Comparative analysis of country-level enablers, barriers and recommendations to strengthen institutional capacity for evidence uptake in decision-making

Abstract

Background Evidence-based decision-making is crucial to leadership in the health sector to identify country-level priorities and generate solutions supported by rigorous research. Barriers and enablers have been explored, but limited evidence about what works to strengthening capacity at individual and institutional levels within countries has been reported, and inconsistent use of evidence to inform policy-making is a persistent challenge and concern. Methods We conducted a framework analysis comparing experiences of nine purposively selected countries (Chile, Ethiopia, Ghana, Kyrgyzstan, Lebanon, Mozambique, Rwanda, South Africa and Sri Lanka). We utilised qualitative case studies developed by in-country teams to explore enablers and barriers described across components of a predefined theory of change and then identified six cross-cutting themes and recommendations for relevant stakeholders associated with each theme. Results The cross-cutting themes included (1) leadership and political will, (2) incentives and resources, (3) infrastructure and access to health data, (4) designated structures and processes, (5) interaction and relationships, and (6) capacity strengthening and engagement. While each case country’s context and experience was different, common enablers and barriers surfaced across each of these themes, with Ministries of Health and other government agencies having strong roles to play, but also recognising the need for other stakeholders, including researchers, donors and civil society, to serve as essential collaborators in order to strengthen evidence uptake. Substantial and sustained investment in research capacities, able leaders and stronger engagement of civil servants are needed to further this progress and strengthen processes of health decision-making. Conclusions All countries represented in this study have made commendable progress in increasing evidence uptake and strengthening supportive systems. Establishing and strengthening necessary structures and the relationships that underpin them takes time as well as resources. Going forward, the findings from this study can help guide and support advocacy to increase domestic funding for health research, especially health policy and systems research, and ensure that civil servants as well as researchers have the capacity and support to collaborate and continue to bolster evidence uptake.

A mapping of facilitators and barriers to evidence-based management in health systems: a scoping review study

“…Political alliances and priorities, knowledge brokers, and other factors have a substantial role to play in applying EBM in health organizations. Hence, after the leaders determined the evidence priorities, they can identify processes for their generation and use them by using political commitments to set up structures to support it [ 17 ].…”

“…On the other hand, proactive leadership can be associated with a more positive attitude toward evidence-based practice (EBP) [ 34 ]. Provision of incentives and motivations [ 2 , 10 , 17 , 27 , 28 , 30 , 35 , 36 ] and explicit effort to capture synergies between various components of the organizations [ 28 ] by a strong and determined leader are the actions that can encourage the members to focus more on the EBM. As well as, presence of multidisciplinary, diverse management teams [ 30 ], virtual communication networks [ 29 , 32 , 35 ], interactive web-based meeting (webinars) [ 35 ], face-to-face meetings [ 28 , 30 ] and brainstorming [ 10 , 29 ], and use of common language and terminology [ 30 ] can facilitate teamwork and consequently enhance the use of evidence in the decision-making process in the organizations.…”

“…This aspect included four sub-aspects, and among them, “sufficient infrastructures or structures” was the most mentioned sub-aspect (24 (49%)) in the studies. In this regard, some factors such as information systems [ 2 , 27 , 28 , 30 , 35 ] and technical infrastructure [ 2 , 14 , 28 , 37 ]; appropriate wireless, internet, and intranet access and computers [ 14 , 16 , 17 , 28 , 29 ]; digitization of datasets, reports, and processes [ 17 ]; access to research and library services [ 10 , 12 , 36 , 38 – 42 , 13 , 14 , 17 , 25 , 27 , 30 , 32 , 35 ]; knowledge on management tools [ 25 , 30 , 38 , 39 ]; and the existence of a department for quality assurance [ 28 ] can have a great impact on providing the necessary infrastructure for EBM and promoting it in the organization.…”

“…Accordingly, “relevance, reliable, interpretable and understandable evidence” was the most mentioned sub-aspect (10 (20%)) in studies. Evidence is the fundamental part of EBM, so the data for use should be real-time, synthesized, and from different agencies [ 17 ], and if so, the managers can make good decisions. Without this information, wrong decisions will be made, and it can lead to not only the organization that does not improve but may push it away from its desired goals.…”

“…However, several studies were performed to identify facilitators and barriers to EBM or EBDM in healthcare organizations; they only focused on some aspects of just one or two of these factors and did not present a comprehensive and complete set or framework for them [ 11 – 16 ]. Therefore, providing a complete map of the EBM facilitators and barriers in health systems can provide a comprehensive view that can help prioritize future efforts and promote the implementation of EBM in the health systems [ 17 ]. Hence, the main purpose of this study was to develop a map of the potential facilitators and barriers to EBM in health systems.…”