar Maina
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Yobe State, Nigeria
- Sussex Neuroscience, School of Life Sciences, University of Sussex, Brighton, UK
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
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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.
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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
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Farran D, Salloum RG, El Jardali F, Abla R, Abu Rmeileh N, Al Sheyab N, Awaw-da S, Chalak A, Jawad M, Khader Y, Mostafa A, Nakkash R. From knowledge production to knowledge translation: Waterpipe tobacco control research in the Eastern Mediterranean Region. Tob Prev Cessat 2024; 10:TPC-10-03. [PMID: 38250221 PMCID: PMC10797642 DOI: 10.18332/tpc/175953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Waterpipe tobacco smoking (WTS) rates in the Eastern Mediterranean Region (EMR) are the highest worldwide, particularly among young people. Although fiscal policies to curb tobacco use have been recommended by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), implementation has been suboptimal. The Eastern Mediterranean Consortium on the Economics of Waterpipe Tobacco Smoking (ECON-WTS) was formed in response to this need to produce knowledge on the economics of WTS in the EMR and apply a comprehensive Knowledge translation (KT) framework. The KT framework comprised priority setting, evidence synthesis, knowledge translation, and knowledge uptake. In this article, we discuss the approaches followed in applying the KT framework to WTS control, providing examples and noting challenges and lessons learned where possible.
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Affiliation(s)
- Dina Farran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ramzi G. Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Fadi El Jardali
- Health Management and Policy Department, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Ruba Abla
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Niveen Abu Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Nihaya Al Sheyab
- Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Sameera Awaw-da
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
- Economics Department, Faculty of Business and Economics, Birzeit University, Birzeit, Palestine
| | - Ali Chalak
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
| | - Yousef Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Lebanon
- Global and Community Health Department, George Mason University, Virginia, USA
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Morankar S, Abraham G, Shroff Z, Birhanu Z. "Research ends with publication": a qualitative study on the use of health policy and systems research in Ethiopia. Health Res Policy Syst 2024; 22:1. [PMID: 38167041 PMCID: PMC10759454 DOI: 10.1186/s12961-023-01091-6] [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: 11/19/2021] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Decision-making about the design and implementation of health care policies should be supported by research evidence. This article reports on a qualitative study on the experiences of both research institutes and policymakers in Ethiopia in generating and using research evidence to inform health policy decision-making. METHODS Semi-structured interviews were conducted from January through March 2020, with representatives of research institutes and with policymakers in Ethiopia. The data collected during the interviews were analyzed thematically. RESULTS Half of the institutions represented had engaged in health policy and systems research (HPSR). These institutes' capacities were limited by multiple factors, including unsupportive research environments; the limited number of researchers with extensive experience; high turnover among senior researchers; lack of staff motivation mechanisms; underdeveloped research culture; limited technical and analytical capacity among researchers; lack of core funding for HPSR; ineffective financial management; and, lack of connections with health policy platforms. Research institutes also lacked the capacity in strategic packaging of findings to influence policy decision-making, although some programs have recently improved in this area. Meanwhile, there lacked a culture of using evidence in policymaking settings. In general, we found that policymakers had poor attitudes towards the quality or value of the evidence, and had little capacity to interpret evidence and apply findings to policy options. As a result, much of the research produced by the institutes have only been relevant academically, with little impact on policy. However, respondents reported that the environment is slowly changing, and the recent creation of a Research Advisory Council at the Ministry of Health offers a promising model. CONCLUSIONS Despite some recent changes, in Ethiopia researchers and policymakers alike often tend to consider health policy and systems research (HPSR) to be not very valuable since the findings generated are rarely used for evidence-informed policy development. Research institutes and researchers need to strengthen their technical, analytical, and administrative capacities (through, among other efforts, seeking more funding for research, and better incentives to attract, retain and build skills among qualified researchers); they also need to improve their understanding of the evidence-to-policy cycle and how to engage effectively with policymakers.
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Affiliation(s)
- Sudhakar Morankar
- Ethiopian Evidence Based Healthcare and Development Centre: a JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- Health, Behavior, and Society Department, Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Ethiopian Evidence Based Healthcare and Development Centre: a JBI Center of Excellence, Jimma University, Jimma, Ethiopia
- Health, Behavior, and Society Department, Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Health Policy and Management Department, Public Health Faculty, Jimma Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Zubin Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Zewdie Birhanu
- Ethiopian Evidence Based Healthcare and Development Centre: a JBI Center of Excellence, Jimma University, Jimma, Ethiopia.
- Health, Behavior, and Society Department, Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia.
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Peters MA, Cloete K, Odwe G, Tadele G, Hirschhorn LR, Magge H, Roder-DeWan S. Embedding implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond. BMJ 2023; 383:e076331. [PMID: 38081643 PMCID: PMC10704412 DOI: 10.1136/bmj-2023-076331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
| | - Keith Cloete
- Western Cape Department of Health and Wellness, Cape Town, South Africa
| | | | | | | | - Hema Magge
- Bill and Melinda Gates Foundation, Seattle, USA
- Harvard University, Brigham and Women's Hospital, Division of Global Equity, Boston, USA
| | - Sanam Roder-DeWan
- World Bank Group, Washington DC, USA
- Dartmouth University, Hanover, USA
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Camacho S, Hilber AM, Ospina-Pinillos L, Sánchez-Nítola M, Shambo-Rodríguez DL, Lee GY, Occhipinti JA. Can participatory processes lead to changes in the configuration of local mental health networks? A social network analysis. Front Public Health 2023; 11:1282662. [PMID: 38026382 PMCID: PMC10663236 DOI: 10.3389/fpubh.2023.1282662] [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: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Systems modeling offers a valuable tool to support strategic decision-making for complex problems because it considers the causal inter-relationships that drive population health outcomes. This tool can be used to simulate policies and initiatives to determine which combinations are likely to deliver the greatest impacts and returns on investment. Systems modeling benefits from participatory approaches where a multidisciplinary stakeholder group actively engages in mapping and contextualizing causal mechanisms driving complex system behaviors. Such approaches can have significant advantages, including that they may improve connection and coordination of the network of stakeholders operating across the system; however, these are often observed in practice as colloquial anecdotes and seldom formally assessed. We used a basic social network analysis to explore the impact on the configuration of the network of mental health providers, decision-makers, and other stakeholders in Bogota, Colombia active in a series of three workshops throughout 2021 and 2022. Overall, our analysis suggests that the participatory process of the systems dynamics exercise impacts the social network's structure, relationships, and dynamics.
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Affiliation(s)
- Salvador Camacho
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Adriane Martin Hilber
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Laura Ospina-Pinillos
- Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Mónica Sánchez-Nítola
- Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Débora L. Shambo-Rodríguez
- Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Grace Yeeun Lee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia
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Peykari N, Mehdipour P, Larijani B, Sepanlou SG, Djalalinia S, Kasaeian A, Parsaeian M, Ahmadvand A, Khosravi A, Malekzadeh R, Farzadfar F. The levels and trends of diabetes prevalence at national and sub-national levels in Iran (1990 - 2016). J Diabetes Metab Disord 2023; 22:743-752. [PMID: 37255825 PMCID: PMC10225396 DOI: 10.1007/s40200-023-01197-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023]
Abstract
Background The increasing trends in Diabetes prevalence and its attributed burden emphasized as an important issue that needs serious and urgent attention, all over the word. We estimated the mean Fasting Plasma Glucose (FPG) and the prevalence of Diabetes in aged 25 years or older Iranian adults, by sex, age, province, and year through the time period of 1990 to 2016. Methods In order to access the most comprehensive relevant data at the same time the systematic data searched added to the data of 5 national surveys and 7 sub-national population based investigations. Two round of modeling, including the Age-Spatio-Temporal and Gaussian Process Regression were used for estimation of mean FPG trend and uncertainties. To estimate Diabetes estimations in target groups, a crosswalk model was applies to the FPG estimates. The model reiterated separately for women and men. All of estimations standardized based on the Iran national census population of 2016 by year, age groups and sexes at national and sub-national levels. Results In 2016, the number of the diabetic population was 4.43 (3.93-4.99) million (2.38 million women). Between 1990 and 2016, the age-standardized mean of FPG increased from 84.69 mg/dl (79.8-89.8) to 100.5 mg/dl (97.9-103.3) in women and from 82.7 mg/dl (78.3-87.5) to 98.8 mg/dl (96.2-101.4) in men. Simultaneously, with considerable difference, the Diabetes prevalence, has increased from 6.1% (4.7-7.8) to 9.8% (8.7-11.1) in women and from 5.0% 18 (3.8-6.3) to 8.1% (7.2-9.2) in men (75% attributed to population growth). Considering the geographical patterns, the greatest increment in the prevalence of Diabetes detected in the northwestern and the central provinces. Conclusion Significant increasing trends of Diabetes led to alarming threat, which can make the strategies and goals of our prevention programs out of control. We should plan for more effective communicative interventions for prevention and management of Diabetes, to be designed, implemented and monitored based on the updated scientific evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01197-2.
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Affiliation(s)
- Niloofar Peykari
- Deputy for Education, Ministry of Health and Medical Education, Tehran, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G Sepanlou
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, Iran
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Amir Kasaeian
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Parsaeian
- Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ahmadvand
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Ardeshir Khosravi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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El-Jardali F, Fadlallah R, Bou Karroum L, Akl EA. Evidence synthesis to policy: development and implementation of an impact-oriented approach from the Eastern Mediterranean Region. Health Res Policy Syst 2023; 21:40. [PMID: 37264415 DOI: 10.1186/s12961-023-00989-5] [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: 12/22/2022] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Despite the importance of evidence syntheses in informing policymaking, their production and use remain limited in the Eastern Mediterranean region (EMR). There is a lack of empirical research on approaches to promote and use policy-relevant evidence syntheses to inform policymaking processes in the EMR. OBJECTIVE This study sought to describe the development of an impact-oriented approach to link evidence synthesis to policy, and its implementation through selected case studies in Lebanon, a middle-income country in the EMR. METHODS This study followed a multifaceted and iterative process that included (i) a review of the literature, (ii) input from international experts in evidence synthesis and evidence-informed health policymaking, and (iii) application in a real-world setting (implementation). We describe four selected case studies of implementation. Surveys were used to assess policy briefs, deliberative dialogues, and post-dialogue activities. Additionally, Kingdon's stream theory was adopted to further explain how and why the selected policy issues rose to the decision agenda. RESULTS The approach incorporates three interrelated phases: (1) priority setting, (2) evidence synthesis, and (3) uptake. Policy-relevant priorities are generated through formal priority setting exercises, direct requests by policymakers and stakeholders, or a focusing event. Identified priorities are translated into focused questions that can be addressed via evidence synthesis (phase 1). Next, a scoping of the literature is conducted to identify existing evidence syntheses addressing the question of interest. Unless the team identifies relevant, up-to-date and high-quality evidence syntheses, it proceeds to conducting SRs addressing the priority questions of interest (phase 2). Next, the team prepares knowledge translation products (e.g., policy briefs) for undertaking knowledge uptake activities, followed by monitoring and evaluation (phase 3). There are two prerequisites to the application of the approach: enhancing contextual awareness and capacity strengthening. The four case studies illustrate how evidence produced from the suites of activities was used to inform health policies and practices. CONCLUSIONS To our knowledge, this is the first study to describe both the development and implementation of an approach to link evidence synthesis to policy in the EMR. We believe the approach will be useful for researchers, knowledge translation platforms, governments, and funders seeking to promote evidence-informed policymaking and practice.
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Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews On Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Becerril-Montekio V, Torres-Pereda P, García-Bello LA, Alcalde-Rabanal J. Replacement of core team members on embedded implementation research teams: experiences from Latin America and the Caribbean. Rev Panam Salud Publica 2023; 47:e82. [PMID: 37223326 PMCID: PMC10202338 DOI: 10.26633/rpsp.2023.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/10/2023] [Indexed: 05/25/2023] Open
Abstract
Objective To understand how replacement of decision-makers (DMs) serving as principal investigators (PI) or co-PIs on research teams may affect the feasibility and value of embedded implementation research (EIR) used to improve health policies, programs, and services in Latin America and the Caribbean. Methods This was a descriptive qualitative study based on 39 semistructured interviews with 13 embedded research teams selected by financing agencies to explore team composition, interaction among members, and research results. Interviews were conducted at three points during the study period from September 2018 to November 2019; data were analyzed from 2020 to 2021. Results Research teams were found to be operating in one of three situations: (i) permanent core team (no change) with either active DM or inactive DM participation; (ii) replacement of DM-PI or co-PI that did not affect EIR research; and (iii) replacement of DM-PI that affected EIR. Conclusions To ensure EIR continuity and stability, research teams should include high-level DMs together with more technical staff performing essential implementation activities. This structure could improve collaboration among professional researchers and ensure greater embeddedness of EIR to strengthen the health system.
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Affiliation(s)
- Victor Becerril-Montekio
- Centro de Investigación en Sistemas de SaludInstituto Nacional de Salud PúblicaCuernavacaMorelosMexicoCentro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
| | - Pilar Torres-Pereda
- Centro de Investigación en Sistemas de SaludInstituto Nacional de Salud PúblicaCuernavacaMorelosMexicoCentro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
| | - Luis Alberto García-Bello
- Dirección de Salud MentalInstituto de Salud Pública del Estado de GuanajuatoLeónGuanajuatoMexicoDirección de Salud Mental, Instituto de Salud Pública del Estado de Guanajuato, León, Guanajuato, Mexico.
| | - Jacqueline Alcalde-Rabanal
- Centro de Investigación en Sistemas de SaludInstituto Nacional de Salud PúblicaCuernavacaMorelosMexicoCentro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
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Strachan DL, Teague K, Asefa A, Annear PL, Ghaffar A, Shroff ZC, McPake B. Using health policy and systems research to influence national health policies: lessons from Mexico, Cambodia and Ghana. Health Policy Plan 2022; 38:3-14. [PMID: 36181467 PMCID: PMC9849714 DOI: 10.1093/heapol/czac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 01/22/2023] Open
Abstract
Health system reforms across Africa, Asia and Latin America in recent decades demonstrate the value of health policy and systems research (HPSR) in moving towards the goals of universal health coverage in different circumstances and by various means. The role of evidence in policy making is widely accepted; less well understood is the influence of the concrete conditions under which HPSR is carried out within the national context and which often determine policy outcomes. We investigated the varied experiences of HPSR in Mexico, Cambodia and Ghana (each selected purposively as a strong example reflecting important lessons under varying conditions) to illustrate the ways in which HPSR is used to influence health policy. We reviewed the academic and grey literature and policy documents, constructed three country case studies and interviewed two leading experts from each of Mexico and Cambodia and three from Ghana (using semi-structured interviews, anonymized to ensure objectivity). For the design of the study, design of the semi-structured topic guide and the analysis of results, we used a modified version of the context-based analytical framework developed by Dobrow et al. (Evidence-based health policy: context and utilisation. Social Science & Medicine 2004;58:207-17). The results demonstrate that HPSR plays a varied but essential role in effective health policy making and that the use, implementation and outcomes of research and research-based evidence occurs inevitably within a national context that is characterized by political circumstances, the infrastructure and capacity for research and the longer-term experience with HPSR processes. This analysis of national experiences demonstrates that embedding HPSR in the policy process is both possible and productive under varying economic and political circumstances. Supporting research structures with social development legislation, establishing relationships based on trust between researchers and policy makers and building a strong domestic capacity for health systems research all demonstrate means by which the value of HPSR can be materialized in strengthening health systems.
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Affiliation(s)
- Daniel Llywelyn Strachan
- *Corresponding author. The Nossal Institute for Global Health, University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia. E-mail:
| | - Kirsty Teague
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
| | - Anteneh Asefa
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia,Institute of Tropical Medicine, Kronenburgstraat 43, Antwerp (ITM) 2000, Belgium
| | - Peter Leslie Annear
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
| | - Abdul Ghaffar
- The Alliance for Health Policy and Systems Research, WHO, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Zubin Cyrus Shroff
- The Alliance for Health Policy and Systems Research, WHO, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Barbara McPake
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
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13
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Witter S, Sheikh K, Schleiff M. Learning health systems in low-income and middle-income countries: exploring evidence and expert insights. BMJ Glob Health 2022; 7:bmjgh-2021-008115. [PMID: 36130793 PMCID: PMC9490579 DOI: 10.1136/bmjgh-2021-008115] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Learning health systems (LHS) is a multifaceted subject. This paper reviewed current concepts as well as real-world experiences of LHS, drawing on published and unpublished knowledge in order to identify and describe important principles and practices that characterise LHS in low/middle-income country (LMIC) settings. Methods We adopted an exploratory approach to the literature review, recognising there are limited studies that focus specifically on system-wide learning in LMICs, but a vast set of connected bodies of literature. 116 studies were included, drawn from an electronic literature search of published and grey literature. In addition, 17 interviews were conducted with health policy and research experts to gain experiential knowledge. Results The findings were structured by eight domains on learning enablers. All of these interact with one another and influence actors from community to international levels. We found that learning comes from the connection between information, deliberation, and action. Moreover, these processes occur at different levels. It is therefore important to consider experiential knowledge from multiple levels and experiences. Creating spaces and providing resources for communities, staff and managers to deliberate on their challenges and find solutions has political implications, however, and is challenging, particularly when resources are constrained, funding and accountability are fragmented and the focus is short-term and narrow. Nevertheless, we can learn from countries that have managed to develop institutional mechanisms and human capacities which help health systems respond to changing environments with ‘best fit’ solutions. Conclusion Health systems are knowledge producers, but learning is not automatic. It needs to be valued and facilitated. Everyday governance of health systems can create spaces for reflective practice and learning within routine processes at different levels. This article highlights important enablers, but there remains much work to be done on developing this field of knowledge.
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Affiliation(s)
- Sophie Witter
- Institute for Global Health and Development & ReBUILD Consortium, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Kabir Sheikh
- Alliance For Health Policy and System Research, Geneva, Switzerland
| | - Meike Schleiff
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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14
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Siu E, Chaloupka FJ, Drope J, Dorokhina M. Achieving policy impact on tobacco economics research: experiences and lessons learnt. Tob Control 2022; 31:tobaccocontrol-2021-056923. [PMID: 35803673 DOI: 10.1136/tobaccocontrol-2021-056923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Erika Siu
- Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
| | - Frank J Chaloupka
- Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
| | - Jeffrey Drope
- Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
| | - Margaret Dorokhina
- Institute for Health Research and Policy, University of Illinois, Chicago, Illinois, USA
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15
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Fadlallah R, Daher N, El-Harakeh A, Hammam R, Brax H, Bou Karroum L, Lopes LC, Arnous G, Kassamany I, Baltayan S, Harb A, Lotfi T, El-Jardali F, Akl EA. Approaches to prioritising primary health research: a scoping review. BMJ Glob Health 2022; 7:bmjgh-2021-007465. [PMID: 35501067 PMCID: PMC9062777 DOI: 10.1136/bmjgh-2021-007465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To systematically identify and describe approaches to prioritise primary research topics in any health-related area. Methods We searched Medline and CINAHL databases and Google Scholar. Teams of two reviewers screened studies and extracted data in duplicate and independently. We synthesised the information across the included approaches by developing common categorisation of relevant concepts. Results Of 44 392 citations, 30 articles reporting on 25 approaches were included, addressing the following fields: health in general (n=9), clinical (n=10), health policy and systems (n=10), public health (n=6) and health service research (n=5) (10 addressed more than 1 field). The approaches proposed the following aspects to be addressed in the prioritisation process: situation analysis/ environmental scan, methods for generation of initial list of topics, use of prioritisation criteria, stakeholder engagement, ranking process/technique, dissemination and implementation, revision and appeal mechanism, and monitoring and evaluation. Twenty-two approaches proposed involving stakeholders in the priority setting process. The most commonly proposed stakeholder category was ‘researchers/academia’ (n=17, 77%) followed by ‘healthcare providers’ (n=16, 73%). Fifteen of the approaches proposed a list of criteria for determining research priorities. We developed a common framework of 28 prioritisation criteria clustered into nine domains. The criterion most frequently mentioned by the identified approaches was ‘health burden’ (n=12, 80%), followed by ‘availability of resources’ (n=11, 73%). Conclusion We identified and described 25 prioritisation approaches for primary research topics in any health-related area. Findings highlight the need for greater participation of potential users (eg, policy-makers and the general public) and incorporation of equity as part of the prioritisation process. Findings can guide the work of researchers, policy-makers and funders seeking to conduct or fund primary health research. More importantly, the findings should be used to enhance a more coordinated approach to prioritising health research to inform decision making at all levels.
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Affiliation(s)
- Racha Fadlallah
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Najla Daher
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Rima Hammam
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Faculty of Medicine, Université Saint-Joseph, Beirut, Lebanon
| | - Lama Bou Karroum
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | | | - Ghida Arnous
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Inas Kassamany
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Stephanie Baltayan
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Aya Harb
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Tamara Lotfi
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon.,Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon .,Clinical Research Institute, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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16
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Jessani NS, Ling B, Babcock C, Valmeekanathan A, Holtgrave DR. Advocacy, activism, and lobbying: How variations in interpretation affects ability for academia to engage with public policy. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000034. [PMID: 36962253 PMCID: PMC10021895 DOI: 10.1371/journal.pgph.0000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/22/2021] [Indexed: 06/18/2023]
Abstract
Research and teaching are considered core-responsibilities for academic researchers. "Practice" activities however are viewed as ancillary, despite university emphasis on their importance. As funders, governments, and academia address the role of research in social impact, the deliberations on researcher activism, advocacy and lobbying have seen a resurgence. This study explores the perceptions of 52 faculty and 24 government decisionmakers on the roles, responsibilities, and restrictions of an academic to proactively engage in efforts that can be interpreted under these three terms. Data was coded through inductive thematic analysis using Atlas.Ti and a framework approach. We found that discordant perceptions about how much activism, advocacy and lobbying faculty should be engaging in, results from how each term is defined, interpreted, supported and reported by the individuals, the School of Public Health (SPH), and government agencies. Influential faculty factors included: seniority, previous experiences, position within the institution, and being embedded in a research center with an advocacy focus. Faculty views on support for advocacy were often divergent. We surmise therefore, that for effective and mutually beneficial collaboration to occur, academic institutions need to align rhetoric with reality with respect to encouraging modes and support for government engagement. Similarly, government agencies need to provide more flexible modes of engagement. This will contribute to alleviating confusion as well as tension leading to more effective engagement and consequently opportunity for evidence-informed decision making in public health globally.
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Affiliation(s)
- Nasreen S. Jessani
- Center for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Brenton Ling
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
- Wholesome Wave, Washington, DC, United States of America
| | - Carly Babcock
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
- CDC Foundation, Atlanta, Georgia, United States of America
| | - Akshara Valmeekanathan
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
- Independent Consultant, India
| | - David R. Holtgrave
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
- School of Public Health, University at Albany, Albany, New York, United States of America
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Awoonor‐Williams JK, Phillips JF. Developing organizational learning for scaling-up community-based primary health care in Ghana. Learn Health Syst 2022; 6:e10282. [PMID: 35036554 PMCID: PMC8753302 DOI: 10.1002/lrh2.10282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Achieving effective community-based primary health care requires evidence for guiding strategic decisions that must be made. However, research processes often limit data collection to particular organizational levels or disseminate results to specific audiences. Decision-making that emerges can fail to account for the contrasting perspectives and needs of managers at each organizational level. The Ghana Health Service (GHS) addressed this problem with a multilevel and sequential research and action approach that has provided two decades of implementation learning for guiding community-based primary health care development. METHOD The GHS implementation research initiatives progressed from (i) a participatory pilot investigation to (ii) an experimental trial of strategies that emerged to (iii) replication research for testing scale-up, culminating in (iv) evidence-based scale-up of a national community-based primary health care program. A reform process subsequently repeated this sequence in a manner that involved stakeholders at the community, sub-district, district, and regional levels of the system. The conduct, interpretation, and dissemination of results that emerged comprised a strategy for achieving systems learning by conducting investigations in phases in conjunction with bottom-up knowledge capture, lateral exchanges for fostering peer learning at each system level, and top-down processes for communicating results as policy. Continuous accumulation of qualitative data on stakeholder reactions to operations at each organizational level was conducted in conjunction with quantitative monitoring of field operations. RESULTS Implementation policies were enhanced by results associated with each phase. A quasi-experiment for testing the reform process showed that scale-up of community-based primary health care was accelerated, leading to improvements in childhood survival and reduced fertility. CONCLUSION Challenges to system learning were overcome despite severe resource constraints. The integration of knowledge generation with ongoing management processes institutionalized learning for achieving evidence-driven program action.
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Affiliation(s)
| | - James F. Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
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18
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Rasanathan K, Tran N, Johnson HL, Hafeez A, Peterson S, Ghaffar A. Realizing the potential of embedded implementation research: Lessons from Pakistan. J Glob Health 2021; 10:020104. [PMID: 33110503 PMCID: PMC7533432 DOI: 10.7189/jogh.10.020104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Nhan Tran
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | | | - Assad Hafeez
- Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | | | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, Geneva, Switzerland
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19
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Varallyay NI, Bennett SC, Kennedy C, Ghaffar A, Peters DH. How does embedded implementation research work? Examining core features through qualitative case studies in Latin America and the Caribbean. Health Policy Plan 2021; 35:ii98-ii111. [PMID: 33156937 PMCID: PMC7646734 DOI: 10.1093/heapol/czaa126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/04/2023] Open
Abstract
Innovative strategies are needed to improve the delivery of evidence-informed health interventions. Embedded implementation research (EIR) seeks to enhance the generation and use of evidence for programme improvement through four core features: (1) central involvement of programme/policy decision-makers in the research cycle; (2) collaborative research partnerships; (3) positioning research within programme processes and (4) research focused on implementation. This paper examines how these features influence evidence-to-action processes and explores how they are operationalized, their effects and supporting conditions needed. We used a qualitative, comparative case study approach, drawing on document analysis and semi-structured interviews across multiple informant groups, to examine three EIR projects in Bolivia, Colombia and the Dominican Republic. Our findings are presented according to the four core EIR features. The central involvement of decision-makers in EIR was enhanced by decision-maker authority over the programme studied, professional networks and critical reflection. Strong research-practice partnerships were facilitated by commitment, a clear and shared purpose and representation of diverse perspectives. Evidence around positioning research within programme processes was less conclusive; however, as all three cases made significant advances in research use and programme improvement, this feature of EIR may be less critical than others, depending on specific circumstances. Finally, a research focus on implementation demanded proactive engagement by decision-makers in conceptualizing the research and identifying opportunities for direct action by decision-makers. As the EIR approach is a novel approach in these low-resource settings, key supports are needed to build capacity of health sector stakeholders and create an enabling environment through system-level strategies. Key implications for such supports include: promoting EIR and creating incentives for decision-makers to engage in it, establishing structures or mechanisms to facilitate decision-maker involvement, allocating funds for EIR, and developing guidance for EIR practitioners.
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Affiliation(s)
- N Ilona Varallyay
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
- Corresponding author. Malabia 1970, Buenos Aires CABA 1414,
Argentina. E-mail:
| | - Sara C Bennett
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Caitlin Kennedy
- Social and Behavioral Interventions Program, Department of
International Health, Johns Hopkins School of Public Health, 615 N Wolfe St,
Baltimore, MD 21205, United States
| | - Abdul Ghaffar
- The Alliance for Health Policy and Systems Research at the
World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
| | - David H Peters
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
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20
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Shahabuddin A, Sharkey A, Khalid F, Rasanathan K, Hasman A, Tran N, Durrani A, Ongwae K, Duncan R, Ahmed KA, Farrukh S, Rutter P, Jackson D, Hafeez A, Peterson SS, Ghaffar A. An embedded implementation research initiative to tackle service delivery bottlenecks in the expanded programme on immunisation in Pakistan: Overview and reflections. J Glob Health 2021; 11:06003. [PMID: 34026053 PMCID: PMC8109843 DOI: 10.7189/jogh.11.06003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Embedded implementation research (IR) can play a critical role in health systems strengthening by tackling systems and implementation bottlenecks of a program. To achieve this aim, with the financial support of GAVI, the Vaccine Alliance, in 2016, the Government of Pakistan, UNICEF and the Alliance for Health Policy and Systems Research (AHPSR) launched an Embedded IR for Immunisation Initiative (the Initiative) to explore health systems and implementation bottlenecks, and potential strategies to tackle such bottlenecks in the Expanded Programme on Immunisation (EPI) in Pakistan. In total, 10 research teams were involved in the Initiative, which was the first of its kind in the country. In this paper, we provided a brief overview of the Initiative's approach as well as the key learnings including challenges and successes of the research teams which could inform future embedded IR Initiatives. Methods Data were collected from members of the IR teams through an online survey. In addition, in-depth interviews were conducted via phone and in-person from IR team members to explore further the challenges they faced while conducting IR in Pakistan and recommendations for future IR initiatives. The qualitative information obtained from these sources was collated and categorized into themes reflecting some of the challenges, successes, and lessons learned, as well as teams' recommendations for future initiatives. Results The embedded IR Initiative in Pakistan followed several steps starting with a desk review to compile information on key implementation challenges of EPI and ended with a dissemination workshop where all the research teams shared their IR results with policymakers and implementers. Key factors that facilitated the successful and timely completion of the studies included appreciation by and leadership of implementers in generation and use of local knowledge, identification of research priorities jointly by EPI managers and researchers and provision of continuous and high-quality support from in-country research partners. Participants in the Initiative indicated that challenges included a lack of clarity on the role and responsibilities of each partner involved and need for further support to facilitate use and dissemination of research findings. Conclusions The Initiative established that an immunisation programme in a lower middle-income country can use small and time-bound embedded IR, based on partnerships between programme managers and local researchers, to generate information and evidence that can inform decision-making. Future embedded IR initiatives should strive to ensure effective coordination and active participation of all key stakeholders, a clear research utilisation plan from the outset, and efforts to strengthen research teams' capacity to foster utilisation of research findings.
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Affiliation(s)
- Asm Shahabuddin
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, USA
| | - Alyssa Sharkey
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, USA
| | - Faraz Khalid
- Universal Health Coverage/Health Systems Department, WHO Regional Office for Eastern Mediterranean
| | | | - Andreas Hasman
- Regional Office for South Asia, UNICEF, Kathmandu, Nepal
| | - Nhan Tran
- Alliance for Health Policy and Systems Research, World Health Organisation, Geneva, Switzerland
| | | | | | - Richard Duncan
- Immunisation Unit, Health Section, Programme Division, UNICEF, New York, USA
| | | | - Saadia Farrukh
- Regional Office for South Asia, UNICEF, Kathmandu, Nepal
| | - Paul Rutter
- Regional Office for South Asia, UNICEF, Kathmandu, Nepal
| | - Debra Jackson
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | - Assad Hafeez
- Ministry of National Health Services, Regulations & Coordination, Islamabad, Pakistan
| | | | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organisation, Geneva, Switzerland
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Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine 2021; 39:1897-1909. [PMID: 33750592 PMCID: PMC10370349 DOI: 10.1016/j.vaccine.2021.02.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Competing priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010. METHODS We searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria. RESULTS Of the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption. CONCLUSIONS The literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.
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Affiliation(s)
- Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Maria Susana Panero
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynnette Ametewee
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Abigail M Shefer
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kumar MB, Madan JJ, Auguste P, Taegtmeyer M, Otiso L, Ochieng CB, Muturi N, Mgamb E, Barasa E. Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya. BMJ Glob Health 2021; 6:e002452. [PMID: 33658302 PMCID: PMC7931757 DOI: 10.1136/bmjgh-2020-002452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Improvements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya. METHODS We estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses. RESULTS We found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars). CONCLUSIONS This analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas.
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Affiliation(s)
- Meghan Bruce Kumar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Jason J Madan
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Peter Auguste
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | - Nelly Muturi
- Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Elizabeth Mgamb
- Department of Health, Migori County Government, Migori, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
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23
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Greene SA, Anya BPM, Asghar H, Chaudhri IA, Datta SD, Donadel ME, Kouadio KI, Shefer AM, Cavallaro KF. Strengthening National Immunization Technical Advisory Groups in resource-limited settings: current and potential linkages with polio national certification committees. Health Res Policy Syst 2020; 18:116. [PMID: 33023599 PMCID: PMC7539480 DOI: 10.1186/s12961-020-00632-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Countries are transitioning assets and functions from polio eradication to integrated immunization and surveillance activities. We assessed the extent of linkages between and perceptions of National Immunization Technical Advisory Groups (NITAGs) and National Certification Committees (NCCs) for polio eradication to understand how linkages can be leveraged to improve efficiencies of these expert bodies. METHODS During May 2017 to May 2018, we administered a 15-question survey to a NITAG chair or member and an NCC counterpart in all countries of the WHO Regions for Africa (AFR) and for the Eastern Mediterranean (EMR) that had both a NITAG and an NCC. Data were analysed using frequency distributions. RESULTS Of countries with both a NITAG and an NCC (n = 44), the response rate was 92% (22/24) in AFR and 75% (15/20) in EMR. Some respondents reported being very familiar with the functions of the other technical bodies, 36% (8/22) for NITAG members and 38% (14/37) for NCC members. Over 85% (51/59) of respondents felt it was somewhat useful or very useful to strengthen ties between bodies. Nearly all respondents (98%, 58/59) felt that NCC expertise could inform measles and rubella elimination programmes. CONCLUSIONS We observed a broad consensus that human resource assets of NCCs may serve an important technical role to support national immunization policy-making. At this stage of the polio eradication initiative, countries should consider how to integrate the technical expertise of NCC members to reinforce NITAGs and maintain the polio essential functions, beginning in countries that have been polio-free for several years.
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Affiliation(s)
- Sharon A Greene
- Centers for Disease Control and Prevention, Atlanta, United States of America.
| | | | - Humayun Asghar
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Irtaza A Chaudhri
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - S Deblina Datta
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Morgane E Donadel
- Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Koffi Isidore Kouadio
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Abigail M Shefer
- Centers for Disease Control and Prevention, Atlanta, United States of America
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Munywoki J, Kagwanja N, Chuma J, Nzinga J, Barasa E, Tsofa B. Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya. Int J Equity Health 2020; 19:165. [PMID: 32958000 PMCID: PMC7507677 DOI: 10.1186/s12939-020-01284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. METHODS We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. RESULTS We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. CONCLUSION Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country's efforts for promoting service delivery equity as a key goal - both for the devolution and the country's quest towards Universal Health Coverage (UHC).
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Affiliation(s)
- Joshua Munywoki
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya.
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.
| | - Nancy Kagwanja
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Jane Chuma
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- The World Bank Group, Kenya Country Office, Nairobi, Kenya
| | - Jacinta Nzinga
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Edwine Barasa
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Benjamin Tsofa
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya.
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.
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Hakoum MB, Bou-Karroum L, Al-Gibbawi M, Khamis AM, Raslan AS, Badour S, Agarwal A, Alturki F, Guyatt G, El-Jardali F, Akl EA. Reporting of conflicts of interest by authors of primary studies on health policy and systems research: a cross-sectional survey. BMJ Open 2020; 10:e032425. [PMID: 32690493 PMCID: PMC7371338 DOI: 10.1136/bmjopen-2019-032425] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The objective of this study was to assess the frequency and types of conflict of interest (COI) disclosed by authors of primary studies of health policy and systems research (HPSR). DESIGN We conducted a cross-sectional survey using standard systematic review methodology for study selection and data extraction. We conducted descriptive analyses. SETTING We collected data from papers published in 2016 in 'health policy and service journals' category in Web of Science database. PARTICIPANTS We included primary studies (eg, randomised controlled trials, cohort studies, qualitative studies) of HPSR published in English in 2016 peer-reviewed health policy and services journals. OUTCOME MEASURES Reported COI disclosures including whether authors reported COI or not, form in which COI disclosures were provided, number of authors per paper who report any type of COI, number of authors per paper who report specific types and subtypes of COI. RESULTS We included 200 eligible primary studies of which 132 (66%) included COI disclosure statements of authors. Of the 132 studies, 19 (14%) had at least one author reporting at least one type of COI and the most frequently reported type was individual financial COI (n=15, 11%). None of the authors reported individual intellectual COIs or personal COIs. Financial and individual COIs were reported more frequently compared with non-financial and institutional COIs. CONCLUSION A low percentage of HPSR primary studies included authors reporting COI. Non-financial or institutional COIs were the least reported types of COI.
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Affiliation(s)
- Maram B Hakoum
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Lama Bou-Karroum
- Center for Systematic Reviews for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Assem M Khamis
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | | | - Sanaa Badour
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Arnav Agarwal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fadel Alturki
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Knowledge to Policy (K2P) Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Shahabuddin ASM, B. Sharkey A, Jackson D, Rutter P, Hasman A, Sarker M. Carrying out embedded implementation research in humanitarian settings: A qualitative study in Cox's Bazar, Bangladesh. PLoS Med 2020; 17:e1003148. [PMID: 32673316 PMCID: PMC7365392 DOI: 10.1371/journal.pmed.1003148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 06/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Embedded implementation research (IR) promotes evidence-informed policy and practices by involving decision-makers and program implementers in research activities that focus on understanding and solving existing implementation challenges. Although embedded IR has been conducted in multiple settings by different organizations, there are limited experiences of embedded IR in humanitarian settings. This study highlights some of the key challenges of conducting embedded IR in a humanitarian setting based on our experience with the Rohingya refugee population in Cox's Bazar, Bangladesh. METHODS AND FINDINGS We collected qualitative data in between January and July 2019. First, we visited Rohingya refugee camps and interviewed representatives from different humanitarian organizations. Second, we conducted interviews with researchers from BRAC University who were engaged with data collection and analysis in a broader embedded IR study on maternal, newborn, child, and adolescent health (MNCAH) program implementation challenges. Data were analyzed using a thematic analysis approach. Two researchers developed and agreed on codes and relevant themes based on the objectives of this study. The findings of this study highlight several challenges encountered while conducting embedded IR in the Rohingya emergency setting in Cox's Bazar, which may have implications for other humanitarian settings. The overall context of the camps was complex, with more than 100 organizations devoted to providing health services for approximately 1 million refugees. Despite the presence of the Bangladesh government, United Nations agencies and other international organizations played key roles in making programmatic and policy decisions for the Rohingya. Because health service delivery modalities and policies and related implementation challenges for MNCAH programs for the refugees changed rapidly, the embedded IR approach used was flexible and able to adapt to changes identified, with research questions and methods modified accordingly. Access to the camps, reaching Rohingya respondents, overcoming language barriers in order to get quality information, and the limited availability of local research collaborators were additional challenges. Working with researchers or research institutes that are familiar with the context and have experience in conducting implementation and health systems research can help with collection of quality data, identifying key stakeholders and bringing them on board to ensure the execution of the project, and ensuring utilization of the research findings. Study limitations include possible constraints in generalizing our conclusions to other humanitarian settings. Implementation research conducted in additional humanitarian settings can contribute to the evidence on this topic. CONCLUSIONS Findings indicate that embedded IR can be done effectively in humanitarian settings if the challenges are anticipated, and appropriate strategies and in-country partners put in place to address or mitigate them, before commencing the funding or starting of the project. Understanding the context and analyzing the role of relevant stakeholders prior to conducting the research, considering a simple descriptive method appropriate to answering real-time IR questions, and working with local researchers or research institutes with specific skill sets and prior experience conducting research in humanization contexts may reduce costs and time spent, and ensure collection of quality data relevant for policy and practice.
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Affiliation(s)
- A. S. M. Shahabuddin
- Implementation Research and Delivery Science Unit, Health Section, UNICEF, New York, New York, United States of America
- * E-mail:
| | - Alyssa B. Sharkey
- Implementation Research and Delivery Science Unit, Health Section, UNICEF, New York, New York, United States of America
| | - Debra Jackson
- Implementation Research and Delivery Science Unit, Health Section, UNICEF, New York, New York, United States of America
| | - Paul Rutter
- Health Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Andreas Hasman
- Health Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Inguane C, Sawadogo-Lewis T, Chaquisse E, Roberton T, Ngale K, Fernandes Q, Dinis A, Augusto O, Covele A, Hicks L, Gremu A, Sherr K. Challenges and facilitators to evidence-based decision-making for maternal and child health in Mozambique: district, municipal and national case studies. BMC Health Serv Res 2020; 20:598. [PMID: 32605564 PMCID: PMC7329398 DOI: 10.1186/s12913-020-05408-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 06/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need for evidence-based decision-making in the health sector is well understood in the global health community. Yet, gaps persist between the availability of evidence and the use of that evidence. Most research on evidence-based decision-making has been carried out in higher-income countries, and most studies look at policy-making rather than decision-making more broadly. We conducted this study to address these gaps and to identify challenges and facilitators to evidence-based decision-making in Maternal, Newborn and Child Health and Nutrition (MNCH&N) at the municipality, district, and national levels in Mozambique. METHODS We used a case study design to capture the experiences of decision-makers and analysts (n = 24) who participated in evidence-based decision-making processes related to health policies and interventions to improve MNCH&N in diverse decision-making contexts (district, municipality, and national levels) in 2014-2017, in Mozambique. We examined six case studies, at the national level, in Maputo City and in two districts of Sofala Province and two of Zambézia Province, using individual in-depth interviews with key informants and a document review, for three weeks, in July 2018. RESULTS Our analysis highlighted various challenges for evidence-based decision-making for MNCH&N, at national, district, and municipality levels in Mozambique, including limited demand for evidence, limited capacity to use evidence, and lack of trust in the available evidence. By contrast, access to evidence, and availability of evidence were viewed positively and seen as potential facilitators. Organizational capacity for the demand and use of evidence appears to be the greatest challenge; while individual capacity is also a barrier. CONCLUSION Evidence-based decision-making requires that actors have access to evidence and are empowered to act on that evidence. This, in turn, requires alignment between those who collect data, those who analyze and interpret data, and those who make and implement decisions. Investments in individual, organizational, and systems capacity to use evidence are needed to foster practices of evidence-based decision-making for improved maternal and child health in Mozambique.
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Affiliation(s)
- Celso Inguane
- Department of Global Health, University of Washington, 1107 45th Street. NE, Suite 350, Seattle, WA, 98105, USA.
| | | | - Eusébio Chaquisse
- National Directorate of Public Health, Ministry of Health, Maputo City, Mozambique
| | - Timothy Roberton
- Institute for International Programs, Johns Hopkins University,, Baltimore, MD, USA
| | - Kátia Ngale
- Institute for International Programs, Johns Hopkins University, Maputo City, Mozambique
| | - Quinhas Fernandes
- Department of Global Health, University of Washington, 1107 45th Street. NE, Suite 350, Seattle, WA, 98105, USA.,National Directorate of Public Health, Ministry of Health, Maputo City, Mozambique
| | - Aneth Dinis
- Department of Global Health, University of Washington, 1107 45th Street. NE, Suite 350, Seattle, WA, 98105, USA.,National Directorate of Public Health, Ministry of Health, Maputo City, Mozambique
| | - Orvalho Augusto
- Department of Global Health, University of Washington, 1107 45th Street. NE, Suite 350, Seattle, WA, 98105, USA.,Department of Community Health, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo City, Mozambique
| | | | | | - Artur Gremu
- Health Alliance International, Maputo City, Mozambique
| | - Kenneth Sherr
- Department of Global Health, University of Washington, 1107 45th Street. NE, Suite 350, Seattle, WA, 98105, USA.,Health Alliance International, Seattle, Washington, USA
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Varallyay NI, Langlois EV, Tran N, Elias V, Reveiz L. Health system decision-makers at the helm of implementation research: development of a framework to evaluate the processes and effectiveness of embedded approaches. Health Res Policy Syst 2020; 18:64. [PMID: 32522238 PMCID: PMC7288439 DOI: 10.1186/s12961-020-00579-9] [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: 06/06/2019] [Accepted: 05/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Embedded approaches to implementation research (IR), whereby health system decision-makers participate actively in the research process, are gaining traction as effective approaches to optimise the delivery of health programmes and policies. However, the evidence base on the processes and effectiveness of such collaborative research remains inchoate. Standardised approaches to evaluate these initiatives are needed to identify core elements of ‘embeddedness’, unveil the underlying pathways of change, and assess contribution to evidence uptake in decision-making and overall outcomes of effect. The framework presented in this paper responds to this need, designed to guide the systematic evaluation of embedded IR. Methods This evaluation framework for embedded IR approaches is based on the experience of a joint initiative by the Pan American Health Organization/Alliance for Health Policy and Systems Research, which has supported 19 IR grants in 10 Latin American and Caribbean countries from 2014 to 2017. The conceptualisation of this framework drew on various sources of information, including empirical evidence and conceptual insights from the literature, interviews with content experts, and a prospective evaluation of the 2016 cohort that included semi-structured key informant interviews, document analysis, and a research team survey to examine key aspects of embedded research. Results We developed a widely applicable conceptual framework to guide the evaluation of embedded IR in various contexts. Focused on uncovering how this collaborative research approach influences programme improvement, it outlines expected processes and intermediate outcomes. It also highlights constructs with which to assess ‘embeddedness’ as well as critical contextual factors. The framework is intended to provide a structure by which to systematically examine such embedded research initiatives, proposing three key stages of evidence-informed decision-making – co-production of evidence, engagement with research, and enactment of programme changes. Conclusion Rigorous evaluation of embedded IR is needed to build the evidence on its processes and effectiveness in influencing decision-making. The evaluation framework presented here addresses this gap with consideration of the complexity of such efforts. Its applicability to similar initiatives is bolstered by virtue of being founded on real-world experience; its potential to contribute to a nuanced understanding of embedded IR is significant.
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Affiliation(s)
- N Ilona Varallyay
- Department of International Health of the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Nhan Tran
- Unintentional Injury Prevention Department for the Management of Non-communicable Diseases, Disability, Violence, and Injury Prevention (NVI), World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Vanesa Elias
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, 525 Twenty-third Street, N.W, Washington, D.C, USA
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, 525 Twenty-third Street, N.W, Washington, D.C, USA
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Learning sites for health system governance in Kenya and South Africa: reflecting on our experience. Health Res Policy Syst 2020; 18:44. [PMID: 32393340 PMCID: PMC7212564 DOI: 10.1186/s12961-020-00552-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/23/2020] [Indexed: 12/04/2022] Open
Abstract
Background Health system governance is widely recognised as critical to well-performing health systems in low- and middle-income countries. However, in 2008, the Alliance for Health Policy and Systems Research identified governance as a neglected health systems research issue. Given the demands of such research, the Alliance recommended applying qualitative approaches and institutional analysis as well as implementing cross-country research programmes in engagement with policy-makers and managers. This Commentary reports on a 7-year programme of work that addressed these recommendations by establishing, in partnership with health managers, three district-level learning sites that supported real-time learning about the micro-practices of governance – that is, managers’ and health workers’ everyday practices of decision-making. Paper focus The paper’s specific focus is methodological and it seeks to prompt wider discussion about the long-term and engaged nature of learning-site work for governance research. It was developed through processes of systematic reflection within and across the learning sites. In the paper, we describe the learning sites and our research approach, and highlight the set of wider activities that spun out of the research partnership, which both supported the research and enabled it to reach wider audiences. We also separately present the views of managers and researchers about the value of this work and reflect carefully on four critiques of the overall approach, drawing on wider co-production literature. Conclusions Ultimately, the key lessons we draw from these experiences are that learning sites offer particular opportunities not only to understand the everyday realities of health system governance but also to support emergent system change led by health managers; the wider impacts of this type of research are enabled by working up the system as well as by infusing research findings into teaching and other activities, and this requires supportive organisational environments, some long-term research funding, recognising the professional and personal risks involved, and sustaining activities over time by paying attention to relationships; and working in multiple settings deepens learning for both researchers and managers. We hope the paper stimulates further reflection about research on health system governance and about co-production as a research approach.
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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.
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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
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Jessani NS, Valmeekanathan A, Babcock C, Ling B, Davey-Rothwell MA, Holtgrave DR. Exploring the evolution of engagement between academic public health researchers and decision-makers: from initiation to dissolution. Health Res Policy Syst 2020; 18:15. [PMID: 32039731 PMCID: PMC7011533 DOI: 10.1186/s12961-019-0516-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
CONTEXT Relationships between researchers and decision-makers have demonstrated positive potential to influence research, policy and practice. Over time, interest in better understanding the relationships between the two parties has grown as demonstrated by a plethora of studies globally. However, what remains elusive is the evolution of these vital relationships and what can be learned from them with respect to advancing evidence-informed decision-making. We therefore explored the nuances around the initiation, maintenance and dissolution of academic-government relationships. METHODS We conducted in-depth interviews with 52 faculty at one school of public health and 24 government decision-makers at city, state, federal and global levels. Interviews were transcribed and coded deductively and inductively using Atlas.Ti. Responses across codes and respondents were extracted into an Excel matrix and compared in order to identify key themes. FINDINGS Eight key drivers to engagement were identified, namely (1) decision-maker research needs, (2) learning, (3) access to resources, (4) student opportunities, (5) capacity strengthening, (6) strategic positioning, (7) institutional conditionalities, and (8) funder conditionalities. There were several elements that enabled initiation of relationships, including the role of faculty members in the decision-making process, individual attributes and reputation, institutional reputation, social capital, and the role of funders. Maintenance of partnerships was dependent on factors such as synergistic collaboration (i.e. both benefit), mutual trust, contractual issues and funding. Dissolution of relationships resulted from champions changing/leaving positions, engagement in transactional relationships, or limited mutual trust and respect. CONCLUSIONS As universities and government agencies establish relationships and utilise opportunities to share ideas, envision change together, and leverage their collaborations to use evidence to inform decision-making, a new modus operandi becomes possible. Embracing the individual, institutional, networked and systems dynamics of relationships can lead to new practices, alternate approaches and transformative change. Government agencies, schools of public health and higher education institutions more broadly, should pay deliberate attention to identifying and managing the various drivers, enablers and disablers for relationship initiation and resilience in order to promote more evidence-informed decision-making.
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Affiliation(s)
- Nasreen S Jessani
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America.
- Center for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
- Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.
| | - Akshara Valmeekanathan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Carly Babcock
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Brenton Ling
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Melissa A Davey-Rothwell
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - David R Holtgrave
- School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
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Murunga VI, Oronje RN, Bates I, Tagoe N, Pulford J. Review of published evidence on knowledge translation capacity, practice and support among researchers and research institutions in low- and middle-income countries. Health Res Policy Syst 2020; 18:16. [PMID: 32039738 PMCID: PMC7011245 DOI: 10.1186/s12961-019-0524-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to yield beneficial outcomes for society. Effective KT requires researchers to play an active role in promoting evidence uptake. This paper presents a systematised review of evidence on low- and middle-income country (LMIC) researchers' KT capacity, practice and interventions for enhancing their KT practice (support) with the aim of identifying gaps and informing future research and interventions. METHODS An electronic search for peer-reviewed publications focusing on LMIC researchers' KT capacity, practice and support across all academic fields, authored in English and from the earliest records available to February 2019, was conducted using PubMed and Scopus. Selected studies were appraised using the Mixed Methods Appraisal Tool, data pertaining to publication characteristics and study design extracted, and an a priori thematic analysis of reported research findings completed. RESULTS The search resulted in 334 screened articles, of which 66 met the inclusion criteria. Most (n = 43) of the articles presented original research findings, 22 were commentaries and 1 was a structured review; 47 articles reported on researchers' KT practice, 12 assessed the KT capacity of researchers or academic/research institutions and 9 reported on KT support for researchers. More than half (59%) of the articles focused on sub-Saharan Africa and the majority (91%) on health research. Most of the primary studies used the case study design (41%). The findings suggest that LMIC researchers rarely conduct KT and face a range of barriers at individual and institutional levels that limit their KT practice, including inadequate KT knowledge and skills, particularly for communicating research and interacting with research end-users, insufficient funding, and inadequate institutional guidelines, structures and incentives promoting KT practice. Furthermore, the evidence-base on effective interventions for enhancing LMIC researchers' KT practice is insufficient and largely of weak quality. CONCLUSIONS More high-quality research on researchers' KT capacity, practice and effective KT capacity strengthening interventions is needed. Study designs that extend beyond case studies and descriptive studies are recommended, including better designed evaluation studies, e.g. use of realist approaches, pragmatic trials, impact evaluations, implementation research and participatory action research.
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Affiliation(s)
- Violet Ibukayo Murunga
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX United Kingdom
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
- African Institute for Development Policy, 6th Floor, Block A, Westcom Point Bldg, Mahiga Mairu Ave Off Waiyaki Way, Westlands, Nairobi, Kenya
| | - Rose Ndakala Oronje
- African Institute for Development Policy, 6th Floor, Block A, Westcom Point Bldg, Mahiga Mairu Ave Off Waiyaki Way, Westlands, Nairobi, Kenya
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
| | - Nadia Tagoe
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Office of Grants and Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Justin Pulford
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
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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.
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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
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Tantivess S, Yothasamut J, Saengsri W. Utilisation of evidence from Thailand's National Health Examination Survey in policy development: finding the weakest link. Health Res Policy Syst 2019; 17:104. [PMID: 31878976 PMCID: PMC6933722 DOI: 10.1186/s12961-019-0512-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Health surveillance and survey data are helpful in evidence-informed policy decisions. This study is part of an evaluation of the National Health Examination Survey (NHES) programme in Thailand. This paper focuses on the obstacles in the translation of survey information into policies at a national level. METHODS In-depth interviews with relevant individuals and representatives of institutes were carried out for the data collection. A total of 26 focal informants included executives and staff of NHES funders, government health agencies, civil society organisations, health experts, NHES programme managers and researchers in the survey network. RESULTS Utilisation of NHES data in policy-making is limited for many reasons. Despite the potential users' positive views on the technical integrity of experts and practitioners involved in the NHES, the strength of employing health examinations in the data collection is not well recognised. Meanwhile, alternative health surveillance platforms that offer similar information on a shorter timescale are preferable in policy monitoring and evaluation. In sum, the lack of governance of Thailand's health surveillance system is identified as a key element hindering the translation of health surveys, including the NHES, into policies. CONCLUSION Despite an adequate capacity to conduct population health surveys, the lack of governance structure and function has resulted in a fragmented health monitoring system. Large and small survey projects are conducted and funded by different institutes without common policy direction and alignment mechanisms for prioritising survey topics, collective planning and capacity-building programmes for survey practitioners and users. Lessons drawn from Thailand's NHES can be helpful for policy-makers in other low- and middle-income countries, as effective governance for evidence generation and utilisation is necessary in all contexts, regardless of income level and available resources.
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Affiliation(s)
- Sripen Tantivess
- Department of Health, Ministry of Public Health, Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Nonthaburi, 11000 Thailand
| | - Jomkwan Yothasamut
- Department of Health, Ministry of Public Health, Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Nonthaburi, 11000 Thailand
| | - Wilailak Saengsri
- Department of Health, Ministry of Public Health, Health Intervention and Technology Assessment Program, 6th Floor, 6th Building, Nonthaburi, 11000 Thailand
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Mirzoev T, Poudel AN, Gissing S, Doan TTD, Ferdous T, Regmi S, Duong MD, Baral S, Chand O, Huque R, Hoang VM, Elsey H. Is evidence-informed urban health planning a myth or reality? Lessons from a qualitative assessment in three Asian cities. Health Policy Plan 2019; 34:773-783. [PMID: 31603206 PMCID: PMC6913712 DOI: 10.1093/heapol/czz097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2019] [Indexed: 11/23/2022] Open
Abstract
City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself. We collected qualitative data between August 2017 and October 2018 using: in-depth interviews with key actors, document review and observations of planning events. Framework approach guided the data analysis. Health is one of competing priorities with multiple plans being produced within each city, using combinations of top-down, bottom-up and fragmented planning approaches. Mostly data from government information systems are used, which were perceived as good quality though often omits the urban poor and migrants. Key common influences on data use include constrained resources and limitations of current planning approaches, alongside data duplication and limited co-ordination within Dhaka's pluralistic system, limited opportunities for data use in Hanoi and inadequate and incomplete data in Pokhara. City governments have the potential to act as a hub for multi-sectoral planning. Our results highlight the tensions this brings, with health receiving less attention than other sector priorities. A key emerging issue is that data on the most marginalized urban poor and migrants are largely unavailable. Feasible improvements to evidence-informed urban health planning include increasing availability and quality of data particularly on the urban poor, aligning different planning processes, introducing clearer mechanisms for data use, working within the current systemic opportunities and enhancing participation of local communities in urban health planning.
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Affiliation(s)
- Tolib Mirzoev
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Ak Narayan Poudel
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Stefanie Gissing
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Thi Thuy Duong Doan
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Tarana Ferdous
- ARK Foundation, C4, House 6, Road 109, Gulshan 2, Dhaka-1212, Bangladesh
| | - Shophika Regmi
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Minh Duc Duong
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Sushil Baral
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Obindra Chand
- HERD International, PO Box 24144, Thapathali Height 11, Kathmandu, Nepal 44600
| | - Rumana Huque
- ARK Foundation, C4, House 6, Road 109, Gulshan 2, Dhaka-1212, Bangladesh
| | - Van Minh Hoang
- Hanoi University of Public Health, 1A Duc Thang, North Tu Liem, Hanoi, Vietnam
| | - Helen Elsey
- University of Leeds, Leeds Institute of Health Sciences, Nuffield Centre for International Health and Development, 10.31b, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
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Craveiro I, Hortale V, Oliveira APCD, Dal Poz M, Portela G, Dussault G. The utilization of research evidence in Health Workforce Policies: the perspectives of Portuguese and Brazilian National Policy-Makers. J Public Health (Oxf) 2019. [PMID: 29538723 DOI: 10.1093/pubmed/fdx148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The production of knowledge on Human Resources for Health (HRH) issues has increased exponentially since 2000 but integration of the research in the policy-making process is often lagging. We looked at how research on HRH contributes or not to inform policy decisions and interventions affecting the health workforce in Portugal and Brazil. Methods We designed a comparative case study of semi-structured interviews with present and past national decision-makers, policy advisors and researchers. Issues explored included the existence of a national HRH policy and the use, or non-use, of research evidence by policy makers and reasons to do so. Interviews were audio recorded, transcribed, anonymized and analysed thematically. Results Policy-makers in Brazil recognize a greater use of evidence in the process of defining HRH policy when compared to Portugal's. But the existence of formal instruments to support policy development is not sufficient to ensure that policies are informed by evidence. Conclusions In both countries the importance of the use of evidence in the formulation of policies was recognized by policy-makers. However, the influence of other factors, such as political pressures from various lobby groups and from the media and the policy short timeframe which requires rapid responses, is predominant.
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Affiliation(s)
- Isabel Craveiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Virginia Hortale
- Escola Nacional de Saúde Pública da Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Paula Cavalcante de Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Mario Dal Poz
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Brazil
| | - Gustavo Portela
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Brazil
| | - Gilles Dussault
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
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Khalid AF, Lavis JN, El-Jardali F, Vanstone M. The governmental health policy-development process for Syrian refugees: an embedded qualitative case studies in Lebanon and Ontario. Confl Health 2019; 13:48. [PMID: 31649748 PMCID: PMC6805559 DOI: 10.1186/s13031-019-0231-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The unprecedented amount of resources dedicated to humanitarian aid has led many stakeholders to demand the use of reliable evidence in humanitarian aid decisions to ensure that desired impacts are achieved at acceptable costs. However, little is known about the factors that influence the use of research evidence in the policy development in humanitarian crises. We examined how research evidence was used to inform two humanitarian policies made in response to the Syrian refugee crisis. METHODS We identified two policies as rich potential case studies to examine the use of evidence in humanitarian aid policy decision-making: Lebanon's 2016 Health Response Strategy and Ontario's 2016 Phase 2: Health System Action Plan, Syrian Refugees. To study each, we used an embedded qualitative case study methodology and recruited senior decision-makers, policy advisors, and healthcare providers who were involved with the development of each policy. We reviewed publicly available documents and media articles that spoke to the factors that influence the process. We used the analytic technique of explanation building to understand the factors that influence the use of research evidence in the policy-development process in crisis zones. RESULTS We interviewed eight informants working in government and six in international agencies in Lebanon, and two informants working in healthcare provider organizations and two in non-governmental organizations in Ontario, for a total of 18 key informants. Based on our interviews and documentary analysis, we identified that there was limited use of research evidence and that four broad categories of factors helped to explain the policy-development process for Syrian refugees - development of health policies without significant chance for derailment from other government bodies (Lebanon) or opposition parties (Ontario) (i.e., facing no veto points), government's engagement with key societal actors to inform the policy-development process, the values underpinning the process, and external factors significantly influencing the policy-development process. CONCLUSIONS This study suggests that use of research evidence in the policy-development process for Syrian refugees was subordinate to key political factors, resulting in limited influence of research evidence in the development of both the Lebanese and Ontarian policy.
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Affiliation(s)
- Ahmad Firas Khalid
- Health Policy PhD Program, McMaster University, Hamilton, ON Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON Canada
| | - John N. Lavis
- Health Policy PhD Program, McMaster University, Hamilton, ON Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON Canada
- McMaster Health Forum, McMaster University, Hamilton, ON Canada
- Department of Political Science, McMaster University, Hamilton, ON Canada
| | - Fadi El-Jardali
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Department of Health Management & Policy, American University of Beirut, Beirut, Lebanon
- Center for Systematic Review in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Meredith Vanstone
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON Canada
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
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Hurd-Kundeti G, Petersen AB, Somsamouth K, Singh PN. Air Pollution in a Nationally Representative Sample: Findings from the National Adult Tobacco Survey of Lao PDR. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3500. [PMID: 31546881 PMCID: PMC6765985 DOI: 10.3390/ijerph16183500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 12/21/2022]
Abstract
In Southeast Asia, household air pollution (HAP) from solid fuel use is the leading cause of disability-adjusted life years (DALYs), a risk which is compounded by exposure to other sources of indoor and outdoor air pollution including secondhand tobacco smoke (SHS). The purpose of this study was to measure the individual and combined prevalence of exposure to household and community sources of air pollution in a national sample of adults in Lao PDR. We analyzed data from the 2012 National Adult Tobacco Survey (NATSL) of Lao PDR-a multi-stage stratified cluster sample of 9706 subjects from 2822 households located in all 17 provinces. Our findings indicate a high prevalence of exposure to household air pollution from cooking fires (78%) and SHS exposure in the home (74.5%). More than a third (32.8%) reported exposure to both inside the home. Exposure to outdoor sources of smoke from cooking, trash, and crop fires was substantial (30.1% to 56.0%). The aggregation of exposures from multiple sources of household air pollution raises the need for initiatives that establish programmatic linkages in the health, environmental, and agricultural sectors to provide a comprehensive strategy to reduce risk factors for respiratory disease in Lao PDR and the region.
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Affiliation(s)
| | - Anne Berit Petersen
- Loma Linda University School of Nursing, 11262 Campus Street, Loma Linda, CA 92350, USA.
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA 92354, USA.
| | | | - Pramil N Singh
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA 92354, USA.
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA 92354, USA.
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Bowsher G, Papamichail A, El Achi N, Ekzayez A, Roberts B, Sullivan R, Patel P. A narrative review of health research capacity strengthening in low and middle-income countries: lessons for conflict-affected areas. Global Health 2019; 15:23. [PMID: 30914049 PMCID: PMC6434620 DOI: 10.1186/s12992-019-0465-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Conducting health research in conflict-affected areas and other complex environments is difficult, yet vital. However, the capacity to undertake such research is often limited and with little translation into practice, particularly in poorer countries. There is therefore a need to strengthen health research capacity in conflict-affected countries and regions.In this narrative review, we draw together evidence from low and middle-income countries to highlight challenges to research capacity strengthening in conflict, as well as examples of good practice. We find that authorship trends in health research indicate global imbalances in research capacity, with implications for the type and priorities of research produced, equity within epistemic communities and the development of sustainable research capacity in low and middle-income countries. Yet, there is little evidence on what constitutes effective health research capacity strengthening in conflict-affected areas. There is more evidence on health research capacity strengthening in general, from which several key enablers emerge: adequate and sustained financing; effective stewardship and equitable research partnerships; mentorship of researchers of all levels; and effective linkages of research to policy and practice.Strengthening health research capacity in conflict-affected areas needs to occur at multiple levels to ensure sustainability and equity. Capacity strengthening interventions need to take into consideration the dynamics of conflict, power dynamics within research collaborations, the potential impact of technology, and the wider political environment in which they take place.
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Affiliation(s)
- Gemma Bowsher
- Conflict and Health Research Group, Department of War Studies, King’s College London, London, UK
| | | | - Nassim El Achi
- R4HC-MENA, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | - Bayard Roberts
- RECAP, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Sullivan
- R4HC-MENA, Institute of Cancer Policy, Conflict and Health Research Group, King’s College London, London, UK
| | - Preeti Patel
- R4HC-MENA, Department of War Studies, King’s College London, London, UK
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Witter S, Anderson I, Annear P, Awosusi A, Bhandari NN, Brikci N, Binachon B, Chanturidze T, Gilbert K, Jensen C, Lievens T, McPake B, Raichowdhury S, Jones A. What, why and how do health systems learn from one another? Insights from eight low- and middle-income country case studies. Health Res Policy Syst 2019; 17:9. [PMID: 30665412 PMCID: PMC6341535 DOI: 10.1186/s12961-018-0410-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All health systems struggle to meet health needs within constrained resources. This is especially true for low-income countries. It is critical that they can learn from wider contexts in order to improve their performance. This article examines policy transfer and evidence use linked to it in low- and middle-income settings. The objective was to inform international investments in improved learning across health systems. METHODS The article uses a comparative case study design, drawing on case studies conducted in Bangladesh, Burkina Faso, Cambodia, Ethiopia, Georgia, Nepal, Rwanda and Solomon Islands. One or two recent health system reforms were selected in each case and 148 key informants were interviewed in total, using a semi-structured tool focused on different stages of the policy cycle. Interviewees were selected for their engagement in the policy process and represented political, technical, development partner, non-governmental, academic and civil society constituencies. Data analysis used a framework approach, allowing for new themes to be developed inductively, focusing initially on each case and then on patterns across cases. RESULTS The selected policies demonstrated a range of influences of externally imposed, co-produced and home-grown solutions on the development of initial policy ideas. Eventual uptake of policy was strongly driven in most settings by local political economic considerations. Policy development post-adoption demonstrated some strong internal review, monitoring and sharing processes but there is a more contested view of the role of evaluation. In many cases, learning was facilitated by direct personal relationships with local development partner staff. While barriers and facilitators to evidence use included supply and demand factors, the most influential facilitators were incentives and capacity to use evidence. CONCLUSIONS These findings emphasise the agency of local actors and the importance of developing national and sub-national institutions for gathering, filtering and sharing evidence. Developing demand for and capacity to use evidence appears more important than augmenting supply of evidence, although specific gaps in supply were identified. The findings also highlight the importance of the local political economy in setting parameters within which evidence is considered and the need for a conceptual framework for health system learning.
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Affiliation(s)
- Sophie Witter
- ReBUILD and Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, EH21 2UU United Kingdom
| | - Ian Anderson
- Crawford School of Public Policy, Australian National University, Canberra, Australia
| | - Peter Annear
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | | | | | - Nouria Brikci
- Oxford Policy Management (OPM), Oxford, United Kingdom
| | | | | | - Katherine Gilbert
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | | | - Tomas Lievens
- Oxford Policy Management (OPM), Oxford, United Kingdom
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | | | - Alex Jones
- Oxford Policy Management (OPM), Oxford, United Kingdom
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Glandon D, Meghani A, Jessani N, Qiu M, Bennett S. Identifying health policy and systems research priorities on multisectoral collaboration for health in low-income and middle-income countries. BMJ Glob Health 2018; 3:e000970. [PMID: 30364329 PMCID: PMC6195136 DOI: 10.1136/bmjgh-2018-000970] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction While efforts to achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) have reinvigorated interest in multisectoral collaborations (MSCs) among the global health and development community, there remains a plethora of questions about how best to conceptualise, plan, implement, evaluate and sustain MSCs. The objective of this paper is to present research priorities on MSC for health from researchers and policymakers around the globe, with an emphasis on low-income and middle-income countries. Methods The authors identified 30 priority research questions from two sources: (1) 38 review articles on MSC for health, and (2) interviews and focus groups with a total of 81 policymakers, including government officials (largely from ministries of health and state/provincial departments of health, but also offices of planning, public service, social development, the prime minister and others), large multilateral or bilateral organisations, and non-governmental organisations. In a third phase, questions were refined and ranked by a diverse group of researchers from around the globe using an online voting platform. Results The top-ranked questions focused predominantly on pragmatic questions, such as how best to structure, implement and sustain MSCs, as well as how to build stakeholder capacity and community partnerships. Despite substantial variation between review articles, policymakers’ reflections and online ranking by researchers, two topics emerged as research priorities for all three: (1) leadership, partnership and governance structures for MSCs; and (2) MSC implementation strategies and mechanisms. The review articles underscored the need for more guidance on appropriate study designs and methods for investigating MSCs, which may be a prerequisite for other identified research priorities. Conclusion These findings could inform efforts within and beyond the health sector to better align research objectives and funding with the evidence needs of policymakers grappling with questions about how best to leverage MSCs to achieve UHC and the SDGs.
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Affiliation(s)
- Douglas Glandon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ankita Meghani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nasreen Jessani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Qiu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Javadi D, Tran N, Ghaffar A. Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research. Health Serv Res 2018; 53 Suppl 2:4024-4033. [PMID: 29797708 PMCID: PMC6149357 DOI: 10.1111/1475-6773.12978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The era of the Sustainable Development Goals calls for multidisciplinary research and intersectoral approaches to addressing health challenges. This presents a unique opportunity for multidisciplinary fields concerned with complex systems. Those working in system-oriented fields such as health policy and systems research (HPSR) and health services research must be forward-thinking in optimizing their collective ability to address these global challenges. OBJECTIVES The objective of this commentary was to share reflections on challenges and strategies in managing the HPSR workforce in order to stimulate dialogue and cross-learning across similar fields. STRATEGIES/FINDINGS The following strategies are discussed here: definitional clarity of expected competencies and coordination across HPS researchers, national investment in HPSR, institutional capacity for coproduction of knowledge across different types of actors, and participatory leadership. CONCLUSIONS Creative approaches in training, financing, developing, and leading the diverse workforce required to strengthen health systems can pave the way for its full-time and part-time members to work together.
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Affiliation(s)
- Dena Javadi
- Alliance for Health Policy and Systems ResearchWorld Health OrganizationGenevaSwitzerland
| | - Nhan Tran
- Alliance for Health Policy and Systems ResearchWorld Health OrganizationGenevaSwitzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems ResearchWorld Health OrganizationGenevaSwitzerland
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Votruba N, Ziemann A, Grant J, Thornicroft G. A systematic review of frameworks for the interrelationships of mental health evidence and policy in low- and middle-income countries. Health Res Policy Syst 2018; 16:85. [PMID: 30134908 PMCID: PMC6106735 DOI: 10.1186/s12961-018-0357-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The interrelationships between research evidence and policy-making are complex. Different theoretical frameworks exist to explain general evidence-policy interactions. One largely unexplored element of these interrelationships is how evidence interrelates with, and influences, policy/political agenda-setting. This review aims to identify the elements and processes of theories, frameworks and models on interrelationships of research evidence and health policy-making, with a focus on actionability and agenda-setting in the context of mental health in low- and middle-income countries (LMICs). METHODS A systematic review of theories was conducted based on the BeHeMOTh search method, using a tested and refined search strategy. Nine electronic databases and other relevant sources were searched for peer-reviewed and grey literature. Two reviewers screened the abstracts, reviewed full-text articles, extracted data and performed quality assessments. Analysis was based on a thematic analysis. The included papers had to present an actionable theoretical framework/model on evidence and policy interrelationships, such as knowledge translation or evidence-based policy, specifically target the agenda-setting process, focus on mental health, be from LMICs and published in English. RESULTS From 236 publications included in the full text analysis, no studies fully complied with our inclusion criteria. Widening the focus by leaving out 'agenda-setting', we included ten studies, four of which had unique conceptual frameworks focusing on mental health and LMICs but not agenda-setting. The four analysed frameworks confirmed research gaps from LMICs and mental health, and a lack of focus on agenda-setting. Frameworks and models from other health and policy areas provide interesting conceptual approaches and lessons with regards to agenda-setting. CONCLUSION Our systematic review identified frameworks on evidence and policy interrelations that differ in their elements and processes. No framework fulfilled all inclusion criteria. Four actionable frameworks are applicable to mental health and LMICs, but none specifically target agenda-setting. We have identified agenda-setting as a research theory gap in the context of mental health knowledge translation in LMICs. Frameworks from other health/policy areas could offer lessons on agenda-setting and new approaches for creating policy impact for mental health and to tackle the translational gap in LMICs.
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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, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
- King’s Improvement Science at the Centre for Implementation Science, NIHR CLAHRC South London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
| | - Alexandra Ziemann
- King’s Improvement Science at the Centre for Implementation Science, NIHR CLAHRC South London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
| | - Jonathan Grant
- Policy Institute at King’s, Virginia Woolf Building, The Strand, King’s College London, London, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, David Goldberg Centre Rm: M0.08 PO Box 28, De Crespigny Park - Denmark Hill, London, SE5 8AF United Kingdom
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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.
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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
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Cleary S, du Toit A, Scott V, Gilson L. Enabling relational leadership in primary healthcare settings: lessons from the DIALHS collaboration. Health Policy Plan 2018; 33:ii65-ii74. [PMID: 30053037 PMCID: PMC6037064 DOI: 10.1093/heapol/czx135] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/13/2022] Open
Abstract
Strong management and leadership competencies have been identified as critical in enhancing health system performance. While the need for strong health system leadership has been raised, an important undertaking for health policy and systems researchers is to generate lessons about how to support leadership development (LD), particularly within the crisis-prone, resource poor contexts that are characteristic of Low- and Middle-Income health systems. As part of the broader DIALHS (District Innovation and Action Learning for Health Systems Development) collaboration, this article reflects on 5 years of action learning and engagement around leadership and LD within primary healthcare (PHC) services. Working in one sub-district in Cape Town, we co-created LD processes with managers from nine PHC facilities and with the six members of the sub-district management team. Within this article, we seek to provide insights into how leadership is currently practiced and to highlight lessons about whether and how our approach to LD enabled a strengthening of leadership within this setting. Findings suggest that the sub-district is located within a hierarchical governance context, with performance monitored through the use of multiple accountability mechanisms including standard operating procedures, facility audits and target setting processes. This context presents an important constraint to the development of a more distributed, relational leadership. While our data suggest that gains in leadership were emerging, our experience is of a system struggling to shift from a hierarchical to a more relational understanding of how to enable improvements in performance, and to implement these changes in practice.
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Affiliation(s)
- Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Alison du Toit
- Self Employed Industrial and Organizational Psychologist and Time to Think coach, Cape Town, South Africa
| | - Vera Scott
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa and
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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George AS, LeFevre AE, Schleiff M, Mancuso A, Sacks E, Sarriot E. Hubris, humility and humanity: expanding evidence approaches for improving and sustaining community health programmes. BMJ Glob Health 2018; 3:e000811. [PMID: 29946489 PMCID: PMC6014224 DOI: 10.1136/bmjgh-2018-000811] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/16/2022] Open
Abstract
Community-based approaches are a critical foundation for many health outcomes, including reproductive, maternal, newborn and child health (RMNCH). Evidence is a vital part of strengthening that foundation, but largely focuses on the technical content of what must be done, rather than on how disparate community actors continuously interpret, implement and adapt interventions in dynamic and varied community health systems. We argue that efforts to strengthen evidence for community programmes must guard against the hubris of relying on a single approach or hierarchy of evidence for the range of research questions that arise when sustaining community programmes at scale. Moving forward we need a broader evidence agenda that better addresses the implementation realities influencing the scale and sustainability of community programmes and the partnerships underpinning them if future gains in community RMNCH are to be realised. This will require humility in understanding communities as social systems, the complexity of the interventions they engage with and the heterogeneity of evidence needs that address the implementation challenges faced. It also entails building common ground across epistemological word views to strengthen the robustness of implementation research by improving the use of conceptual frameworks, addressing uncertainty and fostering collaboration. Given the complexity of scaling up and sustaining community RMNCH, ensuring that evidence translates into action will require the ongoing brokering of relationships to support the human creativity, scepticism and scaffolding that together build layers of evidence, critical thinking and collaborative learning to effect change.
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Affiliation(s)
- Asha S George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Amnesty E LeFevre
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Emma Sacks
- Johns Hopkins University, Baltimore, Maryland, USA.,Maternal and Child Survival Program, USAID, Washington, District of Columbia, USA
| | - Eric Sarriot
- Maternal and Child Survival Program, USAID, Washington, District of Columbia, USA.,Save the Children, Washington, District of Columbia, USA
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Sriram V, Bennett S, Raman VR, Sheikh K. Developing the National Knowledge Platform in India: a policy and institutional analysis. Health Res Policy Syst 2018; 16:13. [PMID: 29463256 PMCID: PMC5819673 DOI: 10.1186/s12961-018-0283-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of strong engagement between researchers and decision-makers in the improvement of health systems is increasingly being recognised in low- and middle-income countries (LMICs). In 2013, in India, the Ministry of Health and Family Welfare began exploring the formation of a National Knowledge Platform (NKP) for guiding and supporting public health and health systems research in the country. The development of the NKP represents an important opportunity to enhance the linkage between policy-makers and researchers from the health policy and systems research field in India. However, the development process also reflects the highly complex reality of policy-making in the Indian health sector. Our objective is to provide insight into the policy-making process for establishing a health sector knowledge platform in India, and in doing so, to analyse the enabling contextual factors, the interests and actions of stakeholders, and the varying institutional arrangements explored in the development of the NKP. METHODS We used a qualitative case study methodology, conducting 16 in-depth interviews and reviewing 42 documents. We utilised General Thematic Analysis to analyse our data. Our research team combined perspectives from both outsiders (independent researchers with no prior or current involvement with the policy) and insiders (researchers involved in the policy-making process). RESULTS We found that enabling contextual factors, and a combination of government and non-governmental stakeholders with core interests in public health and health systems, were able to gain considerable momentum in moving the idea for the NKP forward. However, complex evidence-to-policy processes in the Indian health sector resulted in complications in determining the right institutional arrangement for the platform. Establishing the appropriate balance between legitimacy and independence, as well as frequent changes in institutional leadership, were found to be additional issues that stakeholders contended with in building the NKP. CONCLUSION As interest in platforms linking health sector policy-makers and researchers grows in LMICs, our findings may allow stakeholders to learn from the Indian experience thus far, and to anticipate some of the facilitators and barriers that could potentially arise in establishing such mechanisms.
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Affiliation(s)
- Veena Sriram
- Center for Health and the Social Sciences, 5841 S. Maryland Avenue, MC 1005, Suite M200, Chicago, IL, United States of America.
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Room E8140, 615 N Wolfe St, Baltimore, MD, 21205l, United States of America
| | - V R Raman
- WaterAid, 2nd Floor, New Block, RK Khanna Tennis Stadium, DLTA Complex, 1 Africa Avenue, New Delhi, 110029, India
| | - Kabir Sheikh
- Public Health Foundation of India, Plot No 47, Sector 44, Gurgaon, Haryana, India
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Bennett S, Mahmood SS, Edward A, Tetui M, Ekirapa-Kiracho E. Strengthening scaling up through learning from implementation: comparing experiences from Afghanistan, Bangladesh and Uganda. Health Res Policy Syst 2017; 15:108. [PMID: 29297353 PMCID: PMC5751808 DOI: 10.1186/s12961-017-0270-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Many effective innovations and interventions are never effectively scaled up. Implementation research (IR) has the promise of supporting scale-up through enabling rapid learning about the intervention and its fit with the context in which it is implemented. We integrate conceptual frameworks addressing different dimensions of scaling up (specifically, the attributes of the service or innovation being scaled, the actors involved, the context, and the scale-up strategy) and questions commonly addressed by IR (concerning acceptability, appropriateness, adoption, feasibility, fidelity to original design, implementation costs, coverage and sustainability) to explore how IR can support scale-up. Methods We draw upon three IR studies conducted by Future Health Systems (FHS) in Afghanistan, Bangladesh and Uganda. We reviewed project documents from the period 2011–2016 to identify information related to the dimensions of scaling up. Further, for each country, we developed rich descriptions of how the research teams approached scaling up, and how IR contributed to scale-up. The rich descriptions were checked by FHS research teams. We identified common patterns and differences across the three cases. Results The three cases planned quite different innovations/interventions and had very different types of scale-up strategies. In all three cases, the research teams had extensive prior experience within the study communities, and little explicit attention was paid to contextual factors. All three cases involved complex interactions between the research teams and other stakeholders, among stakeholders, and between stakeholders and the intervention. The IR planned by the research teams focussed primarily on feasibility and effectiveness, but in practice, the research teams also had critical insights into other factors such as sustainability, acceptability, cost-effectiveness and appropriateness. Stakeholder analyses and other project management tools further complemented IR. Conclusions IR can provide significant insights into how best to scale-up a particular intervention. To take advantage of insights from IR, scale-up strategies require flexibility and IR must also be sufficiently flexible to respond to new emerging questions. While commonly used conceptual frameworks for scale-up clearly delineate actors, such as implementers, target communities and the support team, in our experience, IR blurred the links between these groups. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0270-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America.
| | | | - Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
| | - Moses Tetui
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
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The SPARK Tool to prioritise questions for systematic reviews in health policy and systems research: development and initial validation. Health Res Policy Syst 2017; 15:77. [PMID: 28870215 PMCID: PMC5583759 DOI: 10.1186/s12961-017-0242-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 08/16/2017] [Indexed: 12/26/2022] Open
Abstract
Background Groups or institutions funding or conducting systematic reviews in health policy and systems research (HPSR) should prioritise topics according to the needs of policymakers and stakeholders. The aim of this study was to develop and validate a tool to prioritise questions for systematic reviews in HPSR. Methods We developed the tool following a four-step approach consisting of (1) the definition of the purpose and scope of tool, (2) item generation and reduction, (3) testing for content and face validity, (4) and pilot testing of the tool. The research team involved international experts in HPSR, systematic review methodology and tool development, led by the Center for Systematic Reviews on Health Policy and Systems Research (SPARK). We followed an inclusive approach in determining the final selection of items to allow customisation to the user’s needs. Results The purpose of the SPARK tool was to prioritise questions in HPSR in order to address them in systematic reviews. In the item generation and reduction phase, an extensive literature search yielded 40 relevant articles, which were reviewed by the research team to create a preliminary list of 19 candidate items for inclusion in the tool. As part of testing for content and face validity, input from international experts led to the refining, changing, merging and addition of new items, and to organisation of the tool into two modules. Following pilot testing, we finalised the tool, with 22 items organised in two modules – the first module including 13 items to be rated by policymakers and stakeholders, and the second including 9 items to be rated by systematic review teams. Users can customise the tool to their needs, by omitting items that may not be applicable to their settings. We also developed a user manual that provides guidance on how to use the SPARK tool, along with signaling questions. Conclusion We have developed and conducted initial validation of the SPARK tool to prioritise questions for systematic reviews in HPSR, along with a user manual. By aligning systematic review production to policy priorities, the tool will help support evidence-informed policymaking and reduce research waste. We invite others to contribute with additional real-life implementation of the tool. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0242-4) contains supplementary material, which is available to authorized users.
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. Improving maternal and child health policymaking processes in Nigeria: an assessment of policymakers' needs, barriers and facilitators of evidence-informed policymaking. Health Res Policy Syst 2017; 15:48. [PMID: 28722554 PMCID: PMC5516839 DOI: 10.1186/s12961-017-0217-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Nigeria, interest in the evidence-to-policy process is gaining momentum among policymakers involved in maternal, newborn and child health (MNCH). However, numerous gaps exist among policymakers on use of research evidence in policymaking. The objective of this study was to assess the perception of MNCH policymakers regarding their needs and the barriers and facilitators to use of research evidence in policymaking in Nigeria. METHODS The study design was a cross-sectional assessment of perceptions undertaken during a national MNCH stakeholders' engagement event convened in Abuja, Nigeria. A questionnaire designed to assess participants' perceptions was administered in person. Group consultations were also held, which centred on policymakers' evidence-to-policy needs to enhance the use of evidence in policymaking. RESULTS A total of 40 participants completed the questionnaire and participated in the group consultations. According to the respondents, the main barriers to evidence use in MNCH policymaking include inadequate capacity of organisations to conduct policy-relevant research; inadequate budgetary allocation for policy-relevant research; policymakers' indifference to research evidence; poor dissemination of research evidence to policymakers; and lack of interaction fora between researchers and policymakers. The main facilitators of use of research evidence for policymaking in MNCH, as perceived by the respondents, include capacity building for policymakers on use of research evidence in policy formulation; appropriate dissemination of research findings to relevant stakeholders; involving policymakers in research design and execution; and allowing policymakers' needs to drive research. The main ways identified to promote policymakers' use of evidence for policymaking included improving policymakers' skills in information and communication technology, data use, analysis, communication and advocacy. CONCLUSION To improve the use of research evidence in policymaking in Nigeria, there is a need to establish mechanisms that will facilitate the movement from evidence to policy and address the needs identified by policymakers. It is also imperative to improve organisational initiatives that facilitate use of research evidence for policymaking.
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Affiliation(s)
- Chigozie J Uneke
- Knowledge Translation Platform, African Institute for Health Policy & Health Systems, Ebonyi State University, PMB 053, Abakaliki, Nigeria.
| | - Issiaka Sombie
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Namoudou Keita
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Virgil Lokossou
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Ermel Johnson
- West African Health Organisation, 175 avenue Ouezzin Coulibaly, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso
| | - Pierre Ongolo-Zogo
- Hopital Central Yaounde, CDBPH Lawrence VERGNE Building 2nd Floor, Avenue Henry Dunant Messa, Yaoundé, Cameroon
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