This paper provides a systematic overview of the literature on knowledge translation strategies employed by health system researchers and policy-makers in African countries. An evidence mapping methodology was adapted from the social and health sciences literature and used to generate a schema of knowledge translation strategies, outcomes, facilitators and barriers.The knowledge translation literature in African countries is found to be widely distributed, problematically diverse and growing. Significant disparities exist between reports on knowledge translation in different countries, and there are many settings without published evidence of local knowledge translation characteristics. Commonly reported knowledge translation strategies include policy briefs, capacity-building workshops and policy dialogues. Barriers affecting researchers and policy-makers include insufficient skills and capacity to conduct knowledge translation activities, time constraints and a lack of resources. Availability of quality locally relevant research was the most reported facilitator. Limited knowledge translation outcomes reflect persisting difficulties in outcome identification and reporting.
Monitoring equity and research policy
A goal of the health management information system (HMIS) is to provide reliable, comprehensive information about the health system to health managers, to enable them take decisions that will improve the services provided to the consumers. Whereas HMIS quality concerns like the accuracy, completeness and timeliness of reports have been more commonly assessed and reported about in a number of studies, relatively less documentation is found on the actual utilisation of the information generated from HMIS reports. Yet, the HMIS is not an end in itself but just a tool to inform managers and enable them take informed and timely decisions. This study assessed the utilisation of HMIS data for decision making at the grassroots level in Bufumbira East Health Sub-District (HSD) of Kisoro District. It was found that HMIS data were not used for decision making at the point of collection and that the HMIS was dogged by many problems like few dedicated staff. The staff lacked sensitization on the HMIS and were not trained in completing the reports and data analysis. Lower level units submitted their data directly to the district bypassing the HSD. The HMIS was not planned for and lacked funding and stationery. HMIS functioning was not a subject for support supervision and there was only verbal feedback from the district level. It was recommended that the normal flow of HMIS data through the HSD level be re-established and that support supervision on the HMIS be instituted. Planning for the improvement of the system would ultimately lead to its utilisation.
This paper describes how the SUPPORT collaboration developed a short summary format for presenting the results of systematic reviews to policy-makers in low- and middle-income countries (LMICs). SUPPORT carried out 21 user tests in six countries – including South Africa and Uganda – to explore users’ experiences with the summary format. They found that policy makers liked a graded entry format (i.e. short summary with key messages up front). Policy makers particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally relevant detail in the original review. The authors conclude that presenting evidence from systematic reviews to policy makers in LMICs in the form of short summaries can render the information easier to assimilate and more useful, but summaries must be clear and easy to read or scan quickly. Policy makers should also be sensitised to the nature of the information provided by systematic reviews and its relevance for policy decisions.
In this article, the author considers the disadvantages of over-reliance on evidence-based medicine. He argues that a publishing bias exists against studies with negative or inconclusive findings, which skews overall results. Sometimes, there is a significant finding in favour of a trial drug if the study was funded by for-profit organisations, which could not be explained by methodology, statistical analysis or type of study. He also points to a growing trend in industry-sponsored studies: the initial draft is compiled by company employees, before academically affiliated authors, often regarded as key opinion leaders, are sourced as principal or second authors without having substantially contributed to the study. And with increasing levels of data fabrication, the author warns against abandoning clinical experience and judgement in favour of evidence-based approaches.
Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and explains the use of evidence in these contexts. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organisation and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. Both Mozambique and Kenya exhibit Problem-Solving research utilisation with different outcomes.
According to this paper, African research institutions have developed and demonstrated a great capacity to undertake clinical trials in accordance to the International Conference on Harmonisation-Good Clinical Practice (ICH-GCP) standards in the last decade, particularly in the field of malaria vaccines and anti-malarial drugs. This capacity is a result of networking among African scientists in collaboration with other partners, traversing both clinical trials and malaria control programmes as part of the Global Malaria Action Plan (GMAP). GMAP outlined and support global strategies toward the elimination and eradication of malaria in many areas, translating in reduction in public health burden, especially for African children. In the sub-Saharan region the capacity to undertake more clinical trials remains small in comparison to the actual need, the authors point out, but they argue that sustainability of Africa’s already developed capacity is crucial for the evaluation of different interventions and diagnostic tools/strategies for other diseases like TB, HIV, neglected tropical diseases and non-communicable diseases. They call for innovative mechanisms to promote the sustainability and expansion of clinical trial capacity in sub-Saharan Africa.
Expert consultations were held at the Harvard School of Public Health, Boston, from 8 to 9 May 2013, in order to develop operational strategies that can be used by governments and other stakeholders to embed research into decision-making processes, a key recommendation of the WHO Strategy on Health Policy and Systems Research (included in this newsletter). It was agreed that a framework needs to be developed, to guide the embeddedness of research into decision-making. This framework should be based on the needs, the capacities and the available funding situation of each country. There was also agreement on the need to interact with existing initiatives, such as EVIPNet and make use of existing tools and platforms as starting blocks for new and innovative frameworks.
The Global Health Security Index predicted that the world in general was not well prepared for the pandemic but did not predict individual country preparedness. Ten factors seem to have contributed to the index failing to predict country responses, including limited consideration of globalisation, geography, and global governance, bias to high income countries, failure to assess health system capacity, overlooking the role of political leadership and ideology, overlooking the importance of context, the limits of national wealth as a predictive factor, no examination of inequalities within countries, the importance of social security and the provisions to protect people from losing their jobs and homes. The authors note that civil society capacity was not assessed, and the gap between capacity and its application was also not assessed. The authors argue that future assessments of pandemic preparedness need to take these 10 factors into account by adopting a systems approach which enables a focus on critical system components
The complex evidence-policy interface in low and middle income country settings is receiving increasing attention. Future Health Systems (FHS): Innovations for Equity, is a research consortium conducting health systems explorations in six Asian and African countries: Bangladesh, India, China, Afghanistan, Uganda, and Nigeria. Three key activities were undertaken during the initial phase of this five-year project: key considerations in strengthening evidence-policy linkages in health system research were developed through workshops and electronic communications; four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement; and utility of the approach for setting research priorities in health policy and systems research was reflected upon. Developmental consideration with four dimensions a poverty, vulnerabilities, capabilities, and health shocks a provides an entry point in examining research-policy interfaces in the six settings. Research plans focused upon on the ground realities in specific countries strengthens the interface. Focusing on research prioritised by decision-makers, within a politicised health arena, enhances chances of research influencing action. Early and continued engagement of multiple stakeholders, from local to national levels, is conducive to enhanced communication at the interface.
Health systems research is increasingly being funded by international donors and conducted in low and middle-income countries but little conceptual work has been done to clarify the field’s ethical dimensions. This is problematic because health systems research has distinctive features relative to clinical research that may restrict the applicability of existing ethical guidance. This webinar asks: What makes health systems research different from clinical research? What are the key ethical issues in externally-funded health systems research in low and middle-income countries? And do they deserve special consideration in, for example, project design and ethics review? The moderated discussion covers the features of health systems research and examples of what it entails in practice, distinctive ethical issues that arise during the conduct of such research and challenges faced by ethics review committees when considering health systems research projects.