In 2008, Makerere University began a radical institutional change to bring together four schools under one College of Health Sciences. This paper’s objective is to demonstrate how the University’s leadership in training, research and services has impacted health in Uganda. Data were collected through analysis of key documents; systematic review of MakCHS publications and grants; surveys of patients, students and faculty; and key informant interviews of the College’s major stakeholders. The researchers found that the University inputs to the health sector include more than 600 health professionals graduating per year, many of whom assume leadership positions. University contributions to processes include strengthened approaches to engaging communities, standardised clinical care procedures and evidence-informed policy development. Outputs include the largest number of out-patients and in-patient admissions in Uganda. Outcomes include an expanded knowledge pool, and contributions to coverage of health services and healthy behaviours. Pilot projects have applied innovative demand and supply incentives to create a rapid increase in safe deliveries (three-fold increase after three months), and increased quality and use of HIV services with positive collateral improvements on non-HIV health services at community clinics.
Monitoring equity and research policy
The Ghanaian government’s strategy on orphans and vulnerable children (OVCs) recommends they should be encouraged to live in their home communities rather than in institutions. The paper presents lessons here on efforts to use research to build a response across different agencies to address the problems that communities and families face in caring for these children in their communities. This approach to building consensus on research priorities points to the value of collaboration and dialogue with multiple stakeholders as a means of fostering ownership of a research process and supporting the relevance of research to different groups. The authors argue that if the context within which researchers, policy makers and stakeholders work were better understood, the links between them were improved and research were communicated more effectively, then better policy making which links across different sectors may follow. At the same time, collaboration among these different stakeholders to ensure that research meets social needs, must also satisfy the requirements of scientific rigour.
In this study, researchers conducted a comparative analysis of cotrimoxazole preventive therapy (CPT) in Malawi, Uganda and Zambia. They held 47 in-depth interviews to examine the influence of context, evidence and the links between researcher, policy makers and those seeking to influence the policy process. In relation to context, they found a number of factors to be influential, including government structures and their focus, funder interest and involvement, healthcare infrastructure and other uses of cotrimoxazole and related drugs in the country. In terms of the nature of the evidence, the researchers found that how policy makers perceived the strength of evidence behind international recommendations was crucial (if evidence was considered weak then the recommendations were rejected). Finally, the links between different research and policy actors were considered of critical importance, with overlaps between researcher and policy maker networks crucial to facilitate knowledge transfer. Within these networks, in each country the policy development process relied on a powerful policy entrepreneur who helped get CPT onto the policy agenda.
This qualitative study focuses on the research communication and policy-influencing objectives, strategies and experiences of four research consortia working in sexual and reproductive health, HIV and AIDS in nine countries in sub-Saharan Africa and Asia. The authors carried out 22 in-depth interviews with researchers and communications specialists to identify factors that affect the interaction of research evidence with policy and practice, using an adapted version of the Overseas Development Institute’s RAPID analytical framework. Results indicated that the characteristics of researchers and their institutions, policy context, the multiplicity of actors, and the nature of the research evidence all play a role in policy influencing processes. Research actors perceived a trend towards increasingly intensive and varied communication approaches. Effective influencing strategies include making strategic alliances and coalitions and framing research evidence in ways that are most attractive to particular policy audiences. Tensions include the need to identify and avoid unnecessary communication or unintended impacts, challenges in assessing and attributing impact and the need for adequate resources and skills for communications work. The authors conclude that the adapted RAPID framework can serve as a useful tool for research actors to use in resolving tensions.
In this study, researchers analysed the impact of the report ‘Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in a New Era’, which was published in 2007 and built a picture of the HIV and AIDS epidemic as a humanitarian emergency, requiring urgent action from international organisations, external funders and governments. Following a targeted communications effort, the report was believed to have raised the profile of the issue and Swaziland - a success story for HIV and AIDS research. The authors conducted a literature search on the significance of understanding the research-to-policy interface, using the report as a case study. They explored key findings from the assessment, suggesting lessons for future research projects. They demonstrate that, although complex, and not without methodological issues, impact assessment of research can be of real value to researchers in understanding the research-to-policy interface. Only by gaining insight into this process can researchers move forward in delivering effective research, they argue.
The case-studies presented in this paper analyse findings from sexual and reproductive health and HIV research programmes in sub-Saharan Africa, including Ghana, South Africa and Tanzania. The analysis emphasises the relationships and communications involved in using research to influence policy and practice and recognises a distinction whereby practice is not necessarily influenced as a result of policy change – especially in SRH – where there are complex interactions between policy actors. Both frameworks demonstrate how policy networks, partnership and advocacy are critical in shaping the extent to which research is used and the importance of on-going and continuous links between a range of actors to maximise research impact on policy uptake and implementation. The case-studies illustrate the importance of long-term engagement between researchers and policy makers and how to use evidence to develop policies which are sensitive to context: political, cultural and practical.
Assessing the impact that research evidence has on policy is complex, the authors of this paper argue, and they review some of the main conceptualisations of research impact on policy, including generic determinants of research impact identified across a range of settings, as well as the specificities of sexual and reproductive health (SRH) in particular. They identify aspects of the policy landscape and drivers of policy change commonly occurring across multiple sectors and studies to create a framework that researchers can use to examine the influences on research uptake in specific settings, to guide attempts to ensure uptake of their findings. The framework distinguishes between pre-existing factors influencing uptake and the ways in which researchers can actively influence the policy landscape and promote research uptake through their policy engagement actions and strategies. The authors conclude by highlighting the need for continued multi-sectoral work on understanding and measuring research uptake and for prospective approaches to receive greater attention from policy analysts.
This case study from South Africa focuses on the lessons learnt from communicating the results of four trials evaluating treatment for herpes simplex virus type 2 (HSV-2) as a new strategy for HIV prevention. The authors show that contextual factors such as misunderstandings and mistrust played an important role in defining the communications response. Use of different approaches in combination was found to be most effective in building understanding, credibility and trust in the research process. During the communication process, researchers acted beyond their traditional role of neutral observers and became agents of social change. This change in role is in keeping with a global trend towards increased communication of research results and presents both opportunities and challenges for the conduct of future research. Despite disappointing trial results which showed no benefit of HSV-2 treatment for HIV prevention, important lessons were learnt about the value of the communication process in building trust between researchers, community members and policy-makers, and creating an enabling environment for future research partnerships.
This qualitative study focuses on the research communication and policy influencing objectives, strategies and experiences of four research consortia working on sexual and reproductive health (SRH), HIV and AIDS. The researchers carried out 22 in-depth interviews with researchers and communications specialists (research actors) from the four consortia and their partners, working in nine countries in sub-Saharan Africa and Asia. They found that the characteristics of researchers and their institutions, policy context, the multiplicity of actors, and the nature of the research evidence all play a role in policy influencing processes. Research actors perceived a trend towards increasingly intensive and varied communication approaches. Effective influencing strategies include making strategic alliances and coalitions and framing research evidence in ways that are most attractive to particular policy audiences. Tensions include the need to identify and avoid unnecessary communication or unintended impacts, challenges in assessing and attributing impact and the need for adequate resources and skills for communications work.
This article presents the most recent World Health Organisation framework for strengthening health systems and considers how health economics research can be used to measure achievements against each of the goals of the framework. Benefits to health systems strengthening of incorporating health economics tools into operational research are highlighted. Finally, health economic tools are placed within an impact assessment framework that facilitates the capture of health systems considerations in implementation research for innovations in tuberculosis diagnosis.