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.

Our 2018 Annual Report: Evidence Drives Policy Decisions and Action

 

 

The African Institute for Development Policy (AFIDEP) is pleased to share with you the 2018 Annual report: Evidence Drives Policy Decisions and Action. Read how in 2018, evidence on demographic dividend (DD) informed programme priorities for Africa among development partners, and how various African governments moved from awareness to integration of DD in their population policies and national development plans. We also worked towards strengthening accountability and governance systems at national and sub-national levels and witnessed an increase in the demand for use of evidence and skills towards effective governance.

In 2019, we look forward to a vibrant year in which we launch our 2020-2024 strategic plan and renew our commitment and focus to having evidence transform lives in Africa.

We thank you for continued support and collaboration.

Improving governance in Africa: It’s the media’s role to oversight Parliament

Many experts agree that poor governance remains a major issue undermining development efforts in sub-Saharan Africa. In any country, parliament is a central institution for enabling good governance given its functions of oversight over the Executive, budget appropriation and tracking, law-making, and representation. To play these functions effectively, parliament needs other actors, key among them is the media.

In its own right, the media is the public’s watchdog, providing information to the public of how the government (including the Executive, Parliament, and Judiciary) are delivering their duties to the public and expending public resources. Parliament needs the media to inform the public on how it is conducting its functions. It also needs the media to facilitate public participation in parliament’s functions. Of the three arms of government, Parliament is the one that is directly elected by the people to represent their interests in law-making, budgeting, and oversight. As such, it has an important role of facilitating public participation in public policy decision-making, including appropriation of resources and tracking public expenditure.

AFIDEP is supporting the Parliament of Malawi to address the issues that undermine its performance (read more about the Malawi Parliament Enhancement project). This work is funded by Norway’s Ministry of Foreign Affairs through the Royal Norwegian Embassy in Malawi.

As part of this work, we are working with parliament and media in Malawi to improve the quality of media coverage of parliamentary affairs. Specifically, this work is focused on improving the relations between parliament and the media to enable sustained exchange and sharing of information, and to develop capacity of parliamentary reporters to ensure improved understanding of Parliament, its language, procedures and traditions, and its central role in tackling poverty by enabling good governance.

Parliamentary journalists eager to develop in-depth knowledge on parliament and its work

We have been interacting with 25 journalists from different media houses in Malawi who cover parliament through capacity development workshops since March 2019. The initial workshop focused on building journalists’ knowledge in the language of parliament, the Standing Orders that guide parliament procedures, the bill processing stages, and the central role of parliament in enabling democratic governance.

While generally, the journalists had an average understanding of the parliament and its procedures and traditions, many have found the sessions deeply enriching their understanding of parliament. “The discussions on the Standing Orders from the first workshop made me decide to read the Standing Orders in order to have a deeper understanding. And this is helping me do better stories now. For instance, I just did a story on the nomination of the leader of opposition in the new parliament, and I was able to do this story and provide context because of my improved understanding of the Standing Orders,” said one of the journalists involved in these workshops.

The focus on enhancing understanding of the central role of parliament in a country’s development efforts and improving governance has been critical to ensure that journalists provide context to the stories they write on parliament. In sharing her experiences covering the Kenyan parliament at one of the workshops, Ms Roselyne Obala said “you cannot give context to what you do not understand.” It’s therefore critical that parliamentary reporters develop an in-depth knowledge of parliament, and the Constitution and laws, if they are to improve the quality of coverage.

One of the Malawi journalists said that “before these trainings, I have been covering parliament activities as events, without linking them to the role of parliament. But with the understanding that I now have on the role of parliament in good governance, I am now starting to ensure that I link my stories on parliament to bigger development issues.”

Another journalist said “I’ve done a story that questioned MPs’ focus on giving handouts to constituents and buying coffins for funerals in their constituencies, which is not their role. I wrote this story because of the discussions we had in the first workshop on the roles of MPs.”

But whose role is it to ensure that journalists have the capacity they need to effectively report on parliament?

Many of the journalists get allocated to cover parliament without any prior training or knowledge on parliament. This is the case with most of the journalists we have been interacting with under this work. Both parliament and media need to invest in developing the capacity of journalists dedicated to covering parliament. Ms. Obala, the journalist from Kenya, noted that the Kenya Parliamentary Journalists’ Association has been instrumental in engaging parliament strategically to support capacity development for journalists on parliamentary affairs, but also in raising funds from development partners to train journalists who report on parliament.

Media and parliament need a platform for enabling sustained engagement and improved relations

Some of the challenges that hinder journalists from providing quality coverage of parliamentary issues is weak relations with the Parliament’s leadership. For instance, the journalists we have been interacting with in Malawi have decried the fact that some committee chairs in parliament block them from attending committee meetings which should be open to the public. They also said that it’s so hard for them to get audience with the Speaker of Parliament to discuss these challenges.

While the journalists and Malawi Parliament’s Public Relations office have created a Press Gallery Committee to provide a platform for journalists to engage Parliament’s leadership, this committee has been relatively inactive and therefore not playing this role. Partly is because most committee members are no longer actively covering parliament.

The Kenyan journalist noted that Kenyan journalists faced these similar challenges several years ago, and the decision to form the Kenya Parliamentary Journalists Association was made to address this challenge. The association has a Constitution and is formally registered, and it has the Speaker of parliament as its patron. The association facilitates quarterly meetings between journalists who cover parliament and the leadership of parliament to, among others, discuss and resolve challenges.

Form these conversations, Malawi journalists have committed to reviving and strengthening the Press Gallery Committee so that it can provide the platform for sustained engagement with parliament’s leadership.

A media centre was also noted as critical, but currently missing in the Malawi parliament. A media centre would provide a working space in Parliament for journalists, making it easy for them to prepare and file stories from Parliament. While establishing a media centre is one of the planned activities by the Malawi Parliament, the parliament currently has no resources to establish this. This is an area where the parliament of Malawi would benefit from support from development partners focused on improving governance in the country.

Media owes it to the public, which elects parliamentarians, to oversight parliament

While parliament has an oversight role over the Executive and the Judiciary, there is no institution charged with oversighting parliament. As the public’s watchdog, the media therefore have a role to oversight parliament. To play this role, journalists must not only have a deep understanding of parliamentary affairs, but also be critical and analytical in the way they cover parliament. Much of political decisions are not made in formal meetings of plenary or committees. As such, journalists need to develop and nurture sources of information among politicians and parliamentary staff to understand the decisions that committees and MPs make in parliament. These sources are invaluable in providing information on “under the table” and “behind the scenes” machinations that often inform public policy decisions. Investigative journalism skills also come in handy.

Discussing this issue, journalists noted the challenges they face in nurturing information sources in parliament, and still ensuring “arms-length” relationships to maintain objective and balanced coverage. Some lamented about information sources who eventually become friends, making it hard for them to do stories that uncover wrong-doings by these sources. But journalists find ways to navigate these challenges every day. One of them talked about sharing such stories with other journalists or media houses to cover such stories in efforts not to affect the information sources. Others argued that the best way is to be clear to the information sources that the role of media is to inform the public, and not to keep secrets of political leaders.

Another challenge that undermines media’s role in oversighting parliament is the fact that media owners are often political leaders or business men/women with close relations with political leaders. Journalists noted many instances where stories are not published because of the interests of the media owners. Also the reliance of media on advertisements from government often results in some media stories being “killed” in efforts to sustain income coming from government advertisements.

What the journalists have to say

Leading African scholars discuss their plans to contribute to entrenching an evidence use culture in development efforts in Africa

In a context where development challenges remain intractable amid limited resources, the role of robust evidence in informing development decisions cannot be overemphasised. But, evidence often fails to play this role because of many reasons. One of these reasons is the current weak institutional capacity that undermines ease of access to evidence, as well as interest and motivation, to use or consider evidence in policy and programme decisions.

In this series of videos, some of the leading scholars in Africa talk about how they will contribute to efforts to institutionalise evidence-informed decision-making (EIDM) in their countries. These scholars were part of a workshop on May 22-24, 2019 in Nairobi that convened top scholars on the continent to discuss the role they can play in efforts to strengthen institutional capacity within government agencies and universities in order to promote and enable a culture of evidence-informed decision-making (EIDM).

Prof. Mary Abukutsa Onyango, [Professor of Horticulture, Jomo Kenyatta University] – watch video

Prof. Peace Chinedun Babalola, [Professor of Pharmaceutical Chemistry, University of Ibadan, Vice-chancellor, Chrisland University] – watch video

Prof. Fredrick Otieno, [Former Vice chancellor, Masinde Muliro University] – watch video

Prof. Olatunde Farombi, [Dean – Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan] – watch video

Dr. Siana Nkya, [Lecturer, Department of Biological Sciences, University of Dar-es-Salaam] – watch video

Dr. Temitope Olawunmi Sogbanmu, [Assistant Lecturer, Department of Zoology, University of Lagos] – watch video

Dr. Ochieng Odero, [Project Team Leader, East Africa Research Fund], who was one of the facilitators of the workshop – watch video

This workshop was part of the Evidence Leaders in Africa (ELA) project that is being implemented by the African Institute for Development Policy (AFIDEP) and the African Academy of Sciences. The ELA project is funded by the William and Flora Hewlett Foundation.

Stimulating Public Discussion on Sepsis in Malawi: Media interview with Dr Paul Kawale

Sepsis is a life-threatening condition caused by your body’s toxic response to infection. Globally, there are an estimated 30 million cases of sepsis each year, over 7 million of which end in death. In fact, sepsis is the second biggest cause of death in the world and the leading cause of preventable death. Despite being a major killer, sepsis remains broadly unknown by the general public and health care workers and is under-prioritised by decision-makers.

To address this lack of awareness and under-prioritisation of sepsis, Dr Paul Kawale, a public health social scientist and Knowledge Translation Scientist at the African Institute for Development Policy (AFIDEP), was interviewed by journalist Meclina Chirwa in a live broadcast on Timveni Radio in Malawi. Dr Kawale is project manager on the African Research Collaboration on Sepsis (ARCS). The interview was designed to spark dialogue on sepsis in an effort to bring greater awareness to the issue. In his interview, Dr Kawale informed the public on what sepsis is, its burden on society, and why it is critical to prevent sepsis and save lives. The interactive nature of the interview allowed for the general public to call in, to ask questions, and seek clarifications about sepsis. This engaging interview marked an effective way of bringing awareness to an under-appreciated and complicated health issue like sepsis. Below is an overview of key messages that arose from the interview.

Interview: What is sepsis?

Dr Kawale explained sepsis as when the microorganisms (bacterium) that fight diseases in our bodies have multiplied and spread throughout the body causing harm. This may lead to other body parts to stop functioning and many times causes death. Sepsis is caused by viruses, bacteria or fungi that can come from unhygienic water and food. Other ways of transmission include contraction from animals or other people, and unsanitary conditions in hospitals as well as in homes.

Interview: Public queries

After this introductory conversation, the phone line was opened to the audience. People called in from across the country, including from Liwonde in Machinga District, Santhe in Kasungu District, Mvera in Dowa District, Lilongwe City’s Area 24, Mchinji District, Sipwa in Nkhata Bay District, Dedza District and Karonga DIstrict. A majority of the callers expressed having little or no knowledge of sepsis and their questions included:

  • Has there ever been a sepsis case in Malawi?
  • How widespread is sepsis in Malawi?
  • Which groups of people are affected by sepsis?
  • How can sepsis be prevented?
  • What is the connection between AFIDEP and sepsis?

Dr Kawale’s responses to the above questions included noting that everyone is susceptible to sepsis, but vulnerable populations like children and pregnant women are at high risk. Dr Kawale said the best way to prevent sepsis is by preventing infection in the first place. An effective way of controlling infection includes following sanitary practices, for example having good hygiene in hospitals, among health workers and in food handling. Vaccinations can also prevent infection of specific illnesses, like measles. Dr Kawale concluded the interview by reminding the audience that sepsis is killing a lot of people, even in Malawi, but it is preventable. Its massive human and financial costs can be avoided through more research, funding and awareness.

AFIDEP’s work to address sepsis

AFIDEP, together with partners including the Liverpool School of Tropical Medicine, Malawi-Liverpool-Welcome Trust, College of Medicine, the Queen Elizabeth Central Hospital and the African Sepsis Alliance, are looking to tackle sepsis through a consortium called the African Research Collaboration on Sepsis (ARCS). ARCS is being implemented in Malawi, Uganda and Gabon, in order to understand how widespread sepsis is and to identify ways to improve its diagnosis and treatment in our health systems. AFIDEP’s work on ARCS seeks to put sepsis on the national and regional policy agenda. This requires greater awareness on what sepsis is and why it needs to urgently be addressed among populations like the public, health practitioners and decision-makers. The interview demonstrated that although the general public has limited knowledge on sepsis, there is demand to better understand it and how it can be prevented in Malawi. The work that ARCS and AFIDEP are doing is a huge step towards sparking dialogue and generating evidence to address sepsis in Malawi and beyond.

Videos: Sepsis explained in three minutes

Listen to the full interview, conducted in Chichewa here. Courtesy of Timveni Media.

Ending teen pregnancy among girls in school in Malawi: an investment in knowledge pays the best interest

On September 4, 1994, the Cairo International Conference on Population and Development(ICPD) Parliamentarians meeting, with representatives from 179 governments, issue a declaration on population and development supporting the strategy of fully integrating population issues into all development planning policies and programmes. The ICPD Programme of Action emphasized the value of investing in women and girls and affirmed the principle of sexual and reproductive health and rights for all. This outlook shifted the emphasis of population policies away from slowing population growth to improving the lives of individuals, particularly women.

According to the Malawi National Statistic Office, Demographic and Health Survey (DHS) of 2016, between 2010 and 2016, the rate of pregnancy among teenage girls in Malawi increased from 25% to 29%. Overall, one-quarter of all pregnancies in Malawi in 2016 were teen pregnancies. This is a worrying trend and as a result, has negative implications for female education among other issues.

A study by a group of experts from the Faculty of Epidemiology and Population Health at the London School of Hygiene & Tropical Medicine showed that teenage pregnancy and school dropout rates have a two-way relationship; meaning that being out of school increases the risk of teenage pregnancy, while pregnancy also elevates the risk of dropping out of school. In Malawi, over half of the women who have never been to school became pregnant in their teens, compared to 32% of those with primary education, and 19% of those with secondary education according to the DHS. Both teenage pregnancy and school dropout often have similar root causes including early sexual debut, poverty, school performance, overage-for-grade, family circumstances and community norms and attitudes to girls’ education. These facts and figures are especially worrisome for a low-income country like Malawi and require urgent attention and interventions by policymakers in ending teen pregnancies which also perpetuate the poverty cycle.

In response to this and in aligning with the commitments made at ICPD Cairo ’94, AFIDEP is undertaking the ‘Initiative for Learning and Evidence to Address Teen Pregnancy in Malawi’ (I-LEARN), to better understand the causes of school dropout due to pregnancy in Malawi as well as best practices to prevent teen pregnancy and keep girls in school. In order to shed light on these issues and possible solutions, the initiative is exploring the prevalence of pregnancy among girls in school, effective interventions to prevent teen pregnancy among girls in school, as well as talking to teens, teachers, health workers, and other community members in focus group discussions and key informant interviews in two districts in Malawi – Dowa and Mangochi – to find out what their perspectives are on teen pregnancy and how best to address it.

At ICPD Cairo ’94, Governments agreed that that education is the single most important element on the road to equality and empowerment of girls and women. So far, findings from I-LEARN have shown that poverty is a major driver of both teen pregnancy among girls in school and of school dropouts. It was noted that families often struggle to pay for basic needs, including but not limited to school fees, school supplies, and boarding costs. In some instances, girls seek support from boys or men to meet these basic needs, after which they may be pressured into sex. In others, parents pressure or force their underage daughters to marry so that the groom can provide material support to the family, or simply so that their daughter will be supported by someone else. This indicates that greater efforts are needed in understanding and removing social and cultural barriers that hinder girls from completing school after pregnancy.

Unsurprisingly, some of the most effective interventions to prevent teen pregnancy were those that took a holistic approach and sought to keep girls in school by addressing some of these economic barriers to school attendance. For example, the Keep Girls in School (KGIS) initiative in Malawi, which ran from 2012-2018, included cash transfers and school support for girls such as “girls’ spaces”, among a range of other interventions such as investments in sanitation and hygiene in schools and building a college for teacher training. It is therefore important that in tackling the issue of teen pregnancy, policymakers must ensure that policies link economic and social factors in their efforts of improving the quality of living of girls in Malawi.

School by itself has been found to protect against teen pregnancy and school dropout – but what if the economic barriers to schooling are too great? While economic empowerment interventions are often viewed as unsustainable, our early findings indicate that simply educating teen girls and boys about sex, though important, is not enough to prevent teen pregnancy and school dropout – it is also necessary to address the larger context. For many girls in Malawi, that means addressing social, economic and cultural barriers.

As we celebrate World Population Day, we call attention to the unfinished business of the 1994 International Conference on Population and Development and recognise that reproductive health and gender equality are essential in achieving sustainable development.

Reliable, accurate information vital to policymaking in Africa

The Executive Director of the African Institute for Development Policy, Eliya Zulu, spoke to Njiraini Muchira of The East African.

What does the use of evidence in policymaking entail?

The aim is to make sure that decision-makers have reliable and quality evidence every time they make decisions to improve the well-being of people.

Evidence is not the only ingredient that policymakers look at. There are political considerations, the ideological beliefs of policymakers, budget considerations and many other factors.

Yes, policymaking is a process that involves many players and interests. However, only when timely, quality and relevant evidence is on the table, then decisions will be more objective and lead to choices that will optimise chances of achieving development goals.

African governments are always coming up with policies and blueprints. How can you gauge the level of credibility of these policies and what are the shortcomings?

The policies are often not implementation ready—they are big in citing evidence to justify why action should be undertaken but weak in using evidence to determine what cost-effective interventions to implement.

Sub-Saharan Africa has about 660 think tanks yet the continent still faces challenges in terms of sound policies. Where is the disconnect?

Actually, the biggest challenge in Africa is not lack of policies but the poor capacity to translate the policies into action. Many actors have noted that Africa is rich in policies but poor in implementation.

The challenge for evidence practitioners, therefore, is to focus on generating and promoting the use of evidence that addresses the policy-action gap.

The think tanks need to go beyond generating evidence that informs problem definition to generating practical evidence that defines specific actions governments should undertake. Such interventions are a culture of monitoring and evaluation to learn and fix implementation challenges.

There have been calls for think tanks, policy centres, networks and policymakers to work together to strengthen the research-to-policy linkage. Why has this not been happening and what can be done?

Part of the reason is that many organisations have been promoting the use of the evidence that they produce themselves and there is inherent competition. However, as the realisation that a culture of evidence-informed decision making is key for promoting evidence use, organisations realise that they cannot achieve such transformation on their own.

Also as we realise the need to develop the evidence-informed decision-making practice as a development field, there is a need for various people to work together.

Institutions in policy formulation often depend on donors for funding. Does external funding influence the outcomes of research?

Of course, those who pay bills influence what gets done. For our governments to influence research and make sure that it fully meets their policy needs, they must invest in research.

There is a recommendation that government should invest at least two percent of their budgets to research for them to have a substantial say on the type of research that is done and how that research gets used in decision-making processes.

People say that African countries are too poor to invest in research, but it is actually because African countries are poor that they must invest more in research.

Because with the limited resources, they need evidence to ensure they set the right development priorities, allocate resources effectively and implement cost-effective interventions with the best chance of success.

What lessons can Africa learn from other regions that have attained development due to depending on the evidence in policymaking?

A key lesson to learn is that a culture of evidence use does not happen by accident. It has to be planned for and resources need to be there to ensure that there are robust systems and platforms to facilitate evidence use, there are adequate and skilled personnel to enable evidence use, and there are incentives for consistent use of evidence in performance management systems.

This article was initially published by The East African on 15 May 2019: http://bit.ly/2xALHJr