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.
Monitoring equity and research policy
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.
In the case-studies presented in this paper, the authors analyse findings from sexual and reproductive health (SRH) and HIV research programmes in sub-Saharan Africa. In their analysis, they emphasise 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. 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.
It is estimated that more than US$130 billion is invested globally into health research each year, yet, according to this paper, priority setting in health research investments remain inequitable. The authors reviewed selected priority-setting processes at national level in low and middle income countries, and outlined a set of criteria to assess the process of research priority setting and use these to describe and evaluate priority setting exercises that have taken place at country level. Data were gathered from presentations at a meeting held at the World Health Organisation in 2008 and a web-based search. A number of findings emerged. Across the countries surveyed there was a relative lack of genuine stakeholder engagement, while countries varied markedly in the extent to which the priority setting processes were documented. None of the countries surveyed had a systematic or operational appeals process for outlined priorities, and in all countries (except South Africa) the priorities that were outlined described broad disease categories rather than specific research questions. The authors argue that priority setting processes must have in-built mechanisms for publicising results, effective procedures to enforce decisions as well as processes to ensure that the revision of priorities happens in practice.
The GAVI Alliance was created in 2000 to increase access to vaccines. More recently, GAVI has supported evidence-based health systems strengthening to overcome barriers to vaccination. The objectives of this study were: to explore countries' priorities for health systems strengthening; to describe published research summaries for each priority area in relation to their number, quality and relevance; and to describe the use of national data from surveys in identifying barriers. From 44 health systems-strengthening proposals submitted to GAVI in 2007 and 2008, the researchers analysed the topics identified, the coverage of these topics by existing systematic reviews, and the use of nation-wide surveys with vaccination data to justify the needs identified in the proposals. Thirty topics were identified and grouped into three thematic areas: health workforce, organisation and management, and supply, distribution and maintenance. The researchers found no reviews that dealt with health information systems, however. Only seven of the reviews were categorised as ‘highly relevant for policy’. In conclusion, researchers found little quality research that was relevant to managers’ needs. Few proposals used national surveys evidence to identify barriers to vaccination. The author recommends that researchers generating or adapting evidence about health systems need to be more responsive to managers' needs.
Malaria is highly endemic in the Democratic Republic of Congo (DRC), but the limits and intensity of transmission within the country are unknown. It is important to discern these patterns as well as the drivers which may underlie them in order for effective prevention measures to be carried out, the authors of this study argue. Using the 2007 Demographic and Health Survey (DHS) for the DRC, the authors generated prevalence estimates and explored the ecological drivers of malaria. Of the 7,746 respondents, 29.3% were parasitaemic, with males were more likely to be parasitaemic than older people or females, while wealthier people were at a lower risk. Increased community use of bed nets and community wealth were protective against malaria at the community level but not at the individual level. This research demonstrates the feasibility of using population-based behavioural and molecular surveillance in conjunction with DHS data and geographic methods to study endemic infectious diseases. The authors suggest that spatial information and analyses can enable the DRC government to focus its control efforts against malaria.
In this study, researchers aimed to validate vaccination data from a longitudinal population-based demographic surveillance system (DSS) against data from a clinical cohort study. The sample included 821 children in the Vertical Transmission cohort Study (VTS), and researchers found that vaccination data in matched children in the DSS was based on the vaccination card in about two-thirds of the cases and on maternal recall in about one-third. In conclusion, the addition of maternal recall of vaccination status of the child to the child’s card information significantly increased the proportion of children known to be vaccinated across all vaccines in the DSS. The authors recommend that information based on both maternal recall and vaccination cards should be used to identify which children have received a vaccination and which have not.