Transcript Reach to Policy - World Bank Group

Bridging the Worlds of Research and
Policy in Kenya, Tanzania and Uganda:
The Regional East African Community
Health (REACH) Policy Initiative
Nelson K. Sewankambo
Dean, Makerere University, Faculty of Medicine
May 18, 2007, Hamilton, Canada
“Because professionals sometimes do more
harm than good when they intervene in the
lives of other people, their policies and
practices should be informed by rigorous,
transparent, up-to-date evaluation”
Chalmers I: Trying to do more good than harm in
policy and practice: The role of rigorous,
transparent, up-to-date evaluations.
Ann Am Polit Soc Scien 2003; 589:22-40
Background: Global Perspective
Events in the recent years
Many policy dilemmas regarding scaling up global
health initiatives
WHO Ministerial Summit and Global Forum on Health
Research (Mexico, November 2004)
“know-do gap”
Recommended knowledge “observatories”
The Changing Global Environment
Bridging the know-do gap…
The Problem- Know-Do Gap
Use of evidence in WHO recommendations
Andrew D Oxman, John N. Lavis, Atle Fretheim www.thelancet.com
Published online May 9 2007
Leading by example: a culture change at WHO
Tikki Pang WWW.thelancet.com, Published on line May 9 2007
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Scientific evidence is often not used systematically
in the development of recommendations
The needs of end-users are often not taken into
account
There is limited consideration of how to implement
global recommendation in a local context.
WHO does not always follow its own requirements
for development of guidelines
An East African Proposal
REACH Policy Initiative
Regional East African Community Health Policy
Initiative
Time is right to test a dedicated, credible, professional
institutional mechanism to bridge this gap.
Goal
“To improve people’s health
and health equity in East
Africa through more
evidence-based health
policies”
Vision
“To be the East African centre of excellence for
knowledge translation to support formulation
of health policy and research agendas”.
Mission
“To access, synthesise, package and
communicate evidence-based health
information for influencing policy and practice
and for influencing policy relevant research
agendas for improved population health and
health equity”.
Background: Regional Perspective
A
regional initiative
Country consultations: Tanzania, Uganda, Kenya
Synthesis meeting led to institutional design
Sounding board meeting to test-drive ideas and
package proposal
Approval of proposal by EAC Ministers of Health
Finalize funding proposal
Meeting of potential funding partners
Dec 2006 establish Secretariat, implementation
starts
Starting point
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The “Duluti Lake” Consultation, Tanzania (2001)
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Brainstorming convened by MOH Tanzania
Discuss the gaps between research-policy-practice
Conclusions
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Knowledge translation gap is real; and harmful
“Push” and “Pull” systems have not worked well
Need for a new model: “Credible Knowledge Broker”
Ideas for an institutional solution were proposed
Skills and functions were identified
Outcome: IDRC approached to support
development of the concept towards such an
institutional solution
Why is a mechanism needed?
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The “Know-Do Gap”.
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Sufficient evidence, knowledge, and financial
resources exist now to reduce substantially the
intolerable burdens of disease carried by the region.
Rapid and efficient translation of knowledge to policy
and action is weak.
Researchers have been relatively ineffective in
pushing their evidence to policy, and
Policy makers have been relatively inefficient in
pulling evidence into policy and practice.
It has been concluded that a dedicated, credible, professional
institutional mechanism is needed to bridge this gap.
Steps in the process
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Initially for a national mechanism (Tanzania) (Dec
2001)
TZ NIMR commissioned a consultation to examine
options & models ‘03
IDRC provided funding for concept development 2004
Regional case studies prepared as base for country
consultations (2004)
Series of country design workshops (December 04 January 05):
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Tanzania, Uganda, Kenya
Workshops focused on the need, function, institutional
structure, autonomy, resources, country
recommendations.
Country Consultations
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3 countries Tanzania, Uganda, Kenya
20 researchers, policy makers and
synthesis group
Focus of discussions
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The need
Institutional autonomy/relationship
Structure (regional and national
Resources
Country recommendations
Tanzania Consultative meeting
Bagamoyo, 7-8 December 2004
Kenya Consultative Meeting
Naivasha 13-14 January 2005
Steps in the process
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Synthesis for regional institutional design
Health Ministers endorsed the approach in
Arusha (Feb 05)
Prospectus tested by international sounding
board (March 05)
Regional Council of Ministers endorsed
prospectus (July 05)
Funding proposal finalized (June 2006)
Meeting of potential funding partners (Oct 06),
selection of Steering Committee and Interim
Executive Director
Implementation strategy
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The centre shall act as an independent knowledge
broker between researchers and policy makers
Obtain research findings in the region and beyond
especially for key priority regional health challenges
Synthesize the information
Package the synthesized information for influencing
health policy and practice
Communicate the policy briefs.
Monitor the impact on policy change and trends of key
indicators
Formulate research priorities based on policy concerns
Start Up: Interim Mechanism
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Interim regional tripartite committee made up of
representatives of Ministries of Health, Research and
Academic institutions by end of July 2005
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Each country appoints three individuals representing
the above named stakeholders to the interim
committee.
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Interim committee must serve until the substantive
holders of the posts take over
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Suitable individual with visionary leadership be hired
through a competitive process. The non-voting
secretary to the interim committee will be the Health
Coordinator of EAC.
Regional Hub
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Permanent Governance Structure; a tripartite
committee with 3 members from each country
representing the stakeholders
Substantive chief executive of the institution who
will be assisted by technical officers the number
which will be determined by the governance
committee
Lean secretariat with flexibility for continued
consultant utilization
East African Community Health Research Council
Policy
Makers
Tripartite Stakeholders
Committee
External
reviews
9 members
Donors
REACH
Executive
Director
Technical Core
Team
Kenya
Node
Administrative
Support
Tanzania
Node
Uganda
Node
National, Regional, International
Initiatives
National Research
Bodies, Organisations undertaking priority
research
Regional and
International Centres
of Excellence for
Technical Assistance
& Back-stopping
Country Nodes
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Country nodes needed to coordinate and
facilitate country level activities of REACH and
link with the REACH regional hub
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Coordinate, dynamize and catalyze the flow of
information, knowledge and products of REACH
Channel national demands to the REACH hub
Liaise with related national initiatives and partners
REACH Hub to develop common TORs for the
establishment and detailed functions of national
nodes through a broad consultative process
Staffing of National Nodes
To avoid country-level duplication of effort
and resources, national nodes will be
established and hosted by an institution with
adequate physical infrastructure. To function
efficiently, the node will be independent with
its own identity and not answerable to the
head of the hosting institution. The staff will
work with a national multi-sectoral steering
committee.
Main constituencies in the process
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Chief medical officers of Ministries of Health for Kenya,
Tanzania and Uganda
D-Gs of National Health Research Institutes
KEMRI, NIMR, UNHRO
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Leaders of academic and NGO health research
communities of Kenya, Tanzania and Uganda
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East African Community headquarters
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International sounding board
Sounding Board Meeting
Nairobi, 7-8 March 2005
“So if you are poor actually you need
more evidence than if you were rich”
Dr. Hassan Mshinda
Ifakara Centre, Tanzania