Demand-Driven Generation, Uptake and Utilization of Health Research Nelson K. Sewankambo Makerere University College of Health sciences Chair IDRC - IRCI

Overview The problem Challenges Addressing challenges in linking research to policy and practice Innovators at the country level in linking research to policy and practice Monitoring and evaluation of KT Platforms Thinking about the future 2

Good Health at Low Cost (GHLC) 1985: Rockefeller influential Report GHLC Costa Rica, Sri Lanka, China, India State of Kerala At significantly lower levels of income they achieved health levels comparable to wealthier countries To mark the 25 th anniversary of original GHLC, the London School of Hygiene &TM returned to the original question. Assessed the health systems of 5 countries that have achieved better health outcomes than their neighbors with similar incomes: Bangladesh, Ethiopia, Kyrgyzstan, Tamil India, Thailand

Just too much of it and not always what you need Multiple parallel demands Information goes up and never comes down Key consumers of information not being served: –Policy makers –Health Managers –Service Providers –General public The Changing Global Environment Drowning in data!

The Problem- Know-Do Gap

The Changing Global Environment Bridging the know-do gap…

The Value of Health Research “There is mounting quantitative proof of the benefits of research health, society and the economy”

Why Research is not used? The divide between researchers and policy makers Research results are not presented in a user friendly form (comprehensible and credible) for the potential users. Results are not available in a timely manner Failure or inadequate dissemination (to whom and through which channels?) What criteria are used to adopt new intervention (resulting from research). How should an intervention be evaluated during implementation

Challenges in Linking Research to Policy 1.Research competes with many other factors in the policymaking process and research isn’t valued as an information input [General climate for research use] 2.Research evidence isn’t relevant [Production] 3.Research evidence isn’t easy to use [Translation] 13

Challenges Many proven interventions (cheap and cost effective) remain inaccessible. - And do not reach those who need them most. - Are hardly used at all - Widespread implementation may take years or decades

Many Efforts to Bridge the Know-Do-Gap Research-policy initiative Supporting use of research evidence or policy in African health systems Evidence-informed Policy Networks (EVIPNet) Support tools for evidence-informed health policy making The translating Research into Action (TRAction) Knowledge Translation Network (KTNet) IDRC call for Health Policy and Research Organization (HPRO)

Tested Approaches by SURE Project Evidence briefs (policy briefs) Policy dialogues Rapid Response mechanism National Clearing House

SURE Project Addressing Challenge: Evidence Not Easy to Use –Research evidence isn’t communicated effectively (i.e., policymakers and stakeholders hear noise instead of music) One option (among many) for addressing this: -Identify a high-priority issue, identify data and systematic reviews that address different facets of the issue (problem, options and implementation considerations), prepare an ‘evidence brief’ to summarize the findings (all EVIPNet teams) 17

SURE Project Addressing Challenges Research evidence isn’t available when policymakers and stakeholders need it and in a form that they can use Three options (among many) for addressing challenge Promote the use of ‘one-stop shops’ for synthesized research evidence -e.g., Cochrane Library for ‘my health’ -e.g., Health Evidence for ‘our health’ -e.g., Health Systems Evidence for ‘our system’ –Develop a rapid-response mechanism –Provide training (and tools) for policymakers and stakeholders about how to find and use research evidence 18

19 Addressing the Challenge

SURE Project Addressing Challenge –Policymakers lack forums where challenges can be discussed with stakeholders and researchers One option (among many) for addressing challenge –Plan deliberative dialogues at which pre-circulated evidence briefs serve as the starting point for off-the-record deliberations involving policymakers, stakeholders (including citizens), researchers and others 20

Innovators at the Country Level in Linking Research to Policy (EVIPNets) EVIPNet Africa - Participating jurisdictions include Burkina-Faso, Cameroon, Central African Republic, Ethiopia, Mozambique, Niger, and Zambia - Inaugural meeting held in Brazzaville, Congo from March 2006 EVIPNet Asia EVIPNet Americas - Participating jurisdictions include Bolivia, Brazil, Chile, Columbia, Costa Rico, Mexico (both national and El Paso), Paraguay, Puerto Rico, and Trinidad and Tobago - Inaugural meeting held in Washington, DC from 2-3 July

Innovators at the Country Level in Linking Research to Policy 22

Innovators at the Country Level in Linking Research to Policy 23

Bridging the Worlds of Research, Practice and Policy in Kenya, Tanzania and Uganda: The Regional East African Community Health (REACH) Policy Initiative

Innovators at the Country Level in Linking Research to Policy (REACH-P) Regional East Africa Community Health (REACH) – Policy initiative - Participating jurisdictions include Kenya, Tanzania, and Uganda (and now Burundi and Rwanda) - Inaugural meeting held at Duluti Lake in Country consultations held in late 2004/early Sounding board held in Nairobi in Donors’ meeting held in Arusha on October 2006 (followed by official launch) - Workshop on priority-setting, policy briefs and deliberative dialogues held in Arusha on June 25

Sounding Board Meeting Nairobi, 7-8 March 2005

Capacity Building: Research by IDRC International Research Chair-Supported African Students Innovations and their influence on policymaking -Rapid-response services (Rhona Mijumbi and André Zida) -One-stop shops / clearinghouses (Boniface Mutatina) -Evidence discourse (Pierre Ongolo-Zogo ) -Student research and its support to policy and practice (Ekwaro Obuku) -Below are selected examples to discuss in more detail 27

Allen Nsangi and Daniel Semakula: Supporting informed Healthcare Choices in Low- income Countries (SIHCLIC) To develop and evaluate tools/resources that can be used by the public to appraise healthcare information, particularly that pertaining to claims of effects of treatments, and in so-doing empower the public to make appropriate well-informed healthcare choices. Study sites-Uganda, Kenya, Rwanda

Funded by the Netherlands Organisation for Scientific Research (NWO) Hosted by Makerere University School of Public Health Includes eight research coalitions across eight sub-Saharan African countries; Senegal, Ghana, Ethiopia, DR Congo, Uganda, Rwanda, Burundi and South Africa Research Areas: Health financing, maternal and child health, Health Systems strengthening, Service delivery systems (laboratories), community engagement.

Objectives of KTNET Africa 1. Build KT capacity among the eight coalitions and relevant stakeholders 2. Support KT activities across the network by providing technical support and competitive/collaborative grants 3. Host and coordinate platforms for shared learning 4. Evaluate the KT effects across the network so as to identify and document best practices. 30

Gaps and Reflections About the future The Potential Role of Journalists and the Mass Media Monitoring and evaluations of progress Increase efforts in research responding to policy makers and practitioners’ needs Strengthen implementation science 31