Questions for future evidence-informed policy initiatives: insights from the evolution and aspirations of National Immunization Technical Advisory Groups

Abstract

Background: Attention to evidence-informed policy has grown; however, efforts to strengthen the quality and use of evidence are not starting from a blank slate. Changes in health architectures and financing pose different considerations for investments in evidence-informed policy than in the past. We identify major trends that have shifted the environment in which health policies are made, and use the evolution and future aspirations of National Immunization Technical Advisory Groups (NITAGs) in low-and middle-income countries to identify questions the sector must confront when determining how best to structure and strengthen evidence-informed health policy.Discussion: Trends over the last two decades have resulted in a dense arena with many issue-specific groups, discrete initiatives to strengthen evidence-informed policy and increasing responsibility for subnational institutions. Many countries face a shifting resource base, which for some reduces the amount of resources for health. There is global momentum around universal health coverage, reflecting a broader systems approach, but few examples of how the vast array of stakeholders relate within it are available. NITAG aspirations reflect four interconnected themes related to their scope, their integration in national policy processes, health financing and relationships with ministries of finance, and NITAG positioning relative to other domestic and international entities, raising questions such as, What are the bounds of issue-specific groups and their relationship to allocation decision-making processes across health areas? How do technical advisory groups interface with what are inherently political processes? When are finances considered, by whom and how? What is the future of existing groups whose creation was intended to enhance national ownership but who need continued external support to function? When should new entities be created, in what form and with what mandate?Conclusions: Countries must determine who makes decisions about resources, when, using what criteria, and how to do so in a robust yet efficient way given the existing and future landscape. While answers to these questions are necessarily country specific, they are collective matters that cannot be addressed by specialised groups alone and have implications for new investments in evidence-informed policy.

A review of the functionality of Technical Working Groups (TWGs) in enabling Evidence Informed Decision Making (EIDM) within Malawi's Ministry of Health and Population: A cross-sectional qualitative study

“…The study established variations in the capacity of TWGs to generate, synthesize and use research evidence, and this means that efforts to build technical capacity should further be strengthened. These results are consistent with ndings of other studies (7)(8)(9)13). Bell (9) further noted that time and publication languages were barriers to use of evidence by decision and policy makers including TWGs.…”

“…Despite the gap and challenges on the structure and the functionality of TWGs in Malawi and several other countries, there is lack of clarity on how research evidence is utilised in different TWG platforms to inform decisions, and how the TWG discussions are processed and contribute to decision-making at higher levels (9,12,13). This calls for a need to understand the functionality and effectiveness of TWGs in ful lling their de ned mandates, thus the aim of this study.…”

The National Immunization Technical Advisory Group in Israel

“…Formation of national immunization policy by governments is supported by the independent, structured and evidence-informed recommendations and guidance provided by the NITAGs [49]. The issue of allocated budgeting and the part of the Ministry of Finance have been described as highly influential regarding if, when and how NITAG recommendations are adopted and implemented [50]. The NITA Gs worldwide vary as to their affiliation and proximity to the national government, mainly to the Ministry of Health [5][6][7].…”

Lessons learned from strategies for promotion of evidence-to-policy process in health interventions in the ECOWAS region: A rapid review

“… 15 18 22 A TAG or an SC has been defined as a group of health policy actors/experts who meet on a regular basis to decide on, guide, and evaluate a project's implementation, and to recommend strategies on how to best to achieve the project's goal and objectives. 15 49 Available reports have shown that both TAG and SC have played vital roles in bridging the divide between research and policy and promoting EIPM. Such groups and committees have functioned as health coordination mechanisms and have strengthened the development of a sector-wide approach in facilitating EIPM.…”