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.

The post-TB story: Reflections on Post-Tuberculosis (TB) Lung Disease

Paul* has a nervous cheeky smile as he refers to himself as “a walking pharmacy”; a reference his friends gave him due to the fact that he always has a variety of medicine with him. His happy demeanor hides years of pain and numerous hospital visits following his lung collapse and its eventual surgical removal. Paul now functions with one lung and experiences complications as a consequence, such as occasional breathlessness. 

What happened? How did he get here? Paul was diagnosed with tuberculosis (TB) in 2012. He diligently took his daily TB medication for six months and was successfully discharged from the chest clinic after completing therapy. About four years later, Paul started having shortness of breath and difficulty breathing. After a series of tests and numerous hospital visits, he was diagnosed with pneumothorax (collapsed lung). A pneumothorax occurs when air leaks into the space between the lung and chest wall, pushing on the outside of your lung and causing your lung to collapse. During this time, he was diagnosed with TB again and put on a rigorous treatment regimen once again. For Paul, just like many TB survivors, life after TB may never be the same; there may be physical, physiological, social and psychological effects of TB that may continue long after treatment. Paul has a physical effect, post-TB lung disease.

Post-TB lung disease is common, varying in severity and impact on the quality of life. However, there is a lot we do not know about post-TB lung disease. Kenya, a country with a high burden of TB-both drug-sensitive and drug-resistant had 96,478 patients notified to have TB in 2018. How many of these will end up having post-TB lung disease? What are the likely conditions they will present? How will we make the diagnosis? Which department will be responsible for their care? What treatment will they require? How much will their care cost? Who will pay for their management? Will their sources of livelihood be affected? The questions continue with very few answers.

“TB is one of the historic diseases in Kenya, however its story ends with cure yet that is the beginning of another story which, unfortunately, is not captured by the programme, ‘the post-TB’ story”

             Dr. Joseph Kibachio, Head of Strategic National Health Programs-Kenya

On 3rd February 2020, Kenya held the 1st Post TB lung disease stakeholders forum to raise awareness of post-TB lung disease and to deliberate on how to tackle the issue. The stakeholder interface was hosted by the African Institute for Development Policy (AFIDEP) and the Division of National Tuberculosis, Leprosy and Lung Disease Program in Kenya as part of the four year NIHR-funded International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA). There were 44 attendees with representation from Ministry of Health- Department of Strategic National Health Programs, Division of Tuberculosis, Leprosy and Lung Disease Program, University of Nairobi, Respiratory Society of Kenya, KEMRI, Kenyatta National Hospital, Moi Teaching, and Referral Hospital, STOP TB Kenya, AFIDEP, Centre for Health Solutions-Kenya among others. Dr. Kibachio, the Head of Strategic National Health Programs-Kenya, gave opening remarks challenging the teams to address the post-TB story, “TB is one of the historic diseases in Kenya, however, its story ends with cure yet that is the beginning of another story which is unfortunately not captured by the program, ‘the Post TB’ story”. Lung health expert and former president of the Union, Dr. Chakaya, noted in his presentation that: Over 60% of TB patients still have symptoms at the end of TB treatment, >80% have radiological (X-ray or CT scan) findings, >30% have lung function abnormalities and >40% have bronchiectasis. Patients may have persistent symptoms as well as impaired and/or faster decline in lung function.

This limited evidence demonstrates that Post-TB lung disease is a priority that needs attention. What do we need to do? Firstly, we need to quantify the problem. Such data will be critical when setting the post-TB agenda. Next, we need to develop approaches to tackle the problem, including preparing health systems to support patients like Paul. This includes ensuring post-TB lung disease management is covered under universal health coverage as well as offering patients social protection. Furthermore, there is a need to consolidate research around Post-TB lung disease so that we can address the information gaps around the issue, raise more awareness about it and build a community of experts as suggested by Executive Director of the African Institute for Development Policy, Dr. Eliya Zulu. Internationally, the 1st post tuberculosis symposium was held on 22nd  – 23rd  July 2019 in Stellenbosch, South Africa(1). As we aim to ensure a world free of TB as envisioned by the END TB strategy(2) through reaching 90% of people with TB, reaching 90% of the key populations and achieving 90% treatment success; I echo the sentiment of Harries et al on adding a  ‘fourth 90’-Ensuring that 90% of all people successfully completing treatment for TB can have a good health-related quality of life'(3).

[*] Not his real name

References

1.First International Post Tuberculosis Symposium 2019. Stellenbosch, South Africa; 2019.

2.WHO. The END TB Strategy. Geneva: World Health Organisation; 2015.

3.Harries AD, Dlodlo RA, Brigden G, Mortimer K, Jensen P, Fujiwara PI, et al. Should we consider a ‘fourth 90’ for tuberculosis? Int J Tuberc Lung Dis. 2019;23(12):1253-6.

 

Strategy 2024: AFIDEP launches new Strategic Plan

The African Institute for development Policy (AFIDEP) is pleased to announce the release of a new strategic plan for the period 2020-2024. Dubbed Strategy 2024, the plan provides a framework to guide AFIDEP in scaling new heights in its efforts to advance evidence use in transforming lives in Africa.

In Strategy 2024, AFIDEP will expand its scope in advancing evidence use in decision-making as well as providing technical assistance in development programmes. The ultimate goal is to accelerate the achievement of the Sustainable Development Goals (SDGs).

According to AFIDEP’s Executive Director, Dr. Eliya Zulu, Strategy 2024 is guided by an in-depth analysis of the development and political landscape, as well as the external environment; our understanding of how change happens; and lessons learned from our previous work.

 Strategy 2024 identifies the following as AFIDEP’s five priority areas:

  • Population dynamics and the demographic dividend;
  • Health and well-being;
  • Transformative education and skills development;
  • The environment and climate change ; and
  • Governance and accountability .

Prof Nyovani madise, Director of Research and Development Policy and Head of Malawi office- AFIDEP says that gender equality is vital and intrinsically linked to the realization of sustainable development. “It is therefore a cross-cutting theme in all our programmes in Strategy 2024.”

Since its establishment in 2010, AFIDEP has been working across Africa to realize sustainable development by strengthening the use of evidence by decision-makers. Over the years, the institution has experienced significant growth and increasingly being recognized as the go-to research and policy institute in the continent. This work has been driven through the previous plan, 2015-2019 which laid a solid foundation for AFIDEP as a thought leader in the evidence-informed decision-making (EIDM) field.

Strategy 2024 was developed through a participatory and consultative process that took in sentiments and ideas of dedicated staff, management team, board of directors as well as valuable feedback from funders and partners.

AFIDEP aspires for an Africa where evidence is used consistently to transform lives.

 

 

Contributing to knowledge as an early-career woman researcher

Today, on International Day of Women and Girls in Science, I am reflecting on my journey and some of the challenges faced by early-career woman researchers.

The bigger picture: Contributing to knowledge

In a recent staff training on scientific writing, African Institute for Development Policy (AFIDEP) Director of Development Policy, Professor Nyovani Madise, asked staff why publishing in scientific journals was important. Most answers that staff gave were related to improving personal or institutional reputations – demonstrating the research capabilities of an institution, “getting your name out there,” legitimising research activities through the rigorous peer review process, etc.

Prof Madise paused and listened to each of our answers. She then noted that we had forgotten the most important reason to publish: to contribute to knowledge.

One way to work towards publishing in scientific journals and ultimately contribute to knowledge is by participating in relevant scientific conferences. This involves submitting abstracts from your work for selection as either oral or poster presentations. If selected to participate, it is a great platform to get feedback from experienced peers, hone your skills and polish your work, thus increasing chances of being published later on.

Limiting beliefs

I am an early-career researcher. I have worked in research spaces for much of my career, but publishing and submitting abstracts to conferences always seemed daunting or out of reach for me. Academia is still very male-dominated and hierarchical. Despite progress in recent years, women in academia are less likely to be hired, promoted, or earn as much money as male peers in universities.  Even in fields such as global health that have a majority female workforce, leadership positions are often dominated by men – while 70% of the global health workforce is female, only 25% of the leadership positions are occupied by women. Perhaps as a result of this, I never felt that what I was working on was important enough that others would be interested in it.

Moreover, I didn’t know where to start – which conferences and journals to submit to, whether presenting posters was a good use of time, even who to include as an author and in what order. There is a lot of assumed knowledge that is unrelated to research methods.

The importance of female mentorship

Fortunately for me, I had the encouragement, mentorship and support of my colleagues at AFIDEP, including from Prof Madise and other colleagues (both female and male). The importance of female mentorship has been noted, particularly in fields

I manage two research projects at AFIDEP, one qualitative study on antimicrobial resistance (AMR) control policy in Malawi and one mixed-methods study on drivers of and solutions to teenage pregnancy among girls in school in Malawi. AMR and teenage pregnancy are both issues of great concern to policymakers in Malawi and the region, and our findings needed to be disseminated – we needed to contribute to knowledge.

Taking action: Five tips for early-career researchers

In a short time span, I submitted three abstracts – one on findings from our AMR policy study to the University of Malawi College of Medicine Research Dissemination Conference, and two on findings from our study on teen pregnancy in Malawi. The first was accepted as an oral presentation, and the others were accepted as posters. I was very fortunate to be able to source funding to attend both, which otherwise would have been a barrier to attendance for me.

After attending two conferences in three weeks, here is my advice to early career researchers:

  1. Submit abstracts

Most abstracts are relatively short (150-500) words, and in most cases, you do not have to have already written a paper or completed data analysis. Reviewers lookout for relevance to the conference theme, a clear topic, a credible methodology, and a brief summary of findings. Submitting an abstract costs you nothing, and if you are already conducting research, the abstract will write itself.

  1. Apply for travel funding

Be sure to check for opportunities to apply for travel funding. Many international conferences have opportunities for people based in low-income countries. I missed out on an opportunity to attend a high-level conference recently because I missed the deadline to apply for a travel grant.

  1. Get feedback from colleagues

Get feedback on your slides or posters from people who have presented at conferences before. I had never designed a poster before, so I remember running around the office getting samples of posters from my colleagues. Practice giving your presentation to an audience and ask them to ask questions/give you feedback as though you were at a conference, and practice multiple times.

  1. Attend local conferences

The University of Malawi College of Medicine Research Dissemination Conference was an opportunity to deep dive on health issues of importance in Malawi. After my presentation, I met a number of people working on AMR and health policy research in Malawi. I also was approached by policymakers working on AMR and later was invited to give my presentation again at an AMR policy working group.

  1. Present posters

Having your abstract accepted as a poster presentation may not be considered as high profile as an oral presentation, however, I found presenting posters at the Union of African Population Studies 8th African Population Conference to be an extremely valuable experience. I gained experience presenting my findings and fielding questions, and a sense of what people found most interesting about my findings. I met other researchers at various stages in their careers working on teen pregnancy and sexual and reproductive health in other settings, and had rich discussions about similarities and differences, as well as policy solutions.

The bottom line

Your research is important, and you miss 100% of the chances you don’t take. On International Day of Women and Girls in Science, I encourage early-career woman researchers to submit abstracts, seek feedback, and attend conferences if possible. I encourage male academics and researchers to support their female colleagues. Though presenting and publishing is not the only thing to think about as an early-career researcher, it’s one important way to contribute to knowledge and break down barriers.

ELA training workshop: Another cohort of research-to-policy champions

The Evidence Leaders in Africa project (ELA) kicked off the year with a five-day training workshop on research communications and policy engagement. Convened by both AFIDEP and the African Academy of Science (AAS), the workshop brought together 23 early-to-mid-career researchers from East and West Africa to build their capacity on effective research communication and policy engagement strategies. It was held in Nairobi, Kenya between 27-31 January 2020.

The convening of this training was informed by the fact that scientific communication remains one of the notable challenges that researchers in Africa encounter. This, among other challenges such as lack of funding, lack of access and availability of quality data and low uptake of research by policy-makers, undermine researchers’ contributions to policy and programme decisions.

Effective communication is crucial for researchers as it allows them to inform, educate and raise awareness about their work to various audiences. Through this, they are able to generate support for their work and inform decision-making. The training therefore aimed to equip participants with the know-how to effectively communicate with audiences particularly in the policy-making space.

During the workshop, participants benefitted from elaborate sessions that covered various aspects of research communication and policy-engagement strategies. These included practical application sessions that broke away from theory such as crafting evidence-based policy messages, preparing and delivering elevator pitches, writing policy briefs, and preparing effective policy presentations.

Other pertinent issues that dominated the workshop were the barriers researchers encounter while engaging with decision-makers as well as the place of Evidence-Informed Decision-Making (EIDM) in informing and improving policies and practices. This was best explored during a panel discussion on linking research-to-policy. Panellists included Dr. Isavyani Naicker (Director of Partnerships – African Academy of Sciences), Mr. Francis Kundu (Assistant Director of Population – National Council for Population and Development (NCPD), Mr. Bonnie Mathooko (Chief Research Officer – Parliament of Kenya) and Hon. Dr. Makali Mulu (Member of Parliament – Kitui Central and Chair of the Kenya Parliamentary Caucus on Evidence-Informed Oversight and Decision-Making (PC-EIDM).

The panel discussion provided an opportunity for both the panellists and participants to share their experiences on interaction between researchers and policy-makers from respective perspectives. Recommendations on how best to improve this relationship were also highlighted. Policy-makers deplored the inability of many researchers to make their findings accessible, palatable and timely for policy decisions. Researchers, on the other hand, cited resistance from policy-makers to implement policy change despite convincing evidence. They also questioned whether policy-makers were genuinely interested in using evidence in decision-making.

On the importance of evidence in policy processes and the need for a symbiotic relationship between researchers and policy-makers, Mr. Kundu noted that, “constant interaction between researchers and policymakers is crucial to avoid situations where policies are made without being informed by evidence and problems arise at implementation stage.”

The training was apt in empowering the researchers to first, communicate their work in ways that are effective, strategic and politically strong. Second, to understand policy engagement and policy processes in various contexts. Lastly, to become EIDM champions in Africa by renewing their commitment to inculcate a culture of EIDM through promoting the uptake of the best available evidence into practice. Throughout, participants exhibited positivity to the topics and mode of training. They were enthusiastic about utilising the knowledge and skills gained to strengthen their position as change agents through research. Here are excerpts of what the participants said at the end of the workshop:

“I must say this is one of the best training I have ever attended and probably the only one to have learnt so much by end of the training. Keep up the good work you guys are doing.”

Cecil Kingondu, senior lecturer- Botswana International University of Science and Technology

 

 “I have always wanted to produce a policy brief for my work, but I did not have the adequate skills and I found the policy writing skill very interesting. I hope I will start producing policy briefs for my research.”

Eleni Abraham Yitbarek, senior lecturer- University of Pretoria, South Africa

 

“I really appreciate AFIDEP for putting this together, it is really timely.  The testimonies I have heard from my colleagues are positive concerning this kind of model, of transitioning from doing research to policy.”

Olushina Olawale Awe, senior lecturer – Anchor University Lagos, Nigeria

 

 “I feel transformed! I can now look at a group, analyse it, determine my audience and design my message. I have the confidence to communicate my work and can therefore contribute to my country’s growth.”

Faith Philemon Mabiki, senior lecturer – Sokoine University of Agriculture, Tanzania

 

 “I have never written a policy brief before and this has been an eye opener. Going forward, this training has given me capacity and the tools to write policy briefs and to communicate to policy makers.”

Dominic Omosa Ochwang’I, lecturer – University of Nairobi, Kenya

AFIDEP appreciates that getting evidence into policy is a complex task and as such is keen to bridge the gap that exists between researchers and policy-makers. We achieve this by strengthening the capacity and skills of researchers in for instance in scientific communication, evidence synthesis, policy engagement, and scenario building, through seminars and training workshops such as this one. AFIDEP will continue inspiring, engaging and empowering more researchers from across Africa to produce, synthesise and communicate research that can guide decision-making and policy-making processes to overcome challenges facing the continent.

 

 

AFIDEP and the African Academy of Sciences (AAS) convene five-day research communications and policy engagement training

Drawn from East and West Africa, 25 distinguished researchers will be convening for a capacity development workshop in Evidence-Informed Decision-Making (EIDM). The workshop dubbed ‘Research Communications and Policy Engagement Training’ is a collaboration between the African Institute for Development Policy (AFIDEP) and the African Academy of Sciences (AAS). It is a five-day event that will run from 27-31 January, 2020 at Park Inn Hotel, Nairobi-Kenya.

The training targets early-to-mid-career researchers and aims at enhancing understanding of the value and strategies for EIDM. This will be through practical training particularly on effective communication of research findings to policy audiences. AFIDEP hopes to strengthen the participants’ commitment to contribute to efforts to institutionalise a culture of EIDM in their respective spaces. The ultimate goal is to increase the number of academic leaders championing EIDM in Africa.

The training curriculum will cover a variety of strategically selected focus topics including:

  • The context of policy-making processes;
  • Planning for evidence uptake, including conducting policy analysis, stakeholder analysis, and preparing research communication strategies;
  • Packaging evidence for policy-makers, including simplifying evidence for general audiences, writing policy briefs, etc.;
  • Monitoring, Learning and Evaluation (MLE) of research translation and policy engagement efforts

The training will be followed by 6 months mentor-ship to support application of knowledge and skills acquired. The workshop is a key activity of the Evidence Leaders in Africa Project which aims to expand leadership for the use of evidence in policy formulation and implementation by African governments.

 

Why population matters for development: The 8th African Population Conference

About 1000 participants who attended the 8th African Population Conference organized by the Union for African Population Studies under the auspices of the Government of Uganda in Entebbe, Uganda on November 18-22 2019 adopted the “Entebbe Declaration” that called on African governments to mainstream population issues in their policies and development plans.

In reading the declaration, Prof Nyovani Madise, AFIDEP Director of Research and Development Policy and Head of the Malawi office, who chaired the conference scientific committee and is the new Vice President of the Union for African Population Studies (UAPS), noted that “African governments’ commitment to the AU Agenda 2063 and the UN Agenda 2030 constitutes a right step towards realising development, but commitment alone will not be enough if concrete steps are not taken to work towards the attainment of these goals.”

According to the conference statement, the continent’s high population growth is at 2.5 per cent per annum and is projected to reach 2.5 billion (about 26% of the world’s total population) in 2050. With the majority of the current population lacking access to basic services, it could get worse, not to mention the strain on the environment and natural resources if sustainable interventions are not made to address the situation.

Although trends have improved over the years, the number of children and mothers that continue to die from infant and maternal preventable and treatable causes is still a source of concern. For instance, “In 2018, 1 in 13 children in sub-Saharan Africa died before their fifth birthday– this is 15 times higher than the risk a child faces in Europe, where just 1 in 196 children aged less than 5 die,” says the World Health Organisation.

Africa cannot make big leaps in development if these and other prevailing population challenges are not addressed.

The Entebbe declaration called on governments to ensure population issues were incorporated in long-term and medium-term plans, strengthen data collection institutions and processes such as the census and other administrative surveys, and investing in research for use as evidence in informing development priorities.

There is also a huge opportunity for governments to harness the potential of Africa’s youthful population for a demographic dividend by making the right investments in “quality education, employable skill and sustainable livelihoods through entrepreneurial and job creations.”

Cognizant of the need for a multi-stakeholder approach, the call to action was extended to other players. The civil society organisations, the media and the private sector were urged to “to play their roles in Africa’s development, in programming, financing, as well as holding governments to account.” The researchers challenged themselves to pursue innovative and excellent research, mentor early career researchers and play an active role in having the evidence they produce inform government policy and planning.

The theme of the 8th  African Population Conference (APC) was Harnessing Africa’s Population Dynamics for Sustainable Development: 25 Years after Cairo and Beyond. The conference happened a week after the 25th  International Conference on Population and Development (ICPD25) where world leaders took stock of progress governments have made since the first ICPD held in Cairo, Egypt in 1994. ICPD25 was a good precursor and provided momentum for deliberations at the 8th  APC.

In addition to being part of the conference scientific committee, AFIDEP facilitated and or actively participated in 17 sessions at the conference.

The APC is held every four years and is convened by UAPS, a body whose membership is comprised of demographers and other researchers working on population issues in Africa.