Champions of evidence play a pivotal role in bridging research-to-policy gap
This article was co-authored with Ermel Johnson, professional officer, West African Health Organization; Lynette Kamau, senior policy and communications officer, African Population and Health Research Center; and Issiaka Sombié, principal professional officer for research and health information, West African Health Organization.
On their own, research findings are rarely sufficient to trigger policy or programmatic actions to improve people’s health and wellbeing. Researchers and donors have grappled with the best way to promote compelling findings and boost uptake of research evidence among policymakers.
The Innovating for Maternal and Child Health in Africa (IMCHA) initiative developed a unique model to achieve this. The model provides funding to health policy and research organizations (HPROs) to complement the outreach efforts of implementation research teams. As findings are starting to emerge, we, as IMCHA and HPRO employees, are beginning to see these organizations come into their own and deliver tangible results.
IMCHA research teams are working on a total of 28 implementation research projects in 11 countries to improve maternal, newborn, and child health in Africa. HPROs provide support to all 19 research implementation teams to take their findings a step beyond the audiences they can typically reach. They help to pave the way for large-scale research impact by fostering research uptake in policies and practices among more diverse and higher-ranking decision-makers from ministries and national parliaments in 38 countries.
The African Population and Health Research Center leads the HPRO for East Africa, a consortium that also includes the East, Central, and Southern African Health Community and Partners in Population and Development. The HPRO in West Africa is the West African Health Organization (WAHO), the specialized arm of the Economic Community of West African States (ECOWAS) responsible for health issues in the sub-region.
HPROs develop decision-makers' understanding and promote further collaboration with researchers. They accomplish this by building ownership of the research among national program and policy developers; facilitating mutual learning across the IMCHA initiative; and strengthening individual and institutional capacities in research implementation and use.
Top-level buy-in in West Africa
The HPROs have already been demonstrating their effectiveness. For example, ministries of health from the 15 ECOWAS member states adopted a resolution committing them to use research evidence from IMCHA to inform decision-making. The resolution followed a June 2017 WAHO presentation to the Assembly of Health Ministers on using evidence in the development of healthcare policies, plans, standards, and protocols.
Since then, Burkina Faso created a management and knowledge-transfer unit within its Ministry of Health. WAHO is collaborating with this new unit to build knowledge translation capacity in an effort to consolidate collaboration between decision-makers and researchers, synthesize and share evidence, and support decision-makers in using evidence to improve the implementation and quality of maternal and child health programs.
Informing policy dissemination in East Africa
In June 2018, the East Africa HPRO convened an exchange between decision-makers in Tanzania’s health sector — ministries dealing with health, community development, gender, the elderly, and children — and six IMCHA research teams, who presented their work and made recommendations based on findings from nine research projects in the country. The exchange led to tangible improvements, including a new commitment to remove unnecessary hurdles faced by women in antenatal visits.
IMCHA research findings indicated that a misinterpretation of the government’s Spouse Escort Policy discouraged women from initiating antenatal care visits. The policy recommends that partners of pregnant women accompany them to their first antenatal care visit, but researchers found that some health workers in rural areas used this recommendation as justification to deny or delay services for women who came unaccompanied. As a result, women without a stable partner chose either to delay their first antenatal visit (which has known negative impacts on the health of pregnant women and their unborn babies), or to enlist strangers to pretend to be their partners in order to access services. Presented with these facts, the director of human resources at the Ministry of Health decided to train health workers and communicate the policy more clearly to ensure that women are not prevented from accessing antenatal care services if they arrive at a clinic without a partner.
An African solution for evidence-based policymaking
As a novel component of the IMCHA model, it took some trial and error for the HPROs to find their niche and collaborate with IMCHA research teams and other stakeholders. IMCHA’s midterm evaluation conducted in 2018 showed that HPROs have already made notable contributions, while their work also continues to evolve and build momentum. In the latter part of the initiative, we expect more examples of the successful use of evidence to inform sound policies and programs. A final evaluation of the initiative will assess whether the model provides a good platform for African-led solutions to the challenges of maternal and child health and whether the model helps to fill critical knowledge and implementation gaps.