The proposed Kenya Health Knowledge Translation Platform: its adopted model is designed to position it for success

This is the first in a series of three blogs discussing the Kenya Health Knowledge Translation Platform (KTP). The follow-up blog will highlight lessons from existing KTPs for consideration in the establishment of the Kenya Health KTP. The final blog highlights how the Kenya Health KTP builds on recent efforts to improve evidence-informed decision-making in Kenya’s health sector.

Background

A Knowledge Translation Platform (KTP) brings together policymakers, researchers and other stakeholders, including the civil society, for evidence-informed deliberations on identified health priorities. It creates and nurtures links that draw the research and policy communities closer together to ultimately create cycles of policy-informed evidence and evidence-informed policy. The concept of the KTP was initiated and promoted by the World Health Organization beginning in 2005, resulting in numerous national and regional KTPs across the globe. By 2012, twelve countries in Africa either had a national KTP (Cameroon, Malawi, Nigeria, Uganda and Zambia) or were part of a regional KTP e.g. the Regional East African Community Health Policy Initiative (REACH-PI) comprising of Burundi, Kenya, Rwanda, Tanzania and Uganda, although only active for two years from 2006 to 2008.

On 1 March 2018, the Ministry of Health (MoH) convened a stakeholder meeting to discuss the establishment of the Kenya Health and Research Observatory (KHRO). The KHRO aims to promote evidence-informed decision-making (EIDM) in the health sector by improving access and use of research and health information. It is thought of as “a web-based portal designed to facilitate multi-stakeholder collaboration and partnership in accessing and using information for strengthening national health information systems, as well as serving as a repository of the best available information, and provide tools to strengthen monitoring of health status and trends”.

One of three platforms being proposed to be hosted on the KHRO is the Kenya Health Knowledge Translation Platform (KH-KTP), which will “consolidate all health research conducted on Kenya and facilitate discussions and translation of this research by key policy actors to enable its uptake in decision-making in the health sector”.

As part of the deliberation on what to consider when establishing a KTP, AFIDEP was invited to provide insights on the role of KTP in promoting EIDM in the Kenya health sector. What follows is my analysis of the model adopted by the Kenya Health KTP and its potential for success in the context of the evidence-base on KTPs in Cameroon (a);(b), Malawi, Nigeria, Uganda (a);(b) and Zambia.

Proposed structure/model of the Kenya KTP in relation to existing models

A KTP may take several different forms, each with their advantages and disadvantages. It may be a web-based entity or it may be located in a conventional office. Web-based KTPs rely on motivated users, which is difficult to generate in the absence of regular awareness raising/communication activities. On the other hand, KTPs operated from an office and engaged in implementing knowledge translation activities incur high costs, but promote and improve interaction and collaboration among researchers and policymakers and evidence-informed discussions.

The Kenya KTP is adopting a combination of the two as it is proposed to have:

  1. an online repository of local health research; and
  2. a non-online component focused on creating and nurturing links among policymakers, researchers and academic institutions, and other research-users to enable the translation and use of data and research evidence in decision-making.

The combined model is common among the other national KTPs in the African region.

KTPs can also either be health sector-wide as is being proposed for the Kenya KTP or they can be issue-focused. For example, Kenya’s National AIDS Control Council (NACC) runs a web-based knowledge sharing platform, called the Maisha Maarifa Research Hub, which focuses on HIV & AIDS, Sexual and Reproductive Health (SRH) as well as co-morbidities such as Tuberculosis. The Maisha Maarifa Research Hub collates locally generated research findings as well as best practices in programming to inform HIV-related policy and decision-making. To ease its management and enhance performance, health sector-wide KTPs can be organised into communities of practice, which focus on identified priority issues as was done in Cameroon, Malawi and Zambia. The Kenya KTP will adopt this model.

Finally, KTPs can either be housed in a government institution e.g. MoH or other relevant parastatal, academic or research institution (public or private) or a Civil Society Organisation. The Kenya KTP will be housed in the MoH, within the Department of Policy, Planning & Healthcare Financing. The evidence-base on KTPs point to a preference for KTPs to be housed in government or public institutions arguing that due to their close proximity to government policymakers, they tend to have higher buy-in and participation by stakeholders. On the other hand, there is need to take extra steps to ensure the neutrality of KTPs housed in government, the absence of which would compromise its purpose of promoting EIDM.

 The Kenya Health KTP is poised for success, but only if it is adequately funded and staffed. It has adopted the best elements of existing KTPs, in terms of its model:

  • It will be housed in the MoH, which will increase buy-in and chances for securing government funding commitment in addition to other sources of funding
  • It will have both an online repository of local health research as well as organise events that bring together researchers and policymakers to promote EIDM

Read the follow-up blog (Wednesday 14 March 2018) to appreciate some of the soft issues that must be considered in the establishment of the Kenya Health KTP if it is to realise its full potential.

AFIDEP at the What Works Global Summit 2019: Using data to improve accountability in health systems

AFIDEP is attending the What Works Global Summit 2019 (WWGS 2019), an event that brings together policymakers, practitioners, knowledge brokers and researchers from the global evidence community all over the world. The summit will run from 16-18 October 2019 in Mexico City, Mexico.

Dr. Bernard Onyango, a Senior Knowledge Translation Scientist whose role at the Institute includes promoting the use of evidence in decision-making processes at national and regional levels, will speak at a session on Health Systems on 16 October. He will discuss Kenya’s District Health Information System (DHIS2) as a tool to enhance performance monitoring and accountability for the promotion of reproductive, maternal and child health in Kenya.

In 2017/2018, AFIDEP assessed the use of the District Health Information System (DHIS2) as an accountability platform to improve reproductive, maternal and child health in Kenya. We found critical barriers to the use of DHIS2 capabilities, such as performance scorecards and dashboards important to improving outcomes. These included: lack of the necessary infrastructure to operationalise the system at the counties; understaffing at national and counties and lack of trained health workers in monitoring and evaluation (M&E).

“We recommend strengthening the use of DHIS 2 through: continuous capacity building of staff on data management and analysis for decision making; supporting county governments adapt M&E policies to the local context; and, advocating for the use of the scorecards as a data visualisation tool to support decision-makers at both national and county levels,” says Dr Onyango

The What Works Global Summit is an annual event that explores the evidence for designing, implementing and reviewing effective programmes and policies. WWGS 2019 will share the latest evidence synthesis research, research methods and practice strategies for improving the lives of individuals, families, and communities worldwide. Over 500 world leaders in evidence-based decision-making from 30 countries are expected to attend, learn from each other, present their work, share experiences and expand their networks.

 

 

AFIDEP and partners meet to roll out initiative on enhancing use of health research in government decision-making

Between 10-12 October 2019, AFIDEP and partners will hold an inception meeting to develop a work plan for a new initiative aimed at strengthening institutional capacity for evidence use in the Ministries of Health in Kenya, Uganda, and Malawi.

The Heightening Institutional Capacity for Government Use of Health Research (HIGH-Res) project brings together a consortium of partners that include the Kenya Medical Research Institute (KEMRI); the Uganda REACH-PI; the Malawi EvIDeNt network (comprising the Malawi Liverpool Wellcome Trust Centre (MLW), and the College of Medicine at the University of Malawi).

Under the HIGH-Res East Africa Consortium, the Ministries of Health, AFIDEP and partners will design, implement and evaluate innovative and politically responsive interventions that leverage and build on existing relationships and collaborations among the partners to maximise programme impact on building institutional capacity for evidence-informed decision-making (EIDM).

“A major activity of the initiative will be working with Technical Working Groups to build capacity and support sustained use or consideration of research and data in their deliberations,” according to Dr. Rose Oronje, Director of Public Policy and Communications at AFIDEP, and project lead on the High-Res project. The Technical Working Groups are existing structures within the Ministries of Health that convene Ministry officials and stakeholders to deliberate and provide recommendations on policy and programming for health sector service provision.

Another intervention is to jointly work with training institutions to incorporate training modules on evidence-informed decision-making in existing pre-service and in-service training programmes for civil servants. This will ensure that all civil servants in these three countries have access to training programmes that will improve their skills in using research and other evidence in decision-making.

HIGH-Res is supported by the Alliance for Health Policy and Systems Research and Wellcome Trust. The project will be implemented over a period of three years between September 2019-August 2022.

 

 

 

 

 

 

 

AFIDEP welcomes a new member to its Board of Directors: Sarai Chisala-Tempelhoff

AFIDEP is pleased to announce and welcome a new member to its Board of Directors!

Sarai Chisala-Tempelhoff is a human rights and social justice lawyer and legal researcher.

She is a Senior Legal Researcher & Founder of the Gender and Justice Unit, a social justice and gender equality initiative that hones in on legal empowerment. Her research focus is on women and access to justice, and the particular intersections between the letter of the law and women’s lived realities.

Sarai currently serves as the Project Director of Engender Health’s Essential GBV Services and Prevention project in Malawi. Previously, she served as the Director of Gender and Women’s Rights, Malawi Human Rights Commission. With over fifteen years of experience, Sarai has worked with various organisations across the globe, including UN Women, GIZ, UNICEF, the World Justice Forum, and the AIDS, and Rights Alliance for Southern Africa. Sarai has also served in leadership roles as the former President of the Women Lawyer’s Association of Malawi, and other leadership roles in the HIV Justice Network, and the Malawi Law Society.

A trained Lawyer, Sarai holds a Bachelors in Law (LLB) Honors from the University of Malawi, a Master of Laws (LLM) with specialization in Human Rights and Democratization from the University of Pretoria and a Postgraduate Certificate in Gender and Women’s Studies from the University of Memphis.

Leveraging Africa’s demographic transition: The young teachers’ imperative

October 5th, is World Teachers Day, celebrated around the world to highlight the work that teachers play in everyday life in building societies. The theme for this year is “Young Teachers: The future of the Profession.” In Africa, and particularly in Malawi, the theme’s message could not be more poignant. The continent is at a crossroads, and decisions governments make today about the role of teachers in shaping the minds of young Africans will have long-lasting impacts.

A 2015 report by the African Institute for Development Policy (AFIDEP) and the United Nations Population Fund (UNFPA) observed that Africa’s population structure had more young dependents compared to working-age adults. The report stated that 56 percent of Africa’s population was aged between 15 and 64, and that by 2050, that age group would grow to 62 percent. Like the rest of the world, Africa will go from high birth and death rates, to low birth and death rates, creating a youth bulge. This is what is termed as a “demographic transition.” It presents Africa with an unprecedented opportunity “to accelerate the socioeconomic transformation of the continent.” In other words, the demographic transition can become a demographic dividend.

For this to happen, governments on the continent need to invest in education, skills development, health, job creation and improved governance. Investing in these aspects will provide the necessary push to transform the continent and achieve the vision of “an integrated, prosperous and peaceful Africa, driven by its own competent citizens and representing a dynamic force in the global arena.” That vision is at the core of Africa’s continental blueprint widely known as Agenda 2063, articulated in implementation plans including the Continental Education Strategy for Africa (CESA) 2016-2025, and the Science, Technology and Innovation Strategy for Africa (STISA) 2024.

A 2016 report from the Africa Capacity Building Foundation (ACBF) observed that the “single biggest challenge to ownership of Africa’s development agenda and management of its key development programs” was rooted in critical technical skills. The continent was facing serious shortages of critical technical skills and professionals needed to drive key initiatives in the first 10-year implementation plan of Agenda 2063. There was little evidence that governments were making critical technical skills a part of national development strategies, the ACBF report stated.

In order to overcome this challenge, the report recommended nine urgent tasks. Two of these are improving capacity in the continent’s training institutions, and overhauling training and education systems. The report further recommended formation of consortia of top universities, research institutes and think tanks to drive the critical technical skills agenda.

A demographic country case study might help put into context the education imperatives facing the continent in the drive towards Agenda 2063.

Numbers from Malawi’s most recent population census, conducted in 2018, show that 13.7 million Malawians, out of 17.5 million, are aged 34 and under. This means that 78% of the Malawi population are young people under 35 years. The census report also shows that the country has 1.4 million youth aged 14-17 years old. Statistics from the Malawi Government show that the country has about 5 million primary school students, and about 380,000 secondary school students. What this reveals is that four out of five young Malawians of secondary school age, 14-17, are out of school.

Between August and September 2019, the Malawi Ministry of Education, Science and Technology (MoEST) released results for the primary and secondary school examination results. The primary school results showed that 37 percent of the students who passed had been selected to various public secondary schools, leaving out 63 percent. The secondary school results showed that 50 percent passed, down from 63 percent in 2018.

Recent numbers show that public universities enroll only about 5,000 first year students. Numbers from private universities are not available but rough estimates put first year enrollment at 5,000-10,000. Also unavailable are numbers from tertiary institutions such as teacher training, nursing, technical and vocational, but rough estimates would put their first-year enrollment at no more than 20,000.

For the past decade Malawi’s education budget has been close to, and sometimes surpassed, the Dakar Framework recommendation of 20 percent of the national budget. The proposed 2019-2020 budget, present in September, has brought that percentage down to 10.6. Regardless of whether the education budget falls below or surpasses the 20 percent mark, it has always been insufficient due to the actual size of the Malawi economy. Yet, it is only by making education a national priority that the economy can grow in a meaningful and equitable way.

Globally, the teaching profession is in a crisis. Morale is down, and young people prefer more glamorous professions such as medicine, law, engineering, and tech, among others. Many only come to teaching as a last resort. And many young teachers leave after just a few years to migrate to professions that are more attractive. A 2017 study of teachers in Malawi reported that 8 percent of secondary school teachers left the profession in 2014. Many continue to leave even now.

Malawi Government figures show that the country has about 77,000 primary school teachers, against just over 5 million primary school learners. The country needs to double the number of primary school teachers in order to reach a teacher-pupil ratio of 1:35. In other countries, 35 learners is considered a large class, and governments aim for smaller classes to improve the quality of teaching and learning.

The theme for this year’s World Teachers’ Day aims to address challenge of attracting young people to the teaching profession, hence the recognition that the future of the teaching profession lies in young teachers. Both Sustainable Development Goal 4, and the Continental Education Strategy for Africa (CESA) 2016-2025 recognise teachers as key to the achievement of the Education 2030 agenda as well as the “Africa we want.” It is these young teachers who will drive this agenda and impart the critical technical skills the continent needs. These teachers can only do that if they are highly educated and rewarded, and the profession is regarded as prestigious. These young teachers will be at the centre of the demographic transition.

Therein lies Malawi’s, and Africa’s, education imperative.

Teen pregnancies in Kenya: A Call to Action

In Kenya, almost 1 in every 5 girls between the ages of 15 and 19 are reported to be pregnant or have had a child already. This will no doubt be an important issue of focus for world leaders convening at the 25th International Conference on Population and Development (ICPD25) to be held 12-14 November 2019 in Nairobi.

To put a spotlight on the high number of teenage pregnancies and accelerate action to end the problem, the African Institute for Development Policy (AFIDEP) and the United Nations Population Fund (UNFPA) convened a policy dialogue that brought together 70 participants from the government, development partners, the youth, academia, think tanks, civil society, faith-based organisations, and the media.

The meeting arrived at SIX key recommendations that call for action in ongoing approaches and interventions to decisively end the problem of teen pregnancies. These are highlighted below and expounded upon in the attachment. The call to action can also be accessed on this linkCall to Action: Tackling Teen Pregnancy in Kenya

  1. Youth Voices: Nothing for us without us
  2. There’s a need for age-appropriate sexuality education
  3. Parents should be encouraged and empowered to engage teenagers on sexuality matters
  4. Allocate resources to implement sexual and reproductive health interventions
  5. Adopt a coordinated multi-sectoral approach
  6. Use evidence, adopt and leverage innovations

 

Sepsis is a policy issue: Reshaping stakeholders’ perceptions of sepsis in Africa

Sepsis is the second biggest cause of death in the world and the leading cause of preventable death. Globally, there are an estimated 30 million cases of sepsis each year, with over 7 million ending in death. Of these deaths, at least 2 million are estimated to occur in Africa. Despite being a major killer, sepsis remains largely unknown by the general public and health care workers, and is under-prioritised by policy-makers.

From 14th – 16th June 2019, experts converged in Dar es Salaam under the African Research Collaboration on Sepsis (ARCS) initiative to discuss sepsis in Malawi, Gabon and Uganda and the need to highlight sepsis as a policy issue.The meeting saw experts identify three inter-related problems confronting sepsis in these countries.

First is the need for a standardised definition for sepsis. There are many different definitions of sepsis, even among doctors and experts, and this makes it difficult for most people to fully understand and engage with sepsis. Consequently, there is limited to no population awareness of it. Even amongst medical practitioners, there is only a presumptive diagnosis of sepsis and no point-of-care tests. As a result, practitioners put less emphasis on sepsis but rather look at other diseases associated with it, leading to the second issue of lack of data availability due to the syndromic (and not objective) diagnosis of sepsis. This is compounded by the fact that there is no public budget or private funding for sepsis research in Africa, so it is generally not prioritised. This vicious circle is completed by there being no resources for sepsis-related training or treatment and the third problem: lack of population awareness. There is no word for sepsis in vernacular, and consequently no social chatter in communities about sepsis, which would aid in engaging discussion and building pressure for government intervention. There is also no pressure on the government from the medical profession, who consider it as “small fish” secondary to “real” underlying problems associated with sepsis, such as malaria, TB or HIV.

Based on this, participants embarked on the policy-influencing objective of generating more knowledge to recognise sepsis as a priority disease and put it on the agenda. Specifically, there is a need to converge the problem with policy and politics by engaging with eleven stakeholder groups, namely: Civil Society Organisations, Ministries of Health (MoH), Laboratory personnel, Media, Health recorders, International funders, Researchers, Medical teachers, Clinicians, Ethics committees, and Regulatory bodies.

These stakeholders should be engaged in four low-cost outcome mapping approaches:

  1. Informing and translating: This policy learning process should target civil society, media, international funders, MoH, medical teachers and regulatory bodies. Various evidence products developed through sepsis research must be disseminated to these stakeholders. For example, the sepsis fact sheet must be disseminated to civil society and media, whereas the sepsis policy brief should be disseminated to MoH and international funders, and curriculum change recommendations to medical teachers and regulatory bodies.
  2. Linking: This coalition-building process should involve linking sepsis experts to target stakeholders, including MoH technical working groups (TWGs), medical teachers, regulatory bodies and media. Sepsis experts must present to these stakeholders on sepsis-related research through meetings, panel discussions and interviews.
  3. Matchmaking: This attention-focusing process will bring together ethics committees, clinicians, international funders, allied health workers and researchers. Arrangements should be made for clinical and allied health workers to communicate to ethics committees on the gaps in knowledge to accurately diagnose and report sepsis. Communication between ethics committees and international funders must be facilitated for the latter to speak on the gaps in evidence on sepsis. Finally, communication between ethics committees and researchers can be moderated for the latter to speak on the need for permission to audit patient records to generate the knowledge and evidence on sepsis needed by health workers and international funders.
  4. Capacity strengthening: This activity should involve training MoH staff on evidence-informed decision making (EIDM). A curriculum developed by the African Institute for Development Policy (AFIDEP) and their partners is a great starting point, and the training delivery can use sepsis as a case study

With sepsis having human and financial costs, these approaches could bring sepsis on the policy agenda, where it needs to be, by converging the problem with policy and politics. Re-shaping the perception of sepsis among key stakeholders and making it a policy issue is vital to reducing cases in Africa, and the world at large. This World Sepsis Day, let us play our part and spread awareness.

 

 

ARCS is a Global Health Research Group awarded by the National Institute for Health Research (NIHR grant reference number 17/63/42) and led by the Liverpool School of Tropical Medicine (LSTM). This blog presents independent research funded by the NIHR. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.