Research, evidence and policymaking: the perspectives of policy actors on improving uptake of evidence in health policy development and implementation in Uganda

Abstract

BackgroundUse of evidence in health policymaking plays an important role, especially in resource-constrained settings where informed decisions on resource allocation are paramount. Several knowledge translation (KT) models have been developed, but few have been applied to health policymaking in low income countries. If KT models are expected to explain evidence uptake and implementation, or lack of it, they must be contextualized and take into account the specificity of low income countries for example, the strong influence of donors. The main objective of this research is to elaborate a Middle Range Theory (MRT) of KT in Uganda that can also serve as a reference for other low- and middle income countries.MethodsThis two-step study employed qualitative approaches to examine the principal barriers and facilitating factors to KT. Step 1 involved a literature review and identification of common themes. The results informed the development of the initial MRT, which details the facilitating factors and barriers to KT at the different stages of research and policy development. In Step 2, these were further refined through key informant interviews with policymakers and researchers in Uganda. Deductive content and thematic analysis was carried out to assess the degree of convergence with the elements of the initial MRT and to identify other emerging issues.ResultsReview of the literature revealed that the most common emerging facilitating factors could be grouped under institutional strengthening for KT, research characteristics, dissemination, partnerships and political context. The analysis of interviews, however, showed that policymakers and researchers ranked institutional strengthening for KT, research characteristics and partnerships as the most important. New factors emphasized by respondents were the use of mainstreamed structures within MoH to coordinate and disseminate research, the separation of roles between researchers and policymakers, and the role of the community and civil society in KT.ConclusionsThis study refined an initial MRT on KT in policymaking in the health sector in Uganda that was based on a literature review. It provides a framework that can be used in empirical research of the process of KT on specific policy issues.

Evidence-based practice in local public health service in Ghana

“…Several studies have identified lack of training in EBPH as a major hindrance to incorporating evidence into health decisions and interventions in LMICs (Nagpal, Sinclair & Garner 2013;Oliver et al, 2014). For instance, a study by Orem et al (2012) in Uganda which explored the perspectives of policy actors on improving the uptake of evidence in health policy development and implementation identified capacity building in evidence-based practice as key to improving the use of evidence in decision-making. Armstrong et al's (2014) study conducted among Australian local public health managers also revealed that managers who had received training in EBPH had increased level of confidence in searching, assessing quality and combing various sources of evidence to aid decision-making.…”

A call for a backward design to knowledge translation

“…KT platforms), and supportive policy structures for implementation of research evidence (plans, guidelines, monitoring frameworks) (6). These are crucial as they can potentially offset the consequences of the high turnover in government related to leakage of capacity, discontinued relationships and shuffled priorities.…”

“…inadequate food safety laws and weak governance) and prioritize research areas and review questions. Establishing a sustained partnership with all relevant stakeholders that spans the entire process from setting the research agenda to implementation, increases the acceptability of the evidence among stakeholders, which in turn, promotes its uptake and use in policy-making (6,11,14). Although the role of civil societies and community representatives remains largely unexplored (15), involving the latter two groups is important in light of the increasing push for people-centred care and people-centred health systems.…”

“…Despite international initiatives to support the use of research evidence, variations in uptake of evidence persist (8). In this editorial, we bring together and build on existing KT frameworks, theories and gaps to present a simple, yet, holistic approach for promoting evidence-informed health policies (6,7,9). Some of the existing frameworks do not provide emphasis on context and politics.…”

“…For the purpose of this editorial, we define KT as a "dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the healthcare system" (5). A review of the literature revealed a positive movement towards KT in policy-making, with numerous KT frameworks being developed and proposed over the last decade to promote evidence-informed policies (6,7). Despite international initiatives to support the use of research evidence, variations in uptake of evidence persist (8).…”