1. Strengthening the research to policy and practice interface: Exploring strategies HEARD Case Study: The Reviewing ‘ Emergencies ’ Swaziland Report May 2009 Fiona Henry and Alan Whiteside HEARD www.heard.org.za

2. Rationale for the Report Worst epidemic in the world.. but still, inertia Background of work –1994 Socio-economic impact; –2000 ‘Dead people’ newspaper survey; –2003 Drivers of the epidemic report; –2006 Impacts study Deteriorating situation clear from many seperate studies - try to create a holitic picture (using socio-economic indicators)

3. The Report Collected as much information as possible –Data from past & projections and models Big Picture –Bringing many datasets together, –Together they paint a picture of catastrophe Had comparison countries (for advocacy) –Malawi and Zambia (poorer and lower prevalence)

4. Increasing Antenatal Clinic HIV Prevalence

5. Analysis of Indicators DEMOGRAPHICS HEALTH ORPHANS AND VULNERABLE CHILDREN ECONOMIC GROWTH AGRICULTURE

6. Demographics: Life Expectancy

7. The Report’s Conclusion Overall picture is one of a society in distress There are insufficient resources to respond It is a ‘new’ kind of disaster - a long-wave emergency

8. Assessing the Impact of the ‘Reviewing ‘Emergencies’ for Swaziland’. In mid 2008, HEARD commissioned an assessment of the impact of the report They knew the report had had an influence, and were keen to understand why and how

9. Assessment Objectives The specific objectives of the assessment were: –To document the creation and dissemination of the report; –To identify and explain the impact of the report; –To identify any barriers and/or limitations to the impact of the report; –To draw any lessons that might be applicable to maximizing the impact of future research.

10. Methodology We considered ‘impact’ to be three dimensional: –Initial impact/ what stood out, or was most striking –Long-term impact/ influencing thinking and decision making –Potential impact/ those things that, given time and further advocacy could influence thinking and decisions. Impact was analysed within 5 key sectors: 1) Donors, 2) Government, 3) Civil Society and NGOs, 4) the Academic Debate, and 5) in the Media

11. Methodology continued… A qualitative approach was taken to ‘measuring’ impact, since changes in thinking and decision making are difficult to quantify Anecdotal evidence and substantive examples were key to supporting how people believed the report had impacted them Content was compiled in 3 ways: – A desk review – Detailed interviews – A questionnaire

12. A Brief Summary of Findings Increased awareness was achieved. The report was described as a “catalyst for new engagement in Swaziland.” –E.g. The World Bank sent a fact finding mission and develop an Interim Strategy Note (ISN) to consider future support for the country. ‘Reviewing ‘Emergencies’’ aimed to influence debate on the classification of low-middle income countries – this has proved difficult. –The World Bank has recognised that the status masks severe poverty and inequality. However, it is not yet clear if this will result in a real change to the current system.

13. ...Continued The paper has had some success in opening the debate on HIV/AIDS as a long-wave emergency. - E.g. supporting statements from the International Federation of Red Cross and Red Crescent Societies (IFRC) in their 2008 ‘World Disasters Report.’ …“Is HIV also an ‘emergency’ in the contexts where it is a disaster? And does it matter even if defined as such? The short answers are ‘yes’ and ‘yes.’” Much potential in this area for impact, contingent on further research and advocacy. We ask how important publication in peer review journals will be.

14. Limitations Five limitations to the paper’s impact were; 1. The term ‘emergency’ 2. The role of the Swazi Government? 3. Time 4. International insignificance 5. ‘Having to change’ & the entrenchment of thinking

15. Lessons for Future Research A clear message, supported graphically, is crucially important for communication; The demographic implications of AIDS are a powerful way to communicate the severity of the epidemic; Collecting existing data together to tell one clear, holistic story is powerful;

16. Lessons continued… Dissemination is crucial, key actors should be targeted Sustained advocacy is vital in maintaining momentum Identifying a problem is valuable, but must be accompanied by a clear agenda; It is important to consider the implications of terminology.

17. In Conclusion... ‘Reviewing ‘Emergencies’ for Swaziland’ helped re-engage the international community with the plight of the Swazi people. It also fueled a wider debate on the need for urgency combined with long-term responses to the HIV and AIDS epidemic. However, the challenge now is to achieve real change as a result. ……… Thank you.