Does improving the skills of researchers and decision-makers in health policy and systems research lead to enhanced evidence-based decision making in Nigeria?—A short term evaluation

BackgroundGetting evidence from Health Policy and Systems Research (HPSR) into policy and practice for effective control of neglected tropical diseases (NTDs) is essential for providing better service delivery because evidence-informed decision-making improves the effectiveness of a health system and health outcomes. The paper provides new knowledge on the policy-/decision-makers’ level of knowledge, capacity to use, and how evidence from HPSR has been used in decision-making for the control of endemic tropical diseases (ETDs), especially the NTDs and malaria in Nigeria.MethodsA cross-sectional qualitative study of decision-makers was undertaken in Anambra and Enugu states, southeast Nigeria. Data was collected through in-depth interviews (n=22) of purposively selected decision-makers to assess how HPSR evidence is translated into policy and practice for controlling ETDs. The respondents were selected based on their job description, roles, and involvement in the control of ETDs. Data were analyzed using the thematic content approach.ResultsThere is a considerable level of knowledge on HPSR and its relationship with evidence-informed policy- and decision-making towards control of ETDs and health system strengthening. Organizational capacity to use HPSR evidence in decision-making was found to be weak due to various reasons such as no embedded structure for translating research evidence to policy and practice, lack of decision-making autonomy by individuals, and politically driven decisions. Few respondents have either ever used or are currently using HPRS evidence for developing/reviewing and implementing strategies for ETDs programs. Majority of the respondents reported that their main source of evidence was routine data from health information management system, which they found useful due to its representativeness and completeness. Main enabler for using HPSR evidence for decision-making is existing collaborations between researchers and policy-/decision-makers.ConclusionThere is a high level of awareness about evidence from HPSR and the usefulness of such evidence in decision-making. However, this awareness does not translate to optimal use of evidence for decision-making due to weak organizational capacity and other constraints. There is the need to invest in capacity-building activities to develop a critical mass of users of evidence (policy-/decision-makers) to facilitate enhanced uptake of high-quality evidence into policy decisions for better control of ETDs.

Download Full-text

Building the capacity of users and producers of evidence in health policy and systems research for better control of endemic diseases in Nigeria: a situational analysis

Globalization and Health ◽

10.1186/s12992-019-0530-6 ◽

2019 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Obinna Onwujekwe ◽

Enyi Etiaba ◽

Chinyere Mbachu ◽

Uchenna Ezenwaka ◽

Ifeanyi Chikezie ◽

...

Keyword(s):

Decision Making ◽

Health Policy ◽

Health System ◽

Policy Decision ◽

Situational Analysis ◽

Endemic Diseases ◽

Systems Research ◽

The Government ◽

High Level ◽

Health Policy And Systems

Abstract Background There is a current need to build the capacity of Health Policy and Systems Research + Analysis (HPSR+A) in low and middle-income countries (LMICs) as this enhances the processes of decision-making at all levels of the health system. This paper provides information on the HPSR+A knowledge and practice among producers and users of evidence in priority setting for HPSR+A regarding control of endemic diseases in two states in Nigeria. It also highlights the HPSR+A capacity building needs and interventions that will lead to increased HPSR+A and use for actual policy and decision making by the government and other policy actors. Methods Data was collected from 96 purposively selected respondents who are either researchers/ academia (producers of evidence) and policy/decision-makers, programme/project managers (users of evidence) in Enugu and Anambra states, southeast Nigeria. A pre-tested questionnaire was the data collection tool. Analysis was by univariate and bivariate analyses. Results The knowledge on HPSR+A was moderate and many respondents understood the importance of evidence-based decision making. Majority of researcher stated their preferred channel of dissemination of research finding to be journal publication. The mean percentage of using HPSR evidence for programme design & implementation of endemic disease among users of evidence was poor (18.8%) in both states. There is a high level of awareness of the use of evidence to inform policy across the two states and some of the respondents have used some evidence in their work. Conclusion The high level of awareness of the use of HPSR+A evidence for decision making did not translate to the significant actual use of evidence for policy making. The major reasons bordered on lack of autonomy in decision making. Hence, the existing yawning gap in use of evidence has to be bridged for a strengthening of the health system with evidence.

Download Full-text

A Framework for Evidence-Based Decision Making in Large-Scale Food Fortification Programs

Current Developments in Nutrition ◽

10.1093/cdn/nzaa067_029 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1802-1802

Author(s):

Valerie Friesen ◽

Mduduzi Mbuya ◽

Lynnette Neufeld ◽

Frank T Weiringa

Keyword(s):

Decision Making ◽

Large Scale ◽

Program Design ◽

Decision Makers ◽

Evidence Based ◽

Food Fortification ◽

Impact Pathway ◽

Gates Foundation ◽

The Impact ◽

Evidence Based Decision Making

Abstract Objectives The use of evidence on program performance and potential for impact for decision making in food fortification programs is limited and often done in isolation from other micronutrient interventions. We present a framework for fortification stakeholders responsible for making program recommendations and decisions to facilitate and document evidence-based decision making. Methods First, we reviewed the literature to define the key decision makers and decisions necessary for effective fortification program design and delivery, informed by a clear impact pathway. Then we classified decisions by domain, identified data sources and criteria for their assessment, and adapted the GRADE Evidence to Decision framework to summarize the results. Finally, we considered how the framework would apply to different country programs to test its utility. Results Policymakers, particularly government ministries, and the food producers themselves are the most important decision makers in a fortification program, while technical support agencies, donor agencies, and the research community play important roles in translating data and evidence into contextualized recommendations that meet the needs of different decision makers. The main fortification decision types were classified into five domains across the impact pathway: 1) program design (need, food vehicle(s)); 2) program delivery (compliance, quality, coverage); 3) program impact (nutrient intake and status); 4) overlapping micronutrient interventions and/or under-served populations; and 5) decisions to continue or stop programs. Important criteria for the assessment of each decision type included priority, benefits/risks, equity, acceptability, and feasibility among others. Country examples illustrated the importance of coordinating decision-making in the context of overlapping micronutrient interventions to ensure continued safety and impact over time. Conclusions This framework is a practical tool to enable evidence-based decision making by fortification stakeholders. Using evidence in a systematic and transparent way can enable more effective program design, delivery, and ultimately health impacts. Funding Sources Bill & Melinda Gates Foundation.

Download Full-text

Evidence-Based Decision Making for Nutrition Policy and Programme Formulation in Ethiopia: A Qualitative Study Exploring Barriers and Facilitators

Current Developments in Nutrition ◽

10.1093/cdn/nzaa060_004 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1366-1366

Author(s):

Solomon Eshetu Hailu ◽

Tesfaye Bekele ◽

Namukolo Covic ◽

Desalegn Kuche ◽

Beza Teshome ◽

...

Keyword(s):

Decision Making ◽

Nutrition Policy ◽

Decision Makers ◽

Evidence Based ◽

Policy Makers ◽

Program Coordinators ◽

Nutrition Research ◽

Evidence Based Decision Making ◽

Evidence Dissemination ◽

Program Decisions

Abstract Objectives Despite much nutrition research conducted in Ethiopia, none has described existing opportunities for synergy or possible missed opportunities to use research to inform policy and program decisions to foster accelerated progress. The study aimed to describe prevailing processes on evidence use in formulating nutrition policy and program decisions and identify potential barriers and opportunities for evidence-based decision-making for nutrition for Ethiopia's context. Methods In 2017, 29 purposively selected key informants (KIs) were interviewed. They were identified using a consultative stakeholder mapping workshop and represented National Nutrition Program coordinators, key actors in government sectors, program coordinators from selected local and international NGOs, local and international universities and research institutes involved in nutrition research and key actors in policy decision-making. A framework analysis including identifying themes, coding, indexing, charting, mapping and interpretation was used. A validation workshop discussed findings and added perspectives to interpretation. Results The KIs perceived that demand for evidence from the Ethiopian government had been increasing over time. Majority referred to poor research quality as a barrier for using research in decision-making processes. Other challenges identified included limited cross-linkage, coordination gaps between researchers and decision makers, and inadequate translation of research evidence into meaningful information for policy makers. Availability of different forums, research dissemination conferences and suitable institutional structures that enable research and evidence dissemination were considered to be opportunities that should be leveraged to inform policy making. Conclusions The quality of research, and of collaborative engagement between those who produce evidence and decision makers who formulate policies need to be strengthened. Regular evidence dissemination events and publication of action oriented easy to read briefs could increase use of evidence among nutrition policy makers. Funding Sources Ethiopian Public Health Institute and Evidence-informed Decision-making in Health and Nutrition Network.

Download Full-text

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

Implementation Science ◽

10.1186/1748-5908-5-39 ◽

2010 ◽

Vol 5 (1) ◽

Cited By ~ 36

Author(s):

Deirdre McCaughey ◽

Nealia S Bruning

Keyword(s):

Decision Making ◽

Health Policy ◽

Evidence Based ◽

Policy Makers ◽

Evidence Based Decision Making

Download Full-text

Evidence-Based Decision-Making 8: A Primer on Health Policy for Researchers

Methods in Molecular Biology - Clinical Epidemiology ◽

10.1007/978-1-0716-1138-8_28 ◽

2021 ◽

pp. 517-536

Author(s):

Victor Maddalena ◽

Maisam Najafizada

Keyword(s):

Decision Making ◽

Health Policy ◽

Evidence Based ◽

Evidence Based Decision Making

Download Full-text

Local ownership of health policy and systems research in low-income and middle-income countries: a missing element in the uptake debate

BMJ Global Health ◽

10.1136/bmjgh-2019-001523 ◽

2019 ◽

Vol 4 (4) ◽

pp. e001523 ◽

Cited By ~ 2

Author(s):

Kudakwashe Paul Vanyoro ◽

Kate Hawkins ◽

Matthew Greenall ◽

Helen Parry ◽

Lynda Keeru

Keyword(s):

Decision Making ◽

Health Policy ◽

Health Systems ◽

Low Income ◽

Middle Income ◽

Middle Income Countries ◽

Country Level ◽

Systems Research ◽

Research Findings ◽

Health Policy And Systems

Health policy and systems researchers (HPSRs) in low-income and middle-income countries (LMICs) aim to influence health systems planning, costing, policy and implementation. Yet, there is still much that we do not know about the types of health systems evidence that are most compelling and impactful to policymakers and community groups, the factors that facilitate the research to decision-making process and the real-world challenges faced when translating research findings into practice in different contexts. Drawing on an analysis of HPSR from LMICs presented at the Fifth Global Symposium on Health Systems Research (HSR 2018), we argue that while there is a recognition in policy studies more broadly about the role of co-production, collective ownership and the value of localised HPSR in the evidence-to-policy discussion, ‘ownership’ of research at country level is a research uptake catalyst that needs to be further emphasised, particularly in the HPSR context. We consider embedded research, participatory or community-initiated research and emergent/responsive research processes, all of which are ‘owned’ by policymakers, healthcare practitioners/managers or community members. We embrace the view that ownership of HPSR by people directly affected by health problems connects research and decision-making in a tangible way, creating pathways to impact.

Download Full-text

"Research ends with publication": A qualitative study on the use of health policy and systems research in Ethiopia

10.21203/rs.3.rs-1095797/v1 ◽

2021 ◽

Author(s):

Zewdie Birhanu ◽

Sudhakar Morankar ◽

Gelila Abraham ◽

Zubin Shroff

Keyword(s):

Decision Making ◽

Health Policy ◽

Qualitative Study ◽

Research Evidence ◽

Policy Decision ◽

Advisory Council ◽

Systems Research ◽

Research Institutes ◽

Policy Decision Making ◽

Health Policy And Systems

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.

Download Full-text