A recent needs assessment of the status of research use in the health sector in Kenya and Malawi has identified a wide range of factors that are hindering policymakers within the Ministry of Health (MoH) and parliament from using research evidence in their work.
The study identified three categories of barriers, including access barriers, institutional barriers, and individual barriers; these are discussed in a bit more detail below. Respondents of the needs assessment included senior officials and technical staff within the MoH and parliaments in Kenya and Malawi.
Respondents argued that they did not have access to data and research so as to be able to apply these in their work. One of the main reasons why respondents lacked access to data and research was the lack of a repository for health research in each country where policymakers would easily source research for use in their work.
Currently, health research is scattered in various reports and journals, and there is no ‘one-stop shop’ where one would find all health research conducted in the country. Another reason was lacking subscriptions to journals and other online databases – neither MoH nor parliament in either country have invested in journal subscriptions to enable access to research necessary for informing policy decisions.
On the other hand, respondents did not seem to be aware of open-access research resources, which they could draw on form informing their work. Another reason was highlighted as poor packaging and dissemination of research evidence by researchers in the two countries.
Limited operations research was also highlighted as an issue, especially in Kenya, where respondents noted that most research available in the country is disease-specific, yet policymakers require operations research for informing decision-making. In relation to data, respondents indicated that the data collected through the HMIS systems were of poor quality and therefore not usable in policymaking.
Respondents also highlighted their own weak or lacking connections with the researchers and research institutions, which means that they often do not know which new research is coming up and so they have no access to it.
We classified a number of factors identified as hindering research use under institutional barriers because they related to enabling institutional systems and support mechanisms for research use. Respondents noted the limited funding that the two governments allocate to the generation of research as key barriers, which often mean that policymakers do not have the research evidence they really need to tackle policy challenges.
Inadequate staffing was also noted as a major challenge that was more pronounced in the parliament of Malawi, where it was noted that there are very few technical staff to support legislators. These few staff have competing demands, which makes it hard for them to have time to look for, synthesise and provide research evidence to legislators.
There was also the issue of lacking institutional guidelines for enabling data and research use in policymaking. Respondents argued that the presence of guidelines is a common practice in the health bureaucracy and that if there were guidelines for data and research use, they would be inclined to apply the guidelines. The issue of lacking supportive infrastructure such as well-equipped libraries, institutional journal subscriptions, and relevant computer software for enabling research use were also highlighted as key barriers to research use.
Other barriers to research use classified under institutional barriers include: weaker institutional leadership for evidence use, lacking incentives for research use, weak institutional linkages between the MoH and parliament with research institutions, lacking institutional forums for deliberating new research, senior policymakers’ suspicion of using research funded by donor agencies, political interests, and a lacking research use culture.
We classified a number of factors hindering research use under individual barriers. A major barrier identified here was lacking technical skills required to enable research use. Most respondents indicated that they lacked technical skills in searching for or sourcing research evidence, in interpreting and adapting research for local contexts, synthesising findings from different studies into policy recommendations, and summarising research findings into clear policy recommendations for use by senior officials.
Going hand-in-hand with this barrier is the lack of knowledge of where to find research evidence – not knowing the leading health research databases available where they can source research evidence. Another individual level barrier mentioned was lack of time to use research especially in view of the limited staff and competing demands.
This is made worse by the fact that research evidence is often not well packaged for ease of consumption by policymakers. Another barrier reported was limited appreciation of the importance of research use among senior ministry and parliament officials. As such, these officials do not demand for research evidence or require their technical staff to use research evidence.
The barriers to research use identified in this study align with those identified in other studies; see Oliver et al 2014, Liverani et al 2013, WHO 2007, Innvaer et al 2002, among others.
This study was conducted as part of the inception phase of the SECURE Health (Strengthening Capacity to Use Research Evidence in Health Policy) programme in order to inform the programme’s interventions. SECURE Health is being implemented in Kenya and Malawi for a three-year period and is funded by the UK’s Department for International Development (DFID) under the Building Capacity to Use Research Evidence (BCURE) programme.
SECURE Health is led by the African Institute for Development Policy (AFIDEP) and implemented in partnership with the East, Central and Southern African Health Community (ECSA-HC), FHI 360, College of Medicine at the University of Malawi, and the Consortium for National Health Research (CNHR-Kenya).
The UK Parliamentary Office for Science and Technology is a collaborator on the programme. The programme is implemented in partnership with the MoH and parliament in Kenya and Malawi.
Comprehensive country study reports will be available on this website by Feb 28, 2015.
Rose N. Oronje, PhD, is the Senior Policy & Communications Specialist, AFIDEP
Oliver, K., S. Innvaer, T. Lorenc, J. Woodman, and J. Thomas (2014) A systematic review of barriers to and facilitators of the use of use of evidence by policymakers. BMC Health Services Research, vol 14, issue 2. (http://www.biomedcentral.com/1472-6963/14/2/abstract).
Liverani, M., B. Hawkins, J. Parkhurst (2013) Political and institutional influences on the use of evidence in public health policy: A systematic review. PLOS One, vol 8, issue 10 (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0077404).
WHO (2007). Sound Choices. Enhancing Capacity for Evidence-Informed Health Policy (http://www.who.int/alliance-hpsr/resources/Alliance_BR.pdf).
Innvaer, S., G. Vist, M. Trommald, and A. Oxman (2002). Health policy-makers; perceptions of their use of evidence: a systematic review. Journal of Health Services Research & Policy, 7(4): 239-244 (http://www.sandy-campbell.com/sc/Knowledge_Translation_files/innvaer%20systematic%20review.pdf ).