SECURE Health Programme: Interventions, Outcomes & Lessonsecsahc.org/wp-content/uploads/2017/04/Programme-Slides1-.pdf · 2017-07-14 · SECURE Health Programme: Interventions, Outcomes

SECURE Health Programme: Interventions, Outcomes & Lessons

Dr. Rose N. Oronje – Director, Science Communication & Evidence Uptake, AFIDEP KenyaMs. Nissily Mushani – Advocacy Coordinator, AFIDEP Malawi

Mount Meru Hotel, Arusha – February 22, 2017

1

Ministry of HealthParliament of Kenya

Ministry of HealthParliament of Malawi

We make research evidence matter in African-driven development

AFIDEP

• Is an African-led, regional non-profit policy think tank set up in 2009 to bridge the gap between development research, policy & practice in Africa

• Promotes use of research evidence in decision-making processes by addressing barriers in knowledge translation & use:– Fragmented evidence, inappropriate packaging,

discordance between research needs vs research generated, weak linkages, & weak capacity


Vision & Mission

Vision: • We make research evidence matter in African-

driven development

Mission: • To translate and enable utilisation of evidence

in policymaking, primarily in the field of population and sustainable development and health system strengthening in Africa


Our Purpose & Programmes

• Purpose: • Facilitate translation & utilization of research

evidence to strengthen political leadership, investment, & programme effectiveness in Africa

• Modalities of work: – Knowledge Synthesis & Translation – Evidence-based Advocacy– Capacity Strengthening


Areas of Focus

• Population Change & Sustainable Development

• Health Systems Strengthening

Sustainable socio-economic development

Increased demand, access & utilization of socio-economic services

Political commitment &

policy environment improved

Planning & Resource allocation

enhanced

Program design & implementation

enhanced

The Challenge: Fragmented research evidence, evidence not well packaged, evidence produced not evidence needed, weak local capacity to generate & apply evidence, politics & interests

Knowledge Generation & Synthesis

Capacity Strengthening

Knowledge Translation & Utilisation

Wha

t we

do

Background to the SECURE Health Programme


Background

• Research is central to the attainment of the goal & mandate of ECSA Member States in tackling health challenges

• In 2009, ECSA Health Ministers Conference (HMC) passed a resolution to improve thegeneration & use of health research– HMC renewed the Resolution in 2011


SECURE Health Programme

• In Nov 2013, AFIDEP partnered with ECSA & other institutions to design & implement the Strengthening Capacity to Use Research Evidence in Health Policy (SECURE Health) Programme

• At national level, programme goal was to: – Support strengthening of institutional & individual

capacity needed to stimulate demand & use of research evidence in decision-making in the Ministry of Health & Parliament in Kenya & Malawi



At regional level, programme was to: • Work with ECSA-Health Community to stimulate

increased focus on implementing HMC Resolutions on Research Evidence

• Share lessons & tools emerging out of the SECURE Health programme in Kenya & Malawi with ECSA Member States


SECURE Health was a Partnership• SECURE Health was a consortium of 5

institutions partnering with MoH & Parliament in Kenya & Malawi– FHI 360, College of Medicine, ECSA-Health

Community; CNHR-Kenya; UK’s Parliamentary Office of Science & Technology is a collaborator

• Implemented in partnership with MoH & Parliament

• 3-year programme – Nov 2013-Jan 2017

• Funded under DFID’s Building Capacity to Use Research Evidence (BCURE) programme


Past SECURE Health Meetings at ECSA Best Practices Forums

• 1st Meeting in Nov 2014 in Arusha to:– Understand progress towards meeting the 2009/2011

Resolutions– Introduce SECURE Health programme

• 2nd Meeting in Nov 2015 in Port Louis, Mauritius to:– Understand progress towards meeting the 2009/2011

Resolutions– Share progress & emerging lessons from SECURE Health

programme

• 2015 meeting informed a new resolution by HMC


In 2015, the 62 HMC Passed a new Resolution on Evidence Use

ECSA/HMC62/R7: Strengthening the Use of Evidence in Health PolicyUrging Member States to: • Accelerate the implementation of past

resolutions on health research and evidence-based policy making.

• Strengthen coordinating mechanisms for health research

• Directs the Secretariat to Mobilize resources to support regional research initiatives through the ECSA Research Advisory Panel


Meeting Objectives

• Share lessons learnt from programmeimplementation in Kenya & Malawi

• Share some of the tools developed by the programme to support & enable evidence use in decision-making

• Explore opportunities for countries to adapt programme tools and/or implement effective interventions for increasing evidence use


Expected Outcomes

• Increased understanding of what works in efforts to strengthen capacity for increased evidence use

• Increased awareness of existing tools for promoting, supporting & enabling evidence-informed decision-making

• Increase commitment to efforts that enable increased & better use of evidence in decision-making

Lessons & Tools from Implementation of SECURE Health Programme



Primary goal of SECURE Health was to:• Support strengthening of institutional & individual capacity

needed to stimulate demand & use of research evidence in decision-making in the Ministry of Health & Parliament in Kenya

Specific Objectives:• Optimize institutional leadership & capacity to enhance

evidence use• Enhance individual skills & capacity of policymakers in the

MoH & legislature in accessing, appraising, synthesizing & using evidence


Interventions implemented to achieve…

Objective 1: Institutional Capacity

• Sustained advocacy 4 increased priority to research evidence• One-on-One meetings; Annual R2P

Conferences; Regional engagement thru ECSA forums for Ministers & Directors

• Develop Guidelines for Evidence Use in Decision-Making

• Develop Research for Health Policy & Priorities in Kenya

• Assess effectiveness of the Malawi National Health Research Agenda

• Hosting of regular dialogues to discuss evidence on urgent health issues

Objective 2: Individual Capacity

• Developed a Comprehensive Training Curriculum on Evidence-Informed Policy-Making

• Trained & mentored technical staff in MoH & Parliament on Evidence-Informed Policy-Making

• One-month internship for parliament staff in the UK parliament


Monitoring, Learning & Evaluation

Internal MLE: • Baseline & end-line surveys• Mid-term review• Retrospective & prospective policy analysis

studies to examine the role of evidence in actual policymaking

• Pre- & post-training tests, bi-monthly interviews with EIPM trainees

• In-depth interviews with select beneficiaries

• Observation & documentation

External evaluation: • DFID commissioned

external evaluation that has been implemented alongside programmeimplementation

What Difference has the Programmemade at Institutional Level?


Programme provided a ‘Roadmap’ to Operationalise Evidence-Informed Policy-

Making • Programme initiated when opportunities for improving EIPM

had opened up in the context, but there were lacking practical interventions– Presence of the Malawi KTP – Kenya MoH had just formed Division of R&D – Parliament had just hired more than 20 researchers who

required capacity building in EIPM

• Programme’s interventions not only provided a roadmap for operationalizing EIPM…– But also enabled gov’t to maximize returns on the EIPM windows of

opportunities that had just opened


Stimulated & Increased Priority to EIPM among Leaders

• Formation of a caucus of MPs to champion evidence use in parliament in Kenya

• Introduction of a budget-line for MoH’s R&D Unit• Triggered considerations at MoH to adopt Evidence Use as

an indicator for performance – Evidence tools from programme to support ISO quality

certification • Stimulated interest at KEMRI to review its research

dissemination efforts • Stimulated interest at CoM to introduce a training module

on evidence use in graduate training programmes


Provided MoH & Parliament with Institutional Tools for Entrenching & Enabling EIPM

• Guidelines for Evidence Use in Policy-Making developed & adopted by MoH– Parliament yet to adopt Guidelines

• Training Curriculum on Evidence-Informed Policy-Making– Tested & proven curriculum now available

open access online for use & adaption

• Contributed to ongoing development of the Research for Health Policy & Priorities


Stimulating improvements in the Health Sector Policy Development Process

• Policy analysis studies revealed challenges for evidence use in past decision-making processes that MoH has discussed & committed to address

• Development of evidence use guidelines stimulated the development of guidelines for policy development by MoH– Consultative process of developing guidelines identified the lack of

guidelines on policy development as a gap that MoH is now addressing


Enhanced the Positioning of MoH & Parliament for Future EIPM Efforts • Respondents have argued that MoH is now better positioned

to participate in evidence use initiatives – Such as the WHO Data Collaboration largely because of the

programme

• Others argued that the two institutions now have a ‘platform & products to seek additional resources’ for strengthening EIPM

• For Parliament, with the MPs Evidence Caucus having its secretariat in the Research Unit, future parliaments will build on this

What Difference has the Programmemade at Individual Level?


Increased Awareness & Mindset Shift on EIPM

• Trained staff have reported increased awareness & mind-set change on EIPM:

“Without evidence, you are basing it on nothing. (I now have) research mindedness rather than making sweeping policy statements.”


Improved Skills & Confidence in EIPM

• Staff trained & mentored report & demonstrate improved knowledge & skills in EIPM that are helping them work better – Parliament has reported improved quality of evidence briefs – Trained staff have a stronger sense of their role & proactive

contribution, e.g. proactive researching on trending topics; digging deeper into evidence & issues, not just what members want to hear; sense of mission

• Skills in accessing evidence, appraising its quality, synthesizing it & using it in decision-making


Pre & Post Training Test Results: Perceived Impact

The overall rating of the effectiveness of the training workshops in improving participants’ knowledge, skills, & attitudes for accessing, appraising, synthesizing & applying evidence was well above 4 on a Likert scale, for all workshops

Effect of training on skills:• Participants’ ratings of their

skills in accessing, appraising, synthesizing & applying evidence pre & post training revealed an increase of 1 or more points

Effect of training on technical barriers to evidence use• Participants’ rating of these barriers

improved, indicating that the training had helped alleviate the barriers


Stimulated Increased Peer-Support for ensuring quality evidence to committees

• Parliament staff have introduced opportunities for peer-support to enhance quality of briefs to committees – ‘Evidence clinics’


Produced Evidence Champions

• Some policymakers who have interacted with the programme, esp. those trained under EIPM training programme, have become active champions of evidence within their units – Some are championing & modeling specific ways of

working that nurture a culture of evidence use

Highlights from Policy Analysis Study on Evidence Use in Past Health Sector Policy Development


What Role is Evidence Playing in Actual Policy Development at MoH?

SECURE Health Programme conducted a policy analysis study in 2014-2015 to understand the role of evidence in actual policy development in MoH in Kenya & Malawi

Study Objective: To assess the role of evidence in past policy formulation processes by the MoH & the factors that influenced the use of research evidence in the policy-making processes


• Qualitative case study approach

• 3 policies selected in Kenya:• The Malaria Policy 2010• The National Adolescent Sexual & Reproductive Health policy 2015• The Kenya Health Policy 2014-2030

• 3 policies selected in Malawi:• the Guide for the Management of Malaria (2007)• the Malawi Guidelines for Clinical Management of HIV in Children and

Adults (2011)• the National Sexual and Reproductive Health and Rights Policy (2009)

• Data collection methods• Document analysis of the selected policies• Key informant interviews with policy actors involved in each of the policy case studies –

29 & 21 interviews conducted in KE & MLW respectively• A review of secondary sources of information

Methodology


Key Findings

• Kenya MoH lacks guidance for policy formulation – Policy formulation is about dep’ts/divisions assembling a team

from within & out of the MoH to develop a policy

• There are deliberate efforts to use evidence – But quality of evidence used is often poor– Evidence use hampered by weak capacity

• Policy formulation is financed & facilitated by donors – Has implications for evidence use


1. MoH needs to invest in:• Capacity building in evidence-informed policy-making• Policy formulation

2. Policy Dep’t needs to: • Operationalize the guidelines for policy formulation• Operationalize the guidelines for evidence use in policy-

making3. Improve the management of gov’t data relevant for policy

formulation4. Establish a portal for research evidence relevant to policy5. Institute interim expertise sharing mechanisms that

strengthen internal capacity (as opposed to consultants)

Recommendations

So, what do all this tell us?

Lessons & Reflections from Programme Implementation


Strengthening Institutional Leadership & Support Mechanisms for EIPM is Central

• But this is more difficult, complex, & requires long-term efforts: – MoH Guidelines for Evidence Use need to be institutionalised into

existing processes for them to be actively used – EIPM Curriculum needs to be incorporated into existing training

institutions (after piloting)– No guarantee that stronger institutional support will translate to

increased evidence use

• Requires funding, which is often lacking

• Underpinned by building & sustaining meaningful relationships & trust– Can be resource-intensive, but is rewarding once r/ships are functional


Lessons from the EIPM Training Programme

• Well-designed & executed EIPM training programmes can improve knowledge & skills in evidence uptake

• Follow-up programmes in contexts with weak culture for evidence use & general accountability need careful & intense planning– Need to think about incentives - Is the solution close involvement of

supervisors before & after the training?– Can drain project resources

• Ownership of such programmes by beneficiary gov’t agencies is crucial– So is sustained high-level engagement which can be time-consuming,

but is critical to embedding programmes & sustaining change


In Conclusion …

• Changing institutions is complex & requires long-term investments – Programme has only scratched the ground

• Although programme had great effects on individual technical skills, these gains could be lost if efforts to address persisting institutional bottlenecks are not sustained

• There exist many opportunities for entrenching a culture of evidence use– Longer-term efforts are needed to translate opportunities into

action


Points for Discussion

• Thoughts/reflections on whether & how other countries could adapt Guidelines for Evidence Use for their countries

• Thoughts/reflections on how training curriculum for evidence-informed policy-making could benefit other countries

• Other views, reflections, question


We Acknowledge our Partners

Government of Kenya: Ministry of Health, Parliament

Government of Malawi: Ministry of Health, Parliament

Documents

SECURE Health Programme: Interventions, Outcomes & Lessonsecsahc.org/wp-content/uploads/2017/04/Programme-Slides1-.pdf · 2017-07-14 · SECURE Health Programme: Interventions, Outcomes