Promoting evidence informed policymaking for maternal and child health in Nigeria: lessons from a knowledge translation workshop

Institutional roles, structures, funding and research partnerships towards evidence-informed policy-making: a multisector survey among policy-makers in Nigeria

BACKGROUND

Evidence-informed policy-making aims to ensure that the best and most relevant evidence is systematically generated and used for policy-making. The aim of this study was to assess institutional structures, funding, policy-maker perspectives on researcher-policy-maker interactions and the use of research evidence in policy-making in five states in Nigeria.

METHODS

This was a cross-sectional study carried out among 209 participants from two geopolitical zones in Nigeria. Study participants included programme officers/secretaries, managers/department/facility heads and state coordinators/directors/presidents/chairpersons in various ministries and the National Assembly. A pretested semi-structured self-administered questionnaire on a five-point Likert scale was used to collect information on institutional structures for policy and policy-making in participants' organizations, the use of research evidence in policy and policy-making processes, and the status of funding for policy-relevant research in the participants' organizations. Data were analysed using IBM SPSS version 20 software.

RESULTS

The majority of the respondents were older than 45 years (73.2%), were male (63.2) and had spent 5 years or less (74.6%) in their present position. The majority of the respondents' organizations had a policy in place on research involving all key stakeholders (63.6%), integration of stakeholders' views within the policy on research (58.9%) and a forum to coordinate the setting of research priorities (61.2%). A high mean score of 3.26 was found for the use of routine data generated from within the participants' organizations. Funding for policy-relevant research was captured in the budget (mean = 3.47) but was inadequate (mean = 2.53) and mostly donor-driven (mean = 3.64). Funding approval and release/access processes were also reported to be cumbersome, with mean scores of 3.74 and 3.89, respectively. The results showed that capacity existed among career policy-makers and the Department of Planning, Research and Statistics to advocate for internal funds (mean = 3.55) and to attract external funds such as grants (3.76) for policy-relevant research. Interaction as part of the priority-setting process (mean = 3.01) was the most highly rated form of policy-maker-researcher interaction, while long-term partnerships with researchers (mean = 2.61) had the lower mean score. The agreement that involving policy-makers in the planning and execution of programmes could enhance the evidence-to-policy process had the highest score (mean = 4.40).

CONCLUSION

The study revealed that although institutional structures such as institutional policies, fora and stakeholder engagement existed in the organizations studied, there was suboptimal use of evidence obtained from research initiated by both internal and external researchers. Organizations surveyed had budget lines for research, but this funding was depicted as inadequate. There was suboptimal actual participation of policy-makers in the co-creation, production and dissemination of evidence. The implementation of contextually relevant and sustained mutual institutional policy-maker-researcher engagement approaches is needed to promote evidence-informed policy-making. Thus there is a need for institutional prioritization and commitment to research evidence generation.

Engaging stakeholders to identify gaps and develop strategies to inform evidence use for health policymaking in Nigeria

Introduction

recent efforts to bridge the evidence-policy gap in low-and middle-income countries have seen growing interest from key audiences such as government, civil society, international organizations, private sector players, academia, and media. One of such engagement was a two-day virtual participant-driven conference (the convening) in Nigeria. The aim of the convening was to develop strategies for improving evidence use in health policy. The convening witnessed a participant blend of health policymakers, researchers, political policymakers, philanthropists, global health practitioners, program officers, students, and the media.

Methods

in this study, we analyzed conversations at the convening with the aim to disseminate findings to key stakeholders in Nigeria. The recordings from the convening were transcribed and analyzed inductively to identify emerging themes, which were interpreted, and inferences are drawn.

Results

a total of 630 people attended the convening. Participants joined from 13 countries. Participants identified poor collaboration between researchers and policymakers, poor community involvement in research and policy processes, poor funding for research, and inequalities as key factors inhibiting the use of evidence for policymaking in Nigeria. Strategies proposed to address these challenges include the use of participatory and embedded research methods, leveraging existing systems and networks, advocating for improved funding and ownership for research, and the use of context-sensitive knowledge translation strategies.

Conclusion

overall, better interaction among the various stakeholders will improve the evidence generation, translation, and use in Nigeria. A road map for the dissemination of findings from this conference has been developed for implementation across the strata of the health system.

How (not) to promote sub-national ownership of national initiatives in decentralised health systems: The free maternal and child health programme in Nigeria, 2008-2015

BACKGROUND

Promoting the sub-national ownership of national health initiatives is essential for efforts to achieve national health goals in federal systems where sub-national governments are semi-autonomous. Between 2008 and 2015, Nigerian government implemented a pilot free maternal and child health (MCH) programme in selected states to improve MCH by reducing physical and financial barriers of access to services. This study was conducted to better understand why the programme was neither adopted nor scaled-up by sub-national governments after pilot phase.

METHODS

We conducted a qualitative evaluation of the programme in Imo and Niger States, with data from programme documents, in-depth interviews (45) and focus group discussions (16) at State and community levels. Data was analysed using manual thematic coding approach.

RESULT

Our analysis indicates that the programme design had two mutually dependent goals, which were also in tension with one another: 1. To ensure programme performance, the designers sought to shield its implementation from sub-national government politics and bureaucracy; and 2. To gain the buy-in of the same sub-national government politicians and bureaucrats, the designers sought to demonstrate programme performance. The potential for community advocacy for sub-national adoption and scale-up was not considered in the design. Therefore, limited involvement of sub-national governments in the programme design limited sub-national ownership during implementation. And limited oversight of implementation by sub-national government policymakers limited programme performance.

CONCLUSION

Efforts to promote sub-national ownership of national initiatives in decentralised health systems should prioritise inclusiveness in design, implementation, and oversight, and well-resourced community advocacy to sub-national governments for adoption and scale-up.

Training and mentorship as a tool for building African researchers’ capacity in knowledge translation

As one of the main knowledge producers, researchers can play an important role in contributing to efforts that bridge the gap between knowledge, policy and practice. However, for researchers to play this role, they need knowledge translation (KT) capacities that many typically lack. Furthermore, research has confirmed that little is known on KT training approaches for LMICs researchers and their effectiveness. This paper seeks to contribute to filling this knowledge gap on KT training approaches for LMIC researchers by assessing the effectiveness of a training and mentorship intervention to build African researchers’ KT capacity. We conducted KT training and mentorship for 23 early and mid-career researchers from 20 universities in sub-Saharan Africa. This comprised a 5-day intense residential training workshop, followed by a 6-months mentorship. A pre- and post-training test was used to assess the immediate effect of the workshop. The intermediate effect of the training following a 6-month mentorship was assessed by the number of researchers who completed policy briefs during this period and those who participated in the webinar series conducted during this period. Overall, the aggregate average point change in the self-reported learning between the pre-training and the post-training survey was 1.9, which demonstrated the effectiveness of the training workshop. This was confirmed by a 33.7% increase in the aggregate average percentage of participants that responded correctly to questions assessing topics covered in the training between the pre-training and the post-training survey. During the mentorship period, 19 of the 23 researchers prepared and submitted complete drafts of their policy briefs within two months after the training. Fewer (4) researchers revised and submitted final policy briefs. More than half of the trained researchers participated in the webinars conducted in the first three months of the mentorship, whereas less than half of the researchers participated in the webinars conducted in the last three months. KT training and mentorship can be an effective intervention for addressing researchers’ KT capacity gaps. For sustainability, KT training and mentorship need to be integrated in graduate training programmes in universities so that future LMIC researchers leave training institutions with the KT capacities they need for influencing policy and programme decisions and actions.

Identifying advocacy strategies, challenges and opportunities for increasing domestic health policy and health systems research funding in Nigeria: Perspectives of researchers and policymakers

Introduction

Poor funding for Health Policy and Systems Research (HPSR) is a major constraint to the development, generation and uptake of HPSR evidence in Low and Middle-Income countries. The study assessed the status of HPSR domestic funding and advocacy strategies for improving HPSR funding in Nigeria. It equally explored the knowledge and perception of the domestic funding status of HPSR and the effect of capacity building on the knowledge of domestic funding for HPSR in Nigeria.

Methods

This was a sub-national study involving policymakers and researchers from Enugu and Ebonyi States in Southeast Nigeria who participated in the sub-national Health Systems Global convening for the African region. A before-after study design (workshop) was utilized. Data collection employed semi-structured questionnaires, group and panel discussions. The workshop facilitated knowledge of HPSR, funding processes, and advocacy strategies for increased domestic funding for HPSR. Pre and immediate post-workshop knowledge assessments were done. Data were analyzed using SPSS version 25 and thematic analysis.

Results

Twenty-six participants were involved in the study. Half were females (50.0%) and 46.2% were aged 35–44 years. Policymakers constituted 23.1% of the participants. Domestic funding for HPSR in Nigeria was adjudged to be grossly inadequate. Identified barriers to domestic funding of HPSR included bureaucratic bottlenecks, political and policy transitions, and corruption. Potential opportunities centered on existing policy documents and emerging private sector willingness to fund health research. Multi-stakeholder advocacy coalitions, continuous advocacy and researcher skill-building on advocacy with active private sector involvement were the strategies proffered by the participants. Pre-workshop, understanding of the meaning of HPSR had the highest mean ratings while knowledge of budgeting processes and use of legal action to enable opportunities for budget advocacy for HPSR funding had the lowest mean ratings. Following the capacity-building workshop, all knowledge and understanding parameters markedly improved (percentage increase of 12.5%–71.0%).

Conclusion

This study found that there was paucity of domestic funding for HPSR in Nigeria alongside poor knowledge of budgeting and advocacy strategies among both policymakers and researchers. We recommend the deployment of these identified strategies and wider national and regional stakeholder engagement towards prioritizing and improving domestic funding for HPSR.

How does the West African Health Organisation (WAHO) contribute to the evidence based decision-making and practice during COVID-19 pandemic in ECOWAS region?

The COVID-19 pandemic required policy makers to make urgent decisions to limit the spread of the disease. International and regional health bodies and research institutions have a role in supporting decision makers and health actors in providing accurate and timely research evidence and guidance in decision making and practice. In ECOWAS region, the West African Health Organisation (WAHO) has experience in promoting evidence use decision making and practice as part of its role as Health Policy and Research Organisation. Promoting the use of evidence to influence policy and practice is possible through various approaches including training, the development of guides and policy briefs, the synthesis and sharing of evidence, and the organisation of meetings to share experiences. In the context of the COVID-19 pandemic, WAHO has deployed several approaches to bring the use of evidence to decision-makers and stakeholders to influence policy and practice. To improve practices, WAHO has organized regional training workshops on laboratory diagnostic, surveillance and simulation exercises of outbreak response for key actors, as well as webinars on different aspects of COVID-19 pandemic surveillance, coordination and management. In addition, a synthesis of the most recent evidence and epidemiologic models were developed to enlighten decision makers in selecting and implementation response interventions.

A literature review of knowledge translation and partnership research training programs for health researchers

BACKGROUND

Researchers and policy-makers are increasingly working together with the goal of creating research that is focused on solving real-world problems; however, knowledge translation (KT) activities, and the partnerships they often require, can be challenging. The aim of this review is to determine the extent of the literature on training programs designed to improve researcher competency in KT and to describe existing training methods that may be used by those hoping to build capacity for partnership research.

METHODS

MEDLINE, EMBASE, PsycINFO and CINAHL were searched for peer review articles published between January 2000 and July 2019. Studies were eligible for inclusion in the review if they described the development of, curriculum for, or evaluation of KT and/or partnership research training programs. Data extraction included information on evaluation methods, outcomes and implications as well as the format, aims and themes of each capacity-building program.

RESULTS

The review identified nine published articles that met inclusion criteria - four papers described training events, two papers described participant experiences of specific learning sessions within a larger training course, two papers described part time secondments for KT capacity-building and one paper described a plan for KT training embedded within an existing research training course. All programs were delivered face-to-face, all included practical skills-building opportunities, and all employed multiple learning modalities such as seminars and small group discussions. Evaluation of the training programs was primarily conducted through qualitative interviews or feedback surveys.

CONCLUSION

To date, few KT training initiatives have been described in the literature and none of these have been rigorously evaluated. The present review offers insights into the planning, development and participant experiences associated with the small number of training initiatives that have been described. There is insufficient evidence available at present to identify the most effective models for training researchers in KT and partnership skills.