By Ankita Meghani (PhD student in the Health Systems Program in the Department of International Health at Johns Hopkins University) and Nasreen Jessani (Johns Hopkins School of Public Health, USA and Stellenbosch University, South Africa. Currently Vice-Chair of the Evidence to Action Thematic Working Group for Health Systems Global)
“…there is still work to be done on understanding local learning systems, which must include multiple stakeholders such as frontline workers, the media, civil society and the public at large.” Liverpool Statement – Fifth Global Symposium on Health Systems Research (HSR2018) (October 2018)
Already aligned with this belief, the Evidence into Action Thematic Working Group (TWG) of Health Systems Global (HSG) convened a panel on October 10, 2018 at HSR2018 with this very intention. Titled “Bringing the Pieces Together: Multiple Perspectives on Translating Evidence into Action”, the multi-stakeholder interactive session showcased perspectives of various stakeholders, particularly those often neglected but powerful (e.g. civil society and media). The session challenged panelists as well as the audience to think about if, how and when they use evidence and knowledge to develop and influence policy.
Here is a snapshot of what we learned summarized in four key takeaways:
(1) Locally available, reliable, and good quality data (and evidence) lie at the cornerstone of developing effective solutions and are critical for multisectoral engagements
Panelists agreed that good evidence can give policymakers the “political currency” to facilitate policy dialogues and discussion. However, both policymakers and academics agreed that, for this to take place, routinely available good quality data is essential. They highlighted the importance of improving the performance of routine health information systems (HIS) and concurrently strengthening public health surveillance systems in several LMICs where they are currently very weak. A strong HIS providing good quality, timely and relevant data would not only facilitate evidence-based decision-making in the health sector but may ultimately contribute towards planning and executing multisectoral activities. Panelists recognized that harnessing local data across sectors and breaking down data silos that exist by sector is critical for advancing multisectoral actions on health. While work remains to be done, collaboration between academics/researchers and the government was viewed as one way of using data to better understand health problems and inform appropriate health program and policy decisions in a country.
(2) Standing relationships among different actors (e.g., policymakers, researchers, the media, and civil society) can enhance policy discussions and bridge barriers affecting the use of evidence in policy and practice
Cultivating long-standing partnerships between policymakers and researchers – as opposed to having short-lived interactions – was recognized as key for enhancing the use of evidence in decision-making. Panelists reflected that connections between policy and research communities often only last as long as the grant or contract. Instead of having short-lived interactions, Mr. Elijah Ogunsola underscored that this steady connection between policymakers and researchers “should be like an institution“ where one does not seek out the other to address a grant conditionality.
Efforts to establish standing partnerships are already underway. One example, shared by Prof. Fadi El-Jardali, is the Knowledge to Policy (K2P) Center (spearheaded by the American University of Beirut), which aims to enhance the knowledge translation capacity of health policy units within the Ministries of Health in the Middle-East as well as those of civil society and the media. Recognizing the important role the media plays in the dissemination of news and guidelines, the K2P Center engages and trains journalists on knowledge translation practices to promote the appropriate use of evidence and improve health journalism. This approach reflects how a relationship of “engaged scholarship” can be cultivated with the media where the capacity of the journalists is built – to critically think about, as opposed to blindly reporting and incorporating, the information provided to them by the government or academia. Other strategies, such as evidence briefs on alcohol policy in Moldova, as highlighted by Ms. Marcela Tirdea, were considered useful mechanisms of synthesizing existing evidence on a topic and informing policymakers and the media about relevant current and emerging priorities.
(3) The media can be a vehicle for amplifying citizen voices and encouraging better governance
The panel did not address the multiple roles the media plays until Ms. Anoo Bhuyan “stirred the pot” by highlighting the often neglected relationship between researchers and journalists, noting that “it’s a conceited view that researchers engage with policymakers and then policy gets imposed on citizens…that’s not acceptable to me.” In these comments, Ms. Bhuyan highlighted a common challenge: researchers see journalists through the lens of disseminating research findings, rather than as active brokers in how evidence informs policy debates and strengthens citizen perceptions of evidence. By making data and evidence “easier to understand”, journalists can not only bring information to citizens, but also stimulate engagement and debate on critical health systems issues, bring transparency to opaque policymaking processes, and promote rights and democratization.
On the flip side, academic mistrust of how journalists portray evidence is not unfounded. Long-term relationships, such as those brokered by the K2P Center, can improve the foundations of trust between media and academia. These relationships can help journalists “play the connector between policymakers and academia.”
(4) Civil society organizations wear multiple hats – as “defenders for public health” to “citizen journalists” – and use different forms of data to help monitor, shape and inform government policies and programs
CEGSS (Centro de estudios para la equidad y gobernanza en los sistemas de salud) is one example of a civil society organization that has developed a “network of community defenders for the right to health.” Mr. Francisco Osmundo Oxlaj from Guatemala shows how CEGSS, through audiovisual documentation of community experiences, is recording patient experiences in health centers to share with public health authorities, strengthening their knowledge of health facilities and health services to improve accountability. CEGSS also works with community members to plan, monitor, and evaluate health services through a participatory approach enabling them to identify public health service gaps and demand that public health authorities address these gaps. This approach transforms existing power relationships, particularly those between rural populations (who are most affected by social hierarchies), health providers, and local government officials. While this participatory approach helped community members and policymakers interact and reflect on the data collected, Mr. Oxlaj noted that that “this is not enough to change things…”, i.e. to improve health services.
These lessons underscore the need to enhance the commitment and capacity of all actors to use evidence in decision-making for policy and practice. Developing and nurturing relationships between and amongst actors is key to building trust. Several capacity strengthening endeavors exist, like those mentioned above, that enhance evidence-informed decision making (EIDM). The discussions above, however, highlight that the old paradigm of research producers and research users is fading away (and needs to). This allows for more creative initiatives that permit co-ownership, co-production and mutual benefit for all stakeholders, which mainstream and institutionalize the values, processes, and partnerships for EIDM.
We are grateful to the panelists who participated in this session and later facilitated breakout discussions: Ms. Marcela Tirdea (Ministry of Health, Republic of Moldova), Mr. Elijah Ogunsola (Primary Health Care Development Board, Ministry of Health, Nigeria), Prof. Fadi El-Jardali (Professor of Health Policy and Management, Lebanon), Ms. Anoo Bhuyan (Journalist, India), and Mr. Francisco Osmundo Oxlaj (Human Rights Activist, Guatemala). The authors would like to thank Taylor Williamson and Leah Murphy for editorial support for this blog.
Image credit: Pia Mingkwan