BackgroundThe number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone.MethodsA cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities.ResultsThe quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care.ConclusionThe health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.

BackgroundAware of the advantages of a project steering committee (SC) in terms of influencing the development of evidence-based health policies, the West African Health Organisation (WAHO) encouraged and supported the creation of such SCs around four research projects in four countries (Burkina Faso, Nigeria, Senegal and Sierra Leone). This study was conducted to describe the process that was used to establish these committees and its findings aim to assist other stakeholders in initiating this type of process.MethodsThis is a cross-sectional, qualitative study of the initiative’s four projects. In addition to a literature review and a review of the project documents, an interview guide was used to collect data from 14 members of the SCs, research teams, WAHO and the International Development Research Center. The respondents were selected with a view to reaching data saturation. The technique of thematic analysis by simple categorisation was used.ResultsTo set up the SCs, a research team in each country worked with health authorities to identify potential members, organise meetings with these members and sought the authorities’ approval to formalise the SCs. The SCs’ mission was to provide technical assistance to the researchers during the implementation phase and to facilitate the transfer and use of the findings. The ‘doing by learning’ approach used by each research team, combined with WAHO’s catalytic role with each country’s Ministry of Health, helped each SC manage its contextual difficulties and function effectively.ConclusionThe involvement of technical and financial partners motivated the researchers and ministries of health, who, in turn, motivated other actors to volunteer on the SCs. The ‘doing by learning’ approach made it possible to develop strategies adapted to each context to create, facilitate and operate each SC and manage its difficulties. To reproduce such an experience, a strong understanding of the local context and the involvement of strong partners are required.

BackgroundThe paper carries out a situational analysis to examine the production, dissemination and utilisation of reproductive and child health-related evidence to inform policy formulation in Ghana’s health sector.MethodsThe study used Wald’s model of knowledge production, transfer and utilisation as a conceptual model to collect relevant data via interviews and administration of questionnaire to a network of persons who either previously or currently hold policy-relevant positions in Ghana’s health sector. Additional data was also gathered through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and child health policies, protocols and guidelines and information available on the websites of relevant institutions in Ghana’s health sector.ResultsThe findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities (access to major donors who have the resources to fund good quality research and access to both local and international networks for collaborative research). What remains a challenge, however, is the absence of a robust institutional-wide mechanism for collating research needs and communicating these to researchers, communicating research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research into the budget of the health sector.ConclusionThe study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing strengths and opportunities to address the identified challenges.

In most developing countries including Nigeria, one of the most challenging issues associated with evidence-to-policy link is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence. The purpose of this review is to assess the efforts and various initiatives that have been undertaken to deliberately engage policymakers and other stakeholders in the health sector in Nigeria for the promotion of evidence informed policymaking. A MEDLINE Entrez Pubmed search was performed and studies that investigated policy making process, evidence to policy link, research to policy mechanism, and researchers/policymakers interaction in Nigeria in relation to health policy were sought. Of the 132 publications found, 14(10.6%) fulfilled the study inclusion criteria and were selected and included in the review. Of the fourteen scientific publications identified, 11 of the studies targeted both researchers and policymakers and the principal tool of intervention was training workshops which focused on various aspects of evidence informed policymaking. All the studies indicated positive outcomes and impacts in relation to quantifiable improvement in policymakers' knowledge and competence in evidence to policy process. Capacity strengthening engagement mechanism is needed for both researchers to generate better evidence and for policymakers and health-care professionals to better use available evidence.

BackgroundDespite improvements over time, West Africa lags behind global as well as sub-Saharan averages in its maternal, newborn and child health (MNCH) outcomes. This is despite the availability of an increasing body of knowledge on interventions that improve such outcomes. Beyond our knowledge of what interventions work, insights are needed on others factors that facilitate or inhibit MNCH outcome improvement. This study aimed to explore health system factors conducive or limiting to MNCH policy and programme implementation and outcomes in West Africa, and how and why they work in context.MethodsWe conducted a mixed methods multi-country case study focusing predominantly, but not exclusively, on the six West African countries (Burkina Faso, Benin, Mali, Senegal, Nigeria and Ghana) of the Innovating for Maternal and Child Health in Africa initiative. Data collection involved non-exhaustive review of grey and published literature, and 48 key informant interviews. We validated our findings and conclusions at two separate multi-stakeholder meetings organised by the West African Health Organization. To guide our data collection and analysis, we developed a unique theoretical framework of the link between health systems and MNCH, in which we conceptualised health systems as the foundations, pillars and roofing of a shelter for MNCH, and context as the ground on which the foundation is laid.ResultsA multitude of MNCH policies and interventions were being piloted, researched or implemented at scale in the sub-region, most of which faced multiple interacting conducive and limiting health system factors to effective implementation, as well as contextual challenges. Context acted through its effect on health system factors as well as on the social determinants of health.ConclusionsTo accelerate and sustain improvements in MNCH outcomes in West Africa, an integrated approach to research and practice of simultaneously addressing health systems and contextual factors alongside MNCH service delivery interventions is needed. This requires multi-level, multi-sectoral and multi-stakeholder engagement approaches that span current geographical, language, research and practice community boundaries in West Africa, and effectively link the efforts of actors interested in health systems strengthening with those of actors interested in MNCH outcome improvement.

West Africa has adopted numerous strategies to counter maternal and infant mortality, provides national maternal and infant health programmes, and hosts many active technical and financial partners and non-governmental organisations. Despite this, maternal and infant morbidity and mortality indicators are still very high. In this commentary, internal actors and officials of the West African Health Organisation (WAHO) examine the regional organisation’s role in promoting research as a tool for strengthening maternal and infant health in West Africa.As a specialised institution of the Economic Community of West African States (ECOWAS) responsible for health issues, WAHO’s mission is to provide the sub-region’s population with the highest possible health standards by harmonising Member States’ policies, resource pooling, and cooperation among Member States and third countries to collectively and strategically combat the region’s health problems. To achieve this, WAHO’s main intervention strategy is that of facilitation, as this encourages the generation and use of evidence to inform decision-making and reinforce practice.WAHO’s analysis of interventions since 2000 showed that it had effected some changes in research governance, management and funding, as well as in individual and institutional capacity building, research dissemination, collaboration and exchanges between the various stakeholders. It also revealed several challenges such as process ownership, member countries’ commitment, weak individual and institutional capacity, mobilisation, and stakeholder commitment. To better strengthen evidence-based decision-making, in 2016, WAHO created a unique programme aimed at improving the production, dissemination and use of research information and results in health programme planning to ultimately improve population health.While WAHO’s experiences to date demonstrate how a regional health institution can integrate research promotion into the fight against maternal and infant mortality, the challenges the organisation has encountered also demonstrate the importance of cohesion among actors promoting such an initiative, the importance of leadership and commitment among member country actors steering the process, and the need for collaboration and coordination among all partners in member countries and in the region.

Background: There is increasing interest globally in the use of more rigorous processes to ensure that maternal, newborn, and child health (MNCH) care recommendations are informed by the best available research evidence use. The purpose of this study was to engage Nigerian MNCH policy-makers and other stakeholders to consider issues around research to policy and practice interface and to assess their existing knowledge and capacity on the use of research evidence for policy-making and practice. Methods: The study design is a cross-sectional evaluation of MNCH stakeholders’ knowledge as it pertains different dimensions of research to practice. This was undertaken during a national MNCH stakeholders’ engagement event convened under the auspices of the West African Health Organization (WAHO) and the Federal Ministry of Health (FMoH) in Abuja, Nigeria. A questionnaire was administered to participants, which was designed to assess participants’ knowledge, capacity and organizational process of generation, synthesis and utilization of research evidence in policy-making regarding MNCH. Results: A total of 40 participants signed the informed consent form and completed the questionnaire. The mean ratings (MNRs) of participants’ knowledge of electronic databases and capacity to identify and obtain relevant research evidence from electronic databases ranged from 3.62-3.68 on the scale of 5. The MNRs of participants’ level of understanding of a policy brief, a policy dialogue and the role of researchers in policy-making ranged from 3.50-3.86. The MNRs of participants’ level of understanding of evidence in policy-making context, types and sources of evidence, capacity to identify, select, adapt, and transform relevant evidence into policy ranged from 3.63-4.08. The MNRs of the participants’ organization’s capacity to cover their geographical areas of operation were generally low ranging from 3.32-3.38 in terms of manpower, logistics, facilities, and external support. The lowest MNR of 2.66 was recorded in funding. Conclusion: The outcomes of this study suggest that a stakeholders’ engagement event can serve as an important platform to assess policy-makers’ knowledge and capacity for evidence-informed policy-making and for the promotion of evidence use in the policy process.

BackgroundIn Nigeria, interest in the evidence-to-policy process is gaining momentum among policymakers involved in maternal, newborn and child health (MNCH). However, numerous gaps exist among policymakers on use of research evidence in policymaking. The objective of this study was to assess the perception of MNCH policymakers regarding their needs and the barriers and facilitators to use of research evidence in policymaking in Nigeria.MethodsThe study design was a cross-sectional assessment of perceptions undertaken during a national MNCH stakeholders’ engagement event convened in Abuja, Nigeria. A questionnaire designed to assess participants’ perceptions was administered in person. Group consultations were also held, which centred on policymakers’ evidence-to-policy needs to enhance the use of evidence in policymaking.ResultsA total of 40 participants completed the questionnaire and participated in the group consultations. According to the respondents, the main barriers to evidence use in MNCH policymaking include inadequate capacity of organisations to conduct policy-relevant research; inadequate budgetary allocation for policy-relevant research; policymakers’ indifference to research evidence; poor dissemination of research evidence to policymakers; and lack of interaction fora between researchers and policymakers. The main facilitators of use of research evidence for policymaking in MNCH, as perceived by the respondents, include capacity building for policymakers on use of research evidence in policy formulation; appropriate dissemination of research findings to relevant stakeholders; involving policymakers in research design and execution; and allowing policymakers’ needs to drive research. The main ways identified to promote policymakers’ use of evidence for policymaking included improving policymakers’ skills in information and communication technology, data use, analysis, communication and advocacy.ConclusionTo improve the use of research evidence in policymaking in Nigeria, there is a need to establish mechanisms that will facilitate the movement from evidence to policy and address the needs identified by policymakers. It is also imperative to improve organisational initiatives that facilitate use of research evidence for policymaking.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-017-0217-5) contains supplementary material, which is available to authorized users.