Embedding health policy and systems research into decision-making processes in low- and middle-income countries

Abstract

Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization’s Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems.

Feasibility of a rapid response mechanism to meet policymakers' urgent needs for research evidence about health systems in a low income country: a case study

“…What is usually seen when there is need for such evidence is specially convened task forces or think tanks of consultants and experts to address the given situation [38], or special committees and/or advisory bodies [39]. These are similar in a way to the rapid response service described in this paper, although they tend to work more in a reactive manner than proactively.…”

The development of ORACLe: a measure of an organisation’s capacity to engage in evidence-informed health policy

“…Tools and programs to assist leaders of the organisation to actively support the use of research in policy and program development• Training workshops and programs or professional development opportunities to build leadership capacity to support use of research in policy and program development• Organisational leadership and champions of research within the organisation, with a clear vision for research use in policymaking• Incorporation of research use capacity and research skills into position descriptions, retention mechanisms, performance reviews, performance management mechanisms, and appraisals for senior policymakers• Organisational leaders disseminate research through their internal communications (e.g., newsletters, bulletins, updates, tweets, etc.) or other structured mechanisms• Tools and systems to help organisational leaders to disseminate research through their internal communications (e.g., mailing lists, tailored-targeted messages, research monitoring services, specialist staff including knowledge brokers)[9, 11, 14, 19, 27, 28, 49, 65–68]iii. Availability of programs to provide staff with training in using evidence from research in policy and in maintaining these skills• Training workshops and programs for staff to improve research skills• Professional development opportunities to build research skills, or opportunities to undertake university courses• Provision of education in research• Training provided by the in-house library staff• Possessing technical capacity within the organisation to train staff to access and apply research findings to policy• Incorporating participation in training programs and development of research skills into staff performance management mechanisms, retention, and/or promotion[11, 16, 19, 20, 24–26, 28, 48, 64, 69]iv.…”

Improving the use of health data for health system strengthening

“…They can jointly analyze and interpret data to answer programmatic questions. By understanding who your data users and producers are and linking them to each other's work, ownership of data is clarified, the information cycle is strengthened, data-informed decisions are made, and the value of data in relation to program improvement becomes clear (11, 16, 17, 22–24). …”

“…With this knowledge they are able to focus on collecting information that is directly linked to decision making. (16, 24, 33). …”