Policy decisions should be informed by the best available research evidence. Evidence-informed decision making is characterised by systematic and transparent approaches to access, appraise and use evidence as an input to the decision-making process (1). Policy-makers need robust evidence to clarify what services and programmes to offer, how to deliver them and how to implement change (2). Evidence is thus required at various stages of the policy-making process – in defining the problem, assessing potential policy and programme options and in identifying implementation considerations. The Policy BUDDIES – Building Demand for evidence in Decision making through Interaction and Enhancing Skills project is funded by the World Health Organization (WHO). To firstly understand the policymaking process and policymakers’ capacity, as well as enablers and constraints to demanding evidence during policy formulation and implementation we conducted key informant interviews with provincial managers of health programmes related to delivery of Millennium Development Goals 4, 5 and 6.
In most instances, policy development takes place at a National Department level. Where relevant, provinces adapt and translate these policies based on the local context and fiscal considerations, practical, and logistical realities. Various role players are involved in the policy adaptation and translation process, for example bureaucrats, politicians, academics and clinicians. The data or evidence that policy makers use includes routine monitoring data and research evidence, and certain academic institutions and experts inform policy content. The main focus at provincial level is on policy implementation.
When commenting on strategies to enhance the use of research evidence in policy development (Figure 1), programme managers emphasised the importance of joint efforts between researchers and policymakers. Working together with a sense of mutual trust and understanding each other’s environments could enhance the relationship. Specific comments that came out of the interviews included that information needs to be packaged in such a way that it grabs the attention of the busy policymakers, that summaries of research evidence are useful and should highlight key findings as well as shortcomings of research, that researchers should be more aware of implementation challenges and that, importantly; there should be interaction between policymakers and researchers.
Overall, a thorough understanding of how the policy process and the health system operate, and the priorities for policymakers, can inform effective dialogue between researchers, those engaged in systematic reviews and those responsible for making decisions in the health services. This will promote links and relationships between researchers and policymakers, potentially enhancing the use of research evidence in decision making. The findings of this assessment will inform the development of our next phase of capacity development. It will also assist us to identify resources to support policymakers and ultimately enhance the links between researchers and policymakers.
The Policy BUDDIES project is a collaborative project by Centre for Evidence-based Health Care; Health Systems and Services Research, Stellenbosch University; South African Cochrane Centre; Liverpool School Tropical Medicine and Centre for the Development of Best Practices in Health, Cameroon. This project is supported by the Alliance for Health Policy and System Research, WHO.
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