With funding from DFID, AFIDEP implemented one of the pioneer programmes aiming to strengthen individual and institutional capacities and leadership to increase demand and use of evidence in decision-making between 2013 and 2017. The Strengthening Capacity to Use Research Evidence in Health Policy (SECURE Health) programme was a multi-partner, multi-country initiative implemented in the Ministries of Health (MoHs) and Parliaments in Kenya and Malawi, and regionally through the East, Central and Southern Africa Health Community (ECSA-HC). To strengthen individual capacity for evidence-informed decision-making (EIDM), we conducted an intensive one-week training workshop followed by a one-year mentorship of technical staff (i.e. mid-level policymakers) in the MoHs and Parliaments in defining clear policy issues that need evidence, finding the evidence, appraising its quality, synthesizing and packaging the evidence for high-level policymakers, and applying evidence in decision-making.
To strengthen institutional capacities for EIDM, we engaged high-level policymakers on the value of investing in institutional structures that facilitate evidence use through sustained one-on-one meetings and annual conferences; supported MoHs to implement a series of science-policy cafés on their urgent policy issues to elevate evidence and sustain interactions between policymakers and scientists; developed guidelines for evidence use that the MoHs and parliaments adopted and are currently implementing; supported Kenya MoH to develop a Research-for-Health Policy as well as Research-for-Health Priorities to guide the generation and application of research that is responsive to the needs of policymakers; and supported Malawi MoH to review the effectiveness of its National Health Research Agenda adopted in 2011 to improve its effectiveness.
What did we learn?
1. Skills in evidence use are lacking, translating to a huge demand for EIDM training among civil servants
Our capacity needs assessments revealed huge skills gap in EIDM among civil servants in both countries. Our training programme generated substantial demand for this kind of training. Both MoHs requested that we train all their technical staff in EIDM, and the Kenya MoH requested for an abridged version of the training for its higher-level policymakers. The solution, which we are currently exploring, is in embedding EIDM training in existing pre-service and in-service training programmes to ensure that many more civil servants can benefit from this training.
2. Need for training to benefit a critical mass of civil servants clustered within divisions and to involve supervisors and other senior officials
While our training participants from the MoHs were a dispersed group of individuals drawn from different divisions and units, those from the Parliaments were closely connected individuals who work in teams (i.e. research and committees). We therefore achieved a certain level of training a critical mass of civil servants in Parliaments but not in the MoHs. The evaluations revealed that clustering trainees within one division (e.g. more than 3 officials from a division/unit), and involving the high-level leaders (supervisors) so they allow and support trainees to cascade and share their learning, and bring in new ways of working, seems to be a more effective way to seed and cascade EIDM skills. This is especially important because it is unlikely that there will be enough resources to train everyone, so clustering and cascading needs to be used as an explicit strategy to sustain changes in practice after the intervention ends.
3. Ensuring high-level policymaker involvement and ownership from the design of interventions and throughout implementation
The SECURE Health programme was embedded within the MoH and Parliaments and implemented as an institutional programme of these institutions. This meant that high-level policymakers were involved from the design of interventions, implementation and evaluation. This ensured that the project responded to real needs identified by these institutions, thereby supporting the realisation of their objectives. For instance, the programme’s science-policy cafés intervention (i.e. regular evidence dialogues) focused on urgent policy issues that MoH was grappling with, which resulted in active participation of MoH’s high-level policymakers in the cafés, and uptake of the recommendations from the cafés into policies and programmes.
4. Strengthening individual capacities for EIDM must go hand-in-hand with strengthening institutions
The SECURE Health programme was designed to ensure that its interventions to strengthen individual technical capacities in EIDM went hand-in-hand with interventions to strengthen institutional structures, mechanisms and processes for enabling EIDM. While we realised notable successes with strengthening individual capacities, we realised limited success in addressing institutional bottlenecks to evidence use. Introducing new institutional procedures represents a reform process that requires sustained high-level leadership and middle-level steering to embed the reform or change process; from our experience, this is often a long process in many African bureaucracies. And, an EIDM reform has to compete with many other reforms. This is why the external evaluation observed that EIDM reform needs to bring incentives with it, like improving policymakers’ chances of mobilising donor resources, or meeting a political priority, as in lesson 6 below. Future efforts to strengthen institutions will benefit from having a long-term strategic focus, with sustained investments, and built-in incentives for high-level and middle-level policymakers.
5. Taking an “accompaniment” and coproduction approach that enables stakeholders to adapt, own and embed interventions in their contexts
As noted earlier, the design and implementation of SECURE Health was a collaborative effort with the MoHs and Parliaments. This did not only generate ownership and leadership for the interventions by policymakers, it also enabled policymakers to adapt interventions to address specific challenges as well as embed these in their existing strategies and programmes. For instance, the science-policy cafés intervention was coordinated by the MoHs, which ensured that the cafés focused on urgent policy issues the MoHs were dealing with.
6. Linking interventions on a real need by government to solve a problem
The main focus of the SECURE Health programme was to strengthen capacities for EIDM in MoHs and Parliaments in Kenya and Malawi. This was a priority need identified by the government agencies during the development of the proposal for the programme. For example, the MoH in Kenya had just created a Research and Development Division, and the SECURE Health programme was seen by MoH’s leadership as an opportunity to help operationalise the division. In Malawi, the MoH had, two years earlier in 2011, established a Knowledge Translation Platform (KTP), but its operations were limited due to lack of resources. The programme was, therefore, seen as timely in enabling the KTP to realise its goals. In the Kenyan Parliament, the programme was seen as critical in helping build the capacities of new research staff who were recruited during the first year of our implementation (the Parliament expanded its research unit from about 5 staff to 31 in 2014). The successes the programme achieved were largely because senior policymakers in these agencies saw the programme as critical in contributing to addressing real and urgent needs of these institutions.
7. Thinking and working politically
Policymaking is a political process and so efforts to improve the consideration of evidence in decision-making must “think and work politically” if they are to realise success. While the SECURE Health programme exploited political opportunities, which produced notable successes, political economy analysis was not explicitly undertaken to ensure that the programme fully integrates political considerations in its design and implementation. For instance, while the recent creation of a research division within the MoH was an important entry point for the programme within the MoH, we did not constantly analyse the political shifts that were taking place within the MoH during programme implementation and respond to these. These shifts resulted in reduced allocation of human and financial resources to the division and ultimately affected programme implementation.
Dr. Rose Oronje is the Director, Science Communications and Evidence Uptake, AFIDEP. email@example.com
Violet Murunga is a Senior Knowledge Translation Officer, AFIDEP. firstname.lastname@example.org
Dr. Eliya Zulu is the Executive Director, AFIDEP. email@example.com
Isabel Vogel is a Senior Evaluation and Research Consultant. firstname.lastname@example.org
This blog is published in our latest issue of African Development Perspectives. Read more stories here.