Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches

CITATION: Langlois, E. V., et al. 2016. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches. Health Research Policy and Systems, 14:20, doi:10.1186/s12961-016-0089-0.The original publication is available at http://health-policy-systems.biomedcentral.comENGLISH SUMMARY : Background: There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings. Methods: The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals’ abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a ‘buddying’ process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design. Results: In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge. Conclusions: The collaborative evidence-to-policy approaches underline the importance of iterations and continuity in the engagement of researchers and policymakers/programme managers, in order to account for swift evolutions in health policy planning and implementation. In developing and supporting evidence-to-policy interventions, due consideration should be given to fit-for-purpose approaches, as different needs in policymaking cycles require adapted processes and knowledge. Greater consideration should be provided to approaches embedding the use of research in real-world policymaking, better suited to the complex adaptive nature of health systems.http://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-016-0089-0Publisher's versio

Evaluation of Communities of Practice performance developing implementation research to enhance maternal health decision-making in Mexico and Nicaragua

Abstract Background Despite the existence of proven solutions to improve maternal health, innovative approaches are still necessary to support the implementation of programs and policies in real-world settings. To address this challenge, we developed a participatory capacity strengthening model based on Communities of Practice (CoPs) of maternal health frontline personnel and decision-makers involved in implementing maternal health programs in Latin America. The activities focused on the conduct and use of implementation research to enhance maternal health decision-making. Our objective is to evaluate the performance of the Communities of Practice in using implementation research to support decision-making in maternal health programs in Mexico and Nicaragua. Methods We evaluated the CoPs’ performance using a mixed methods approach. We appraised the performance of CoPs using five criteria: (i) integration of the CoP, (ii) ownership of the methodology, (iii) timely delivery of products, (iv) feedback to decision-makers, and (v) influence on program changes. We also included an assessment of the barriers and facilitators to the conduct and uptake of implementation research findings in maternal health decision-making. Results Two CoPs showed “sub-optimal” performance, one was signaled as “needing strengthening,” and three reached “optimal” performance in the use of implementation research to enhance maternal health programs. The relationships between champions, facilitators, and research team were the main internal enabling factor for success. Externally, political and epidemiological environments acted as the main barriers to the performance of CoPs. Conclusions Our study highlights the value of involving decision-makers in CoPs, ensuring varied skill sets and profiles of health professionals, as well as maintaining strong and continuous collaborations with researchers. Collaborative approaches and meaningful engagement of decision-makers and researchers are useful in conducting implementation research and promoting the use of evidence to improve maternal health programs in resource-strained settings

Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches

Abstract Background There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings. Methods The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals’ abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a ‘buddying’ process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design. Results In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge. Conclusions The collaborative evidence-to-policy approaches underline the importance of iterations and continuity in the engagement of researchers and policymakers/programme managers, in order to account for swift evolutions in health policy planning and implementation. In developing and supporting evidence-to-policy interventions, due consideration should be given to fit-for-purpose approaches, as different needs in policymaking cycles require adapted processes and knowledge. Greater consideration should be provided to approaches embedding the use of research in real-world policymaking, better suited to the complex adaptive nature of health systems