Annals of African Medicine
Home About AAM Editorial board Ahead of print Current Issue Archives Instructions Subscribe Contact us Search Login 


 
Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 21  |  Issue : 3  |  Page : 223-230  

Promoting the use of evidence in health policy-making in the economic commission of the West African States Region: Exploring the perception of policy-makers on the necessity of an evidence-based policy-making guidance


1 Department of Health Policy/Systems, African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, Nigeria
2 Department of Public Health and Research, West African Health Organisation, Bobo Dioulasso, Burkina Faso

Date of Submission30-Sep-2020
Date of Decision03-Mar-2021
Date of Acceptance29-Apr-2021
Date of Web Publication26-Sep-2022

Correspondence Address:
Chigozie Jesse Uneke
African Institute for Health Policy and Health Systems, CAS Campus, Ebonyi State University, PMB 053 Abakaliki
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_90_20

Rights and Permissions
   Abstract 


Background: The West African Health Organization (WAHO) is promoting the use of evidence in policy-making within West Africa. The need for increased understanding of the complexities of the evidence-to-policy process among policy-makers in West Africa necessitates the development of evidence-based policy-making (EBPM) guidance. The purpose of this study was to interact with policy-makers from West African countries to identify the necessity of EBPM guidance for the subregion. Methods: A cross-sectional qualitative study design was used to elicit the views/opinions of senior health policy-makers from across the 15 West African countries on why an EBPM Guidance is necessary for the subregion. The policy-makers were engaged during WAHO-organized regional evidence-to-policy meetings on the improvement of maternal and child health outcomes held in Senegal in 2019. Face-to-face, one-on-one interactions, interviews, and deliberations during the meeting plenary sessions were held with the policy-makers, who participated in the regional meeting. Results: Up to 23 policy-makers representing 15 West African countries participated in the study. Policy-makers who took part in the study supported the development of an EBPM Guidance to facilitate evidence-to-policy process. Among the identified reasons why an EBPM Guidance for West Africa is a necessity were to understand: (i) how to deal with barriers and facilitators that influence evidence to policy process; (ii) how to acquire, access, adapt, and apply available research evidence in policy-making; (iii) how to deal with contextual issues and broad range of evidence; and (iv) how to engage parliamentarians and policy legislators to promote policy development. Conclusion: An EBPM is a valuable tool that can provide health sector policy-makers the needed guide on the evidence-to-policy process. Studies that will evaluate the impact of EBPM guidance on the policy-making process in low- and middle-income countries are advocated.

   Abstract in French 

Résumé
Contexte: L'Organisation Ouest Africaine de la Santé (OOAS) encourage l'utilisation de données probantes dans l'élaboration des politiques en Afrique de l'Ouest. La compréhension de la complexité du processus des données probantes aux politiques auprès les décideurs d'Afrique de l'Ouest nécessite l'élaboration d'un guide d'orientation sur l'élaboration de politiques fondées sur des données probantes. L'objectif de cette étude était d'interagir avec les décideurs politiques des pays d'Afrique de l'Ouest afin d'identifier la nécessité d'un guide d'orientation en matière de politiques fondées sur les données probantes pour la sous-région. Méthodes: Une étude qualitative transversale a été utilisée pour obtenir les points de vue/opinions des responsables de la politique de santé des 15 pays d'Afrique de l'Ouest sur les raisons pour lesquelles un guide d'orientation est nécessaire pour la sous-région. Les décideurs ont été sollicités lors des réunions régionales sur l'amélioration des résultats en matière de santé maternelle et infantile organisées par l'OOAS, qui se sont tenues au Sénégal en 2019. Des interactions individuelles en face à face, des entretiens et des délibérations pendant les sessions plénières de la réunion ont été organisés avec les décideurs politiques, qui ont participé à la réunion régionale. Résultats: Au total 23 décideurs politiques représentant 15 pays d'Afrique de l'Ouest ont participé à l'étude. Les décideurs qui ont pris part à l'étude ont soutenu le développement d'un guide d'orientation pour faciliter le processus de mise en relation des données probantes et des politiques. Parmi les besoins identifiés pour un guide d'orientation pour l'Afrique de l'Ouest, il y avait la nécessité de comprendre : (i) comment traiter les obstacles et les facilitateurs qui influencent le processus de mise en pratique des données probantes dans les politiques ; (ii) comment acquérir, accéder, adapter et appliquer les données de recherche disponibles dans l'élaboration des politiques ; (iii) comment traiter les questions contextuelles et le large éventail de données probantes ; et (iv) comment engager les parlementaires et les législateurs politiques à promouvoir le développement des politiques. Conclusion: Un guide d'orientation est un outil précieux qui peut fournir aux décideurs du secteur de la santé les orientations nécessaires sur le processus de mise en relation des données probantes et des politiques. Des études qui évalueront l'impact de ce guide sur le processus d'élaboration des politiques dans les pays à revenu faible et intermédiaire sont préconisées.
Mots-clés: Données probantes, guide d'orientation, santé, élaboration de politiques, Afrique de l'Ouest.

Keywords: Evidence, guidance, health, policy-making, West Africa


How to cite this article:
Uneke CJ, Sombie I, Johnson E, Uneke BI, Okolo S. Promoting the use of evidence in health policy-making in the economic commission of the West African States Region: Exploring the perception of policy-makers on the necessity of an evidence-based policy-making guidance. Ann Afr Med 2022;21:223-30

How to cite this URL:
Uneke CJ, Sombie I, Johnson E, Uneke BI, Okolo S. Promoting the use of evidence in health policy-making in the economic commission of the West African States Region: Exploring the perception of policy-makers on the necessity of an evidence-based policy-making guidance. Ann Afr Med [serial online] 2022 [cited 2023 Feb 6];21:223-30. Available from: https://www.annalsafrmed.org/text.asp?2022/21/3/223/356834




   Introduction Top


Within the last decade, there has been increasing acceptance worldwide that health policies that are based on evidence are critical toward the achievement of health systems that are very functional and that will result in the improvement of health outcomes in a continuous and efficient manner.[1],[2] The World Health Organization noted that if the evidence is properly used in policy formulation, more lives can be saved because the policies developed will be more effective as they will take into account scientific and technological advances, the use of resources more efficiently and citizens' needs will be better met.[3] In most low- and middle-income countries (LMIC), the health sector stakeholders and policy-makers are increasingly recognizing that policies that are based on evidence are indispensable to the process of strengthening weak country health systems.[4],[5],[6]

The countries in West Africa are among the LMIC with weak health systems and unacceptable health outcomes.[7],[8] As part of the effort to address the weak health systems and improve health outcomes, the West African Health Organization (WAHO), a specialized health institution of the Economic Commission of the West African States, is aggressively promoting the use of evidence in policy-making within the subregion.[9] Bowen and Zwi[10] had argued that a key challenge to public health in most LMICs including those in West Africa for more effective policy-making and practice is to better contextualize evidence.

The process of making use of evidence for policy formulation also referred as evidence-informed policy-making (EIPM) or evidence-based policy-making (EBPM) has been defined as the access and appraisal of different kinds of available evidence in a systematic and transparent manner as input into the process of policy-making.[11] Strydom et al.[12] have noted that in addition to scientific evidence which typically includes research/surveys, quantitative/statistical data, qualitative data, and analysis, evidence also includes economic, attitudinal, behavioral, and anecdotal evidence, as well as experts opinion. According to Salchev et al.[13] in EBPM, there is a shift away from policies and practices that are based on opinion to the approach that is more rigorous, transparent, and rational in assembling and appraising high-quality research evidence in a critical way to inform the health policy-making process, health system operations, and professional practice.

It is pertinent to state that the combination of different forms of evidence not only creates but also acknowledges the different contexts in which knowledge exists and understood.[14] Adequate combination of both scientific and other forms of evidence is therefore the hallmark of evidence-based decision-making, a process that must be employed if effective and result-oriented health policies are to be achieved in a region like West Africa. The bottom line here is that policy-making is a complex process, that is neither linear nor predictable, often described as incremental and messy and the initial assumptions that research outputs or other forms of evidence will easily be integrated into policy-making are now recognized widely as naïve.[15] Jones and Walsh[16] had earlier noted that the integration of evidence into policy decision-making is a complicated process of which multiple sets of influences, compete and/or intertwine to determine the policy outcome, with evidence playing just one of many roles.

The need for a better understanding of the complexities of the evidence to policy process among policy-makers in West Africa and also the necessity for guidance on EBPM have been advocated.[17],[18],[19],[20] A guidance has been defined as “the systematically developed body of knowledge, integrating research evidence and descriptions of the types of other considerations needed to inform decision making about appropriate health system arrangements in specific settings.”[21] There is a scarcity of guidance documents with a specific focus on EBPM targeted at low-income settings. As part of the process leading to the development of an EBPM Guidance, we interacted with policy-makers from West African countries to identify the necessity of such vital guidance for the subregion.


   Methods Top


Setting

The 15 countries that make up the West African subregion include Benin, Burkina Faso, Cape Verde, Cote d'Ivoire, the Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Nigeria, Niger, Sierra Leone, Senegal, and Togo. With a combined population size of up to 360 million, the subregion is home to about one-third of the entire African population and majority of the countries have a poor Human Development Index.[7] Some countries in the subregion such as the Gambia, Liberia, Nigeria, Mali, Benin, and Sierra Leone record maternal mortality rate (MMR) and under-five mortality rates (U5MR) that are among the highest in the world (MMR 706–1360/100,000 and U5MR 100–118/1000).[8] The region has a rich and complex social structure which to a large extent influences the policy-making process.

Design

We employed a cross-sectional qualitative study design to elicit the views/opinions of senior health policy-makers from across the 15 West African countries on why an EBPM Guidance is necessary for the subregion. The policy-makers were engaged during WAHO-organized regional evidence-to-policy meeting on the improvement of maternal and child health outcomes held in Senegal in 2019. Face-to-face, one-on-one interactions and interviews were held with the policy-makers representing each of the 15 West African countries who participated in the regional meeting. The policy-makers were engaged before the meeting started, during break time, and at the end of the meeting. The interaction lasted about 10 min and notes were taken on the response of the participants. The policy-makers were asked if an EBPM Guidance for West Africa was necessary and if yes, how they thought such Guidance can help to promote the evidence-to-policy process within the context of West Africa. The importance and need for the EBPM Guidance were also discussed during the meeting plenary sessions and additional information in that regard was obtained. Prior to the engagement, verbal consent to participate in the study was obtained from all participants. At the end of the meeting, all responses were reviewed and analyzed using the phenomenological approach first described by Giorgi[22] and elaborated by Albert et al.[23] The following sequence was employed in the analysis: (i) going over all the textual data to gain an overall impression; (ii) identifying all comments/responses that appeared noteworthy to the research and extracting these meaning units; and (iii) independent abstracting of the meaning units, followed by discussion and consensus.


   Results Top


Up to 23 policy-makers representing 15 West African countries participated in the study. All the policy-makers who took part in the study fully supported the development of an EBPM Guidance to facilitate evidence-to-policy process. Following the review of their responses and comments, the identified necessity for an EBPM Guidance for West Africa was categorized into nine items, as summarized in [Table 1].
Table 1: Summary of the identified necessities for guidance for evidence-based policy-making for West Africa

Click here to view



   Discussion Top


The outcome of this study clearly suggests that the West African health policy-makers are in support of the development of an EBPM guidance that will foster effective use of evidence in policy formulation and implementation in the region. Their views are consistent with reports from a number of previous studies that advocated for mechanisms (including an EBPM guidance) that will enhance the understanding and skill of policy-makers on how best to use evidence in policy-making within the context of West Africa.[17],[18],[19],[20] In the following sections, we discuss the items suggested by the West African policy-makers on why an EBPM Guidance is a necessity.

To understand how to deal with barriers and facilitators that influence evidence to policy process

The policy-makers noted that EBPM guidance should help them to understand how to deal with barriers and facilitators that influence evidence-to-policy process. The process of EBPM is often characterized by multiple barriers and facilitators that are country and context specific. It is important for an EBPM guidance to take these factors into consideration. Commonly identified barriers include lack of policy-relevant research, lack of adequate support by the government, weak policy-making organizational and administrative structure, policy-makers with capacity constraint to acquire, assess, adapt, and apply evidence, as well as low demand for scientific evidence by policy-makers.[18],[24],[25],[26] Among the main facilitators are increased investment into research that is policy-relevant, availability, and enhanced access to research outputs that satisfy policy needs, bridging the gap between and enhancing linkage between policy-makers and researchers, improved dissemination of findings from research, and policy-makers' capacity enhancement in EIPM.[18],[24],[26] Several previous reports have clearly indicated that the successful implementation of strategies to address the know-do-gap is highly dependent on the identification of the barriers and facilitators of uptake of research into policy in each specific setting.[27],[28],[29]

Strydom et al.[12] in a review of the factors influencing the uptake of evidence in decision-making identified the following factors: (a) the manner an organization is composed, its structure, and way it functions, (b) the social and economic contexts, (c) the type of message and way it is communicated, (d) the transparency and authenticity of the information, (e) the credibility and reliability of the knowledge producers or scientist, and (f) the level of cooperation and understanding between policy-makers and scientists in terms of each other's viewpoints, ethics, and priorities. In addition to this, the authors noted that personal value systems and beliefs, as well as perceptions, political power influence, and time constraints are among the key human factors that influence policy-making.[12] These are major considerations that must be taken into account in the development of EBPM guidance.

To understand how to acquire, access, adapt, and apply available research evidence in policy-making

Understanding how to acquire and apply scientific evidence in policy-making is a major capacity constraint to policy-makers. Findings from numerous previous reports suggested that among the major challenges and barriers to the uptake of research evidence into policy and practice among policy-makers in LMIC is the capacity constraints to acquire, access, adapt, and apply available research evidence in policy-making.[30],[31],[32],[33] [31],[32],[33] In line with the advice of MacGregor et al.,[34] an EBPM Guidance should outline mechanisms that will enhance the capacity of policy-makers to acquire (i.e., ability to search and access research evidence), assess (i.e., ability to rigorously appraise the quality and reliability of research evidence), adapt (i.e., ability to contextualize research evidence), and apply (i.e., ability to process use the research evidence for policy formulation). According to Green and Bennett,[35] among the key capacity needs of policy-makers are the competency and skill to access evidence from multiple sources and ability to use the right evidence appropriately in specific policy-making contexts, and an EBPM guidance must take this into account. Without the prerequisite skill and competency, policy-makers will not be able to obtain and synthesize valuable information for policy-making and this can lead to loss of opportunity for shared learning.[36] Given the limited capacity of policy-makers, especially in West Africa, to find and use research evidence, the EBPM guidance must describe strategies and mechanisms that will enhance the skill of policy-makers with a focus on the provision of appropriate tools and resources required to facilitate the acquisition, assessing, adapting, and applying research evidence as recommended by Wilson et al.[37]

To understand how to deal with contextual issues and broad range of evidence that will help diagnose, develop, implement, monitor, and evaluate policies

Although evidence is very important to policy-making, it is by no means the only input into the process. The policy-makers in this study were aware of the challenges associated with dealing with contextual issues in policy formulation. The West African societies have very diverse contexts such as values, beliefs, traditions, religion, and political and governance structure, all of which play a critical role in determining the policy-making process. An EBPM guidance must provide information on how to understand and address the contextual issues in policy-making. Policy-makers have the huge responsibility to exercise considerable judgment about the nature and type of evidence required in a policy-making context when the evidence is needed and from which source and how to ensure that decisions are based on the evidence and in a timely fashion.[38] This is because policy decisions are made in line with other considerations such as the availability of funds that can be used to source for the evidence. This implies that EBPM guidance must show policy-makers how to engage evidence-informed approaches with some level of flexibility so as to properly give adequate attention to the quality, transparency, authenticity, and reliability of the processes through which evidence is acquired and applied.[38] Since contextual factors are known to be extremely important in shaping decisions about health systems, an EBPM guidance should include information about the pros and cons of various policy recommendations and options, the factors that will play a critical or major contributory role in influencing decisions about the recommendations and options in different contexts, and the supporting tools that will guide the policy development.[39]

EBPM guidance should provide recommendations on a broad range of evidence that can help policy-makers to diagnose, develop, implement, monitor, and evaluate their policies. The guidance needs to provide the framework that will guide the use of not only research evidence but also other types of evidence necessary to inform the decisions that need to be taken throughout the policy cycle of diagnosis, formulation, implementation, monitoring, and evaluation.[38],[40]

To understanding how to bridge the gap between research producers and research users within the evidence ecosystem

The policy-makers identified the need to be guided on how to bridge the divide between research and policy. An EBPM guidance should provide the framework on how research evidence can optimally contribute to the improvement and sustenance of the health system performance and how to ensure its transferability between different “evidence ecosystem” elements.[41] The evidence ecosystem is vast and can include those producing primary evidence, synthesizing the evidence, and producing evidence-informed decision products (e.g., researchers); those responsible for implementing evidence-informed options within health systems (e.g., program managers and decision-makers); and those involved in delivering and using health services (e.g., service providers, service users and citizens).[41],[42] The guidance should outline mechanisms that can be employed to bridge the gap between knowledge producers and knowledge users. In the event of scarcity of evidence, especially local or context-specific evidence, one effective way to generate policy-relevant evidence is for policy-makers to commission a research. The guidance should describe how this can be achieved and the possible ways sustainable partnerships can be built between the two parties. Uneke et al.[43] suggested that the types of partnership can include special committees comprising researchers, policy-makers, knowledge brokers, and other stakeholders as members and informal partnerships involving policy-makers and researchers. EBPM guidance should describe how these partnerships can be used to achieve evidence-to-policy-to-practice.

To understand how to use knowledge translation and its application to policy-making

The concept of knowledge translation (KT) is gaining increasing attention in the policy-making arena worldwide and the policy-makers in this study alluded to this. The Canadian Institutes of Health Research defined KT “as the exchange, synthesis and ethically-sound application of knowledge – within a complex system of interactions among researchers and users – to accelerate the capture of the benefits of research through improved health, more effective services and products, and a strengthened health care system.”[44] An EBPM guidance must highlight the KT principle as an interactive process underpinned by effective exchanges between researchers and decision-makers.[45]

The guidance should place emphasis on knowledge dissemination, communication, knowledge management, knowledge utilization, two-way exchange between researchers and those who apply knowledge, synthesis of results with the country context, and development of consensus recommendations all of which are key KT components.[46] An EBPM guidance should contain strategies that will promote the engagement of researchers, policy-makers, practitioners, stakeholders in the health sector, and citizens in mutually beneficial research that can involve the co-creation of knowledge, identification of research questions, collection and analysis of data, and dissemination of the research outputs.[47] Bosch-Capblanch et al.[48] highlighted the need for a guidance document to demonstrate how to translate research on problems, interventions, and implementation into appropriate decisions regarding policies and practice. This is very important in the present dispensation because many policy-makers in LMIC including the West African subregion lack the knowledge of how to translate research on specific health sector policy problems and interventions.[17] There is a growing consensus among guidance developers that among the many processes needed to improve the linkage between research, policy, and practice are frequent iterative involvement from research evidence into policy formulation and from policy evaluation into prioritization of research.[48]

Among such processes is the use of policy briefs and policy dialogues. It is important for the EBPM guidance to emphasize the use of policy briefs and policy dialogues. Lavis et al.[49] described that a policy brief is a reliable evidence-packaging tool that can be used to enhance the policy-making process by supporting EIPM. The authors also described policy dialog as an interactive knowledge-sharing tool that has the potential of bringing research evidence together with the views, expertise, and tacit knowledge of those who will be involved in, or affected by, decisions concerning health issues of high priority.[49]

To understand how to apply systems thinking perspectives in policy-making

Understanding how to apply systems thinking in the policy-making process is important to the policy-makers in this study. The health system is a complex multidimensional entity with components (building blocks) that are constantly interacting and influencing one another.[3] An EBPM guidance should essentially take into consideration the relationships and interactions of the elements that constitute the entire system. This is known as systems thinking, a phenomenon that has gained a global recognition in health systems in recent times. According to Bosch-Capblanch et al.,[48] the production of guidance not only entails putting research evidence into specific context perspectives but also taking cognizance of the health system perspective. De Savigny and Adam[50] defined systems thinking as “an approach to problem solving that views “problems” as part of a wider dynamic system, involving much more than a reaction to present outcomes or events but demands a deeper understanding of the linkages, relationships, interactions and behaviours among the elements that characterize the entire system.” An effective EBPM guidance should incorporate the systems thinking perspectives, which has been described as an understanding of systems and their subcomponents as interconnected and interrelated with one other in an intimate fashion such that the workings of the systems are viewed and interpreted based on the interrelationships and interactions within and between system components.[51] It is believed that a deeper understanding of the behavior of complex adaptive systems in designing, implementing, and evaluating health policies will maximize health benefits and health equity.[52]

To understand how to combine colloquial evidence with research evidence in decision-making

It is well established that evidence from research can enhance the health policy process and development.[53],[54],[55],[56] However, the use of research evidence alone cannot guarantee the development of effective policies that are capable of addressing context-specific health sector problems. Other forms of evidence, especially colloquial evidence generated through a deliberative process where evidence is interpreted and contextualized, are an indispensable inclusion in the EBPM process. The policy-makers involved in this study stressed the importance of colloquial evidence and advocated for guidance on how it could be combined with research evidence appropriately. Colloquial evidence (e.g., tacit or experiential knowledge) can enhance the interpretation or contextualization of evidence from research and can further facilitate the process of understanding how to address situations where local evidence is lacking but that may play a role in decision-making.[48] There is often a need to contextualize evidence and to understand how it should be applied in policy-making, this is because without contextualization, guidance and policies may be too generic and fail to produce the desired results.[57] The EBPM guidance must promote the use of deliberative process such as stakeholders' engagement events, and citizens' panels because these can make colloquial evidence explicit and to a large extent enhance transparency, knowledge exchange, evidence filtration, and amplification.[21],[48],[57]

To understand the politics of policy-making and how to manage it to achieve political acceptability of policy

The policy-makers in this study were concerned about the interference of politics in the policy-making process and made a case for better understanding of the political perspectives of policy-making. It is pertinent to state that policy-making and politics are inseparable. Scientific investigations often identify the causes and solutions to health problems, but it is only politics that can actually transform these solutions into realities and tangible outcomes.[58] Health is political because all its social determinants are influenced and amenable to political processes and interventions and are thereby dependent on political action.[59] In line with a number of previous reports, an EBPM guidance should clearly show that the challenge of getting research and other forms of evidence into the policy-making process is not only a technical matter of KT or EIPM but also political.[60],[61] Since politics determine the factors that influence policy-making process, for instance, who should receive a particular service, what the health priorities should be, who becomes the service provider, how budgets are allocated and disbursed, etc.,[62],[63] the EBPM guidance must take these into account. The guidance must emphasize that one of the first critical issues in policy development is to make sure that the policy to be developed is acceptable politically. The guidance should highlight strategies to facilitate the political support of a policy, such as (i) aligning the policy with the mandate and priority of the government in power; (ii) engaging the leaders of ruling political party as champions of the policy development process; (iii) involving relevant government apparatus in all stages of the policy development; and (iv) employing the process of lobbying of very influential persons in the government to drive the policy process. It is, however, pertinent to state that understanding the politics of health policy is not an invitation to downplay the rigors of scientific research or to alter research findings so that they are consistent with political interests but rather an opportunity to better align scientific research to policy-makers' needs and priorities.[64] Evidence from studies conducted in West African showed that politics was instrumental to the success and failures recorded in the policy-making and policy implementation of some health interventions.[65],[66]

To understand how to engage parliamentarians and policy legislators to promote policy development and implementation

It was a general consensus among the policy-makers in this study that understanding the role of and how to engage the parliament in the policy process is very imperative. It was therefore their opinion that EBPM guidance should provide information on the best approaches to effectively engage the parliamentarians in policy process. This is because the parliamentarians are among the most powerful (but often neglected or underestimated) policy actors at the national level in Africa.[67] The parliament is the key institution responsible for legislation of policies on all aspects of the social systems including health and has an important responsibility of ensuring that health policies and health legislations are informed by robust scientific evidence. It has been argued that the parliament is an information-intensive and information-demanding institution, consequently, evidence is fundamental to the execution of a parliament's three core functions of representation, scrutiny, and oversight.[67],[68] Unfortunately, in most of West Africa, there exist a huge divide among researchers, policy-makers, and parliamentarians and studies involving health policy-making and the parliament are essentially lacking. Some studies that focused on elected parliamentarians and their use of evidence for health policy decisions showed that health researchers, policy-makers, and practitioners have capacity constraints in the presentation of evidence properly to parliamentarians.[69],[70],[71] EBPM guidance should therefore highlight a comprehensive approach that can be used to identify, manage, and provide relevant evidence to parliamentarians. Without a range of different sources and types of timely and accurate evidence, parliaments cannot meaningfully hold the executive to account nor represent the citizenry.[68] Therefore, EBPM guidance should describe the process of acquiring, organizing, managing, and presenting evidence to parliamentarians because this is very critical to the parliament's constitutional mandate.[67] In the parliament, evidence is intertwined with political landscape and this requires a better understanding of the entire process of getting evidence into policy-making and policy legislation.


   Conclusion Top


The need to enhance the capacity of policy-makers so they can develop policies that are informed by evidence will continuously be advocated. Despite the complexity of the policy-making process, an EBPM is a valuable tool that can provide health sector policy-makers the needed guide. This study makes a case for further discourse on EBPM guidance and for more studies that will evaluate the impact of such guidance on the policy-making process in LMIC including West Africa.

Ethics approval and consent to participate

Ethical clearance for this study was obtained from the University Research Ethics Committee of Ebonyi State University Nigeria (the institution of the principal author) (Ref No: EBSU/UREC/015/10/03). Verbal consent was approved for the study on the basis that each participant receives official invitation for the meeting and notification for the study and agrees to participate.

Availability of data and materials

The authors confirm that all data underlying the findings are fully available without restriction upon reasonable request, which should be made to the corresponding author.

Acknowledgments

The authors wish to thank all the policy-makers from West Africa who participated in the study.

Financial support and sponsorship

This study was a component of the “Moving Maternal, Neonatal and Child Health Evidence into Policy in West Africa” (MEP) project funded by the WAHO and the International Development Research Centre Canada (Reference: IDRC 107892_001). The funding was limited to provision of the research grant and technical support. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the WAHO, IDRC, or governments of the countries involved in the study.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder AA, et al. Overcoming health-systems constraints to achieve the Millennium Development Goals. Lancet 2004;364:900-6.  Back to cited text no. 1
    
2.
World Health Organization. Report on Meeting on Health Systems Strengthening and Primary Health Care. Report Series No. RS/2008/GE/35(PHL). Regional Office for the Western Pacific Manila, Philippines: WHO; 2008.  Back to cited text no. 2
    
3.
World Health Organization. World Report on Knowledge for Better Health: Strengthening Health Systems. Geneva: WHO; 2004. Available from: http://www.who.int/rpc/meetings/world_report_on_knowledge_for_better_health.pdf. [Last accessed on 2020 Sep 29].  Back to cited text no. 3
    
4.
Koon AD, Windmeyer L, Bigdeli M, Charles J, El Jardali F, Uneke J, et al. A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries. Health Res Policy Syst 2020;18:7.  Back to cited text no. 4
    
5.
Khalid AF, Lavis JN, El-Jardali F, Vanstone M. Supporting the use of research evidence in decision-making in crisis zones in low- and middle-income countries: A critical interpretive synthesis. Health Res Policy Syst 2020;18:21.  Back to cited text no. 5
    
6.
Shroff Z, Aulakh B, Gilson L, Agyepong IA, El-Jardali F, Ghaffar A. Incorporating research evidence into decision-making processes: Researcher and decision-maker perceptions from five low- and middle-income countries. Health Res Policy Syst 2015;13:70.  Back to cited text no. 6
    
7.
United Nations Development Programme. Human Development Indicatorsand Indices: 2018 Statistical Update Team. United Nations Development Programme, 1 UN Plaza, New York, NY 10017 USA; 2018. Available from: http://www.hdr.undp.org/sites/default/files/2018_human_development_statistical_update. [Last accessed on 2020 Sep 29].  Back to cited text no. 7
    
8.
World Health Organization. Global Health Observatory Country Views; 2016. Available from: http://apps.who.int/gho/data/node.country. [Last accessed on 2020 Sep 29].  Back to cited text no. 8
    
9.
Sombie I, Bouwayé A, Mongbo Y, Keita N, Lokossou V, Johnson E, et al. Promoting research to improve maternal, neonatal, infant and adolescent health in West Africa: the role of the West African Health Organisation. Health Res Policy Syst. 2017;15(Suppl 1):53.  Back to cited text no. 9
    
10.
Bowen S, Zwi AB. Pathways to “evidence-informed” policy and practice: A framework for action. PLoS Med 2005;2:e166.  Back to cited text no. 10
    
11.
Lavis J, Davies H, Oxman A, Denis JL, Golden-Biddle K, Ferlie E. Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy 2005;10 Suppl 1:35-48.  Back to cited text no. 11
    
12.
Strydom WF, Funke N, Nienaber S, Nortje K, Steyn M. Evidence-based policy-making: A review. S Afr J Sci 2010;106:249.  Back to cited text no. 12
    
13.
Salchev P, Hristov N, Georgieva L. Evidence Based Policy – Practical Approaches. The Bulgarian National Health Strategy; 2007-2012. Available from: https://biecoll.ub.uni-bielefeld.de/index.php/publichealth/article/view/508/603. [Last accessed on 2020 Sep 29].  Back to cited text no. 13
    
14.
Juntti M, Russel D, Turnpenny J. Evidence, politics and power in public policy for the environment. Environ Sci Policy 2009;12:207-15.  Back to cited text no. 14
    
15.
Alliance for Health Policy and Systems Research. Sound Choices: Enhancing Capacity for Evidence-Informed Health Policy. Geneva: World Health Organization; 2007.  Back to cited text no. 15
    
16.
Jones N, Walsh C. Policy Briefs as a Communication Tool for Development Research: Background Note. London: Overseas Development Institute; 2008.  Back to cited text no. 16
    
17.
Defor S, Kwamie A, Agyepong IA. Understanding the state of health policy and systems research in West Africa and capacity strengthening needs: Scoping of peer-reviewed publications trends and patterns 1990-2015. Health Res Policy Syst 2017;15 Suppl 1:55.  Back to cited text no. 17
    
18.
Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. Improving maternal and child health policymaking processes in Nigeria: An assessment of policymakers' needs, barriers and facilitators of evidence-informed policymaking. Health Res Policy Syst 2017;15:48.  Back to cited text no. 18
    
19.
Keita N, Lokossou V, Berthe A, Sombie I, Johnson E, Busia K. The West African experience in establishing steering committees for better collaboration between researchers and decision-makers to increase the use of health research findings. Health Res Policy Syst 2017;15:50.  Back to cited text no. 19
    
20.
Sombié I, Aidam J, Montorzi G. Evaluation of regional project to strengthen national health research systems in four countries in West Africa: Lessons learned. Health Res Policy Syst 2017;15:46.  Back to cited text no. 20
    
21.
Project Team, Swiss Tropical and Public Health Institute. Handbook for Supporting the Development of Health System Guidance-Supporting Informed Judgements for Health System Policies. Basel, Switzerland: Swiss Tropical and Public Health Institute; 2011.  Back to cited text no. 21
    
22.
Giorgi A, editor. Sketch of a psychological phenomenological method. In: Phenomenology and Psychological Research: Essays. Pittsburgh, PA: Duquesne University Press; 1985. p. 8-22.  Back to cited text no. 22
    
23.
Albert MA, Fretheim A, Maïga D. Factors influencing the utilization of research findings by health policy-makers in a developing country: The selection of Mali's essential medicines. Health Res Policy Syst 2007;5:2.  Back to cited text no. 23
    
24.
Abou-Zeid A, Galal Y, Shawky M, El-Rabbat M. Exploring barriers to research utilization in policy formulation in Egypt: Researchers' perspectives. J Am Sci 2012;8:43-9.  Back to cited text no. 24
    
25.
El-Jardali F, Lavis JN, Ataya N, Jamal D, Ammar W, Raouf S. Use of health systems evidence by policymakers in eastern Mediterranean countries: Views, practices, and contextual influences. BMC Health Serv Res 2012;12:200.  Back to cited text no. 25
    
26.
Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res 2014;14:2.  Back to cited text no. 26
    
27.
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: Time for a map? J Contin Educ Health Prof 2006;26:13-24.  Back to cited text no. 27
    
28.
Graham ID, Tetroe J; KT Theories Research Group. Some theoretical underpinnings of knowledge translation. Acad Emerg Med 2007;14:936-41.  Back to cited text no. 28
    
29.
Lavis JN. Research, public policy-making, and knowledge translation processes: Canadian efforts to build bridges. J Contin Educ Health Prof 2006; 26:37-45.  Back to cited text no. 29
    
30.
Fadlallah R, El-Jardali F, Hemadi N, Morsi RZ, Abou Samra CA, Ahmad A, et al. Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: A systematic review. Int J Equity Health 2018;17:13.  Back to cited text no. 30
    
31.
Uneke CJ, Ezeoha AE, Ndukwe CD, Oyibo PG, Onwe F, Igbinedion EB, et al. Individual and organisational capacity for evidence use in policy making in Nigeria: An exploratory study of the perceptions of Nigeria health policy makers. Evid Policy 2011;7:251-76.  Back to cited text no. 31
    
32.
Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P, et al. Assessment of policy makers' individual and organizational capacity to acquire, assess, adapt and apply research evidence for maternal and child health policy making in Nigeria: A cross-sectional quantitative survey. Afr Health Sci 2017;17:700-11.  Back to cited text no. 32
    
33.
Gonzalez Block MA, Mills A. Assessing capacity for health policy and systems research in low and middle income countries* Health Res Policy Syst 2003;1:1.  Back to cited text no. 33
    
34.
MacGregor JC, Kothari A, LeMoine K, Labelle J. Linking research to action for youth violence prevention: Community capacity to acquire, assess, adapt and apply research evidence. Can J Public Health 2013;104:e394-9.  Back to cited text no. 34
    
35.
Green A, Bennett S. Sound Choices: Enhancing Capacity for Evidence-Informed Health Policy. Geneva: World Health Organization; 2007.  Back to cited text no. 35
    
36.
Dawad S, Veenstra N. Comparative health systems research in a context of HIV/AIDS: Lessons from a multi-country study in South Africa, Tanzania and Zambia. Health Res Policy Syst 2007;5:13.  Back to cited text no. 36
    
37.
Wilson MG, Rourke SB, Lavis JN, Bacon J, Travers R. Community capacity to acquire, assess, adapt, and apply research evidence: A survey of Ontario's HIV/AIDS sector. Implement Sci 2011;6:54.  Back to cited text no. 37
    
38.
Wills A, Tshangela M, Shaxson L, Datta A, Matomela B. Guidelines and Good Practices for Evidence-Informed Policy-Making in a Government Department. Pretoria: Department of Environmental Affairs; and London: Overseas Development Institute; 2016.  Back to cited text no. 38
    
39.
Lavis JN, Røttingen JA, Bosch-Capblanch X, Atun R, El-Jardali F, Gilson L, et al. A guidance for evidence-informed policies about health systems: Linking Guidance development to policy development. PLoS Med 2012;9:e1001186.  Back to cited text no. 39
    
40.
Scott JW, Schwartz TA, Dimick JB. Practical guide to health policy evaluation using observational data. JAMA Surg 2020;155:353-4.  Back to cited text no. 40
    
41.
Lewin S, Glenton C. Are we entering a new era for qualitative research? Using qualitative evidence to support guidance and guideline development by the World Health Organization. Int J Equity Health 2018;17:126.  Back to cited text no. 41
    
42.
Shepherd JP. How to Achieve More Effective Services: The Evidence Ecosystem. Cardiff, UK: What Works Network/Cardiff University; 2014. Available from: http://www.scie-socialcareonline.org.uk/how-to-achieve-more-effective-services-theevidence-ecosystem/r/a11G0000006z7vXIAQ. [Last accessed on 2020 Sep 29].  Back to cited text no. 42
    
43.
Uneke CJ, Ezeoha AE, Ndukwe CD, Oyibo PG, Onwe F. Promotion of evidence-informed health policymaking in Nigeria: Bridging the gap between researchers and policymakers. Glob Public Health 2012;7:750-65.  Back to cited text no. 43
    
44.
Canadian Institutes of Health Research. About Knowledge Translation; 2005. Available from: http://www.cihr-irsc.gc.ca/e/29418.html. [Last accessed on 2020 Sep 29].  Back to cited text no. 44
    
45.
Sudsawad P. Knowledge Translation: Introduction to Models, Strategies, and Measures. Austin, TX: Southwest Educational Development Laboratory, National Center for the Dissemination of Disability Research; 2007.  Back to cited text no. 45
    
46.
Canadian Institutes of Health Research. Knowledge Translation Strategy 2004–2009: Innovation in Action; 2004. Available from: http://www.cihr-irsc.gc.ca/e/26574.html. [Last accessed on 2020 Sep 29].  Back to cited text no. 46
    
47.
Kothari A, Wathen CN. Integrated knowledge translation: Digging deeper, moving forward. J Epidemiol Community Health 2017;71:619-23.  Back to cited text no. 47
    
48.
Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, Røttingen JA, Dröschel D, et al. Guidance for evidence-informed policies about health systems: Rationale for and challenges of guidance development. PLoS Med 2012;9:e1001185.  Back to cited text no. 48
    
49.
Lavis JN, Permanand G, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking. Health Res Policy Syst 2009;7 Suppl 1:S13.  Back to cited text no. 49
    
50.
De Savigny D, Adam T, editors. Systems Thinking for Health Systems Strengthening. Geneva: Alliance for Health Policy and Systems Research; 2012.  Back to cited text no. 50
    
51.
Adam T. Advancing the application of systems thinking in health. Health Res Policy Syst 2014;12:50.  Back to cited text no. 51
    
52.
Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ 2008;336:1281-3.  Back to cited text no. 52
    
53.
Campbell DM, Redman S, Jorm L, Cooke M, Zwi AB, Rychetnik L. Increasing the use of evidence in health policy: Practice and views of policy makers and researchers. Aust N Z Health Pol 2009;6: 21.  Back to cited text no. 53
    
54.
Dobrow MJ, Goel V, Upshur RE. Evidence-based health policy: Context and utilisation. Soc Sci Med 2004;58:207-17.  Back to cited text no. 54
    
55.
Hanney SR, Gonzalez-Block MA, Buxton MJ, Kogan M. The utilization of health research in policy-making: Concepts, examples and methods of assessment. Health Res Pol Syst 2003;1:2-9.  Back to cited text no. 55
    
56.
Innvar S, Vist G, Trommald M, Oxman A. Health Policy-Makers' Perceptions of their use of evidence: A systematic review. J Health Serv Res Pol 2002;7:239-44.  Back to cited text no. 56
    
57.
Sharma T, Choudhury M, Kaur B, Naidoo B, Garner S, Littlejohns P, et al. Evidence informed decision making: The use of “colloquial evidence” at nice. Int J Technol Assess Health Care 2015;31:138-46.  Back to cited text no. 57
    
58.
Oliver TR. The politics of public health policy. Annu Rev Public Health 2006;27:195-233.  Back to cited text no. 58
    
59.
Bambra C, Fox D, Scott-Samuel A. Towards a politics of health. Health Promot Int 2005;20:187-93.  Back to cited text no. 59
    
60.
Humphreys K, Piot P. Scientific evidence alone is not sufficient basis for health policy. BMJ 2012;344:e1316.  Back to cited text no. 60
    
61.
Liverani M, Hawkins B, Parkhurst JO. Political and institutional influences on the use of evidence in public health policy. A systematic review. PLoS One 2013;8:e77404.  Back to cited text no. 61
    
62.
Glassman A, Buse K. Politics, and public health policy reform. In: Heggenhougen K, Quah S, editors. International Encyclopedia of Public Health. Vol. 5. San Diego: Academic Press; 2008. p. 163-70.  Back to cited text no. 62
    
63.
Reich MR. The politics of health sector reform in developing countries: Three cases of pharmaceutical policy. Health Policy 1995;32:47-77.  Back to cited text no. 63
    
64.
Greer SL, Bekker M, de Leeuw E, Wismar M, Helderman JK, Ribeiro S, et al. Policy, politics and public health. Eur J Public Health 2017;27:40-3.  Back to cited text no. 64
    
65.
Dossou JP, Cresswell JA, Makoutodé P, De Brouwere V, Witter S, Filippi V, et al. 'Rowing against the current': The policy process and effects of removing user fees for caesarean sections in Benin. BMJ Glob Health 2018;3:e000537.  Back to cited text no. 65
    
66.
Blau J, Faye PC, Senouci K, Dagnan SN, Douba A, Saracino JT, Gessner BD. Establishment of a National Immunization Technical Advisory Group in Côte d'Ivoire: Process and lessons learned. Vaccine 2012;30:2588-93.  Back to cited text no. 66
    
67.
Draman R, Titriku A, Lampo L, Hayter E, Holden K. Evidence in African Parliaments. Oxford OX1 1RR, UK: INASP 2/3 Cambridge Terrace; 2017.  Back to cited text no. 67
    
68.
Datta A, Jones N. Linkages between Researchers and Legislators in Developing Countries: A Scoping Study. 111 Westminster Bridge Road, London SE1 7JD: Overseas Development Institute; 2011.  Back to cited text no. 68
    
69.
Woodruff K, Roberts SC. “My good friends on the other side of the aisle aren't bothered by those facts”: U.S. State legislators' use of evidence in making policy on abortion. Contraception 2020;101:249-55.  Back to cited text no. 69
    
70.
Purtle J, Brownson RC, Proctor EK. Infusing science into politics and policy: The importance of legislators as an audience in mental health policy dissemination research. Adm Policy Ment Health 2017;44:160-3.  Back to cited text no. 70
    
71.
Cockcroft A, Masisi M, Thabane L, Andersson N. Building capacities of elected national representatives to interpret and to use evidence for health-related policy decisions: A case study from Botswana. J Public Health Policy 2014;35:475-88.  Back to cited text no. 71
    



 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Methods
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed650    
    Printed28    
    Emailed0    
    PDF Downloaded5    
    Comments [Add]    

Recommend this journal