Personal reflections from our Chair, Ruth Stewart, of an international meeting to advance the field of evidence-informed decision-making

By  Ruth Stewart, Chairperson of the Africa Evidence Network 

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An international meeting to advance the field of evidence-informed decision-making in Bellagio, Italy, 28th-31st August 2018.

Is there such a thing as ‘an evidence-informed decision-making field’? Indeed, what might make something ‘a field’? Wikipedia equates a ‘field’ to a ‘discipline’ and defines it as ‘a branch of knowledge that incorporates expertise, people, projects, communities, challenges, studies, inquiry and research areas’. That sounds close enough to what many of us in the Africa Evidence Network do and the context within which we work. However, Wikipedia goes on to say that such things should be ‘strongly associated with a given scholastic subject area or college department’. And I have to admit that such departments in universities (let alone outside academia) are few and far between. It was therefore with some curiosity that I took up an invitation from the William and Flora Hewlett Foundation to spend three days exploring these issues at the Rockefeller retreat in Bellagio Italy. Along with 21 others, we were gathered to discuss how to advance the evidence-informed decision-making field. These are my personal reflections on the week.

Sharing experiences

 I love hearing about others’ work and it was great to learn of others’ experiences from countries as far afield as Mexico and India. Africa was well represented, a reflection of both Hewlett’s work and, I like to think, of the innovative work underway in the evidence arena across Africa. As one of my colleagues from Kenya highlighted, Africa is leading the field in many ways and we want the world to know about what we are doing. I wish we’d all had more time to learn from each other as I heard snippets of innovation, both successful and unsuccessful, from around the world. Despite the limited time, I do come away with strengthened relationships and new contacts and, like many of my fellow participants, will be following up on many initiated conversations. I hope some of these will lead to concrete collaborations in the future. As we look forwards to EVIDENCE 2018, we will continue many of these discussions with all of you in just a few weeks.

A retreat

 It was a privilege to spend time away from the demands of email and the office, and even more so to be on the shores of Lake Como with colleagues from around the world. I’ve been thinking a lot about smaller retreats that we’ve held with colleagues from ACE in South Africa and about our AEN roadshows from 2016 and I am convinced more than ever of the value of holding small group meetings. I’m hoping to build on some of these ideas as we develop plans for AEN activities over the coming year.

A taste of what we discussed

Discussions were wide reaching and it’s not possible to capture it all, but a few things stand out for me now. For various reasons, in my work we talk about evidence-informed decision-making instead of evidence-informed policy-making. My argument is that policy-making invokes ideas of a one-off policy decision, rather than the multiple decisions that are made at policy, practice and personal levels that can be informed by evidence. This distinction in terminology is something I’ve been arguing for over many years now, and I thought perhaps I was still alone in my campaign. I was encouraged in Bellagio to hear others argue for similar use of decision-making rather than policy-making, and I suspect a wider shift is coming.

What we didn’t do is discuss what counts as ‘evidence’ and there were some frustrations about this. I believe we were right to avoid spending too much time debating definitions – which may have sucked us in and taken our will to live – nevertheless I shared the sense that it would have been good to tease out the many different types of evidence that we see at play in the evidence ecosystem. Indeed within the room there were those specialising in evaluations of government programmes, national and international data sets of various kinds, national statistics systems, citizens’ evidence, and randomised controlled trials, to name just a few. Others, including me, advocate more for the collation of individual forms of evidence into systematic summaries for use by decision-makers (systematic reviews, maps and other forms of collated evidence). We also need to consider as a next step, how evidence is used, by whom and how we know if we are doing it right.

We didn’t have a chance to think about how these all fit together and might support one another in our common goal: something to pick up on in future discussions.

We also touched on, but didn’t delve into, the different interfaces between evidence production and the governments that might use that evidence (and our focus at this meeting was government decision-makers rather than other users). I think all of us would have liked to hear more from decision-makers at various levels about their use of evidence and views on it, but we also understood that taking time out of our own work was challenging enough. Engaging with decision-makers might need a different kind of forum.

There was discussion about the extent to which the public(s) engage/s with evidence. With my own background in patient involvement in research, I find these discussions fascinating. There is still a sense, misinformed I believe, that the average citizen can’t or won’t engage with research evidence. It was great to hear stories from colleagues at the meeting of citizens engaging with and advocating for the use of evidence.

We talked about the challenges of the post-truth, post-fact environment in which many of us work, not least our colleagues from the USA. Whilst this environment is a depressing reality, we encouraged one another to make use of the current climate to promote the use of evidence in decision-making: having a common villain can motivate people to advocate for science.

 

So what?

Throughout the week, I had a constant echo in my mind of those voices of those who were not present in Bellagio, and I know many others did too. I asked myself: “what would my colleagues think of all of this?” And I heard a constant challenge in the back of my mind: “what did you think you were really advancing with so few of you over such a short period of time?” I was encouraged by the commitment of all in the room to widen these discussions amongst their own networks to ensure that this conversation is open and inclusive. Personally, I’m committed to ensuring that the AEN and its members are included in these discussions and will be exploring appropriate ways of doing so over the coming months.

So did we move forwards in the development of a field of evidence-informed decision/policy-making? We took some steps, together and individually. Each of us moved forwards in different ways and in different directions. I learnt a lot. I made new contacts. We came up with some preliminary action plans. These were, I believe, in part of ourselves as individuals, in part to share and test out with wider colleagues, and in part for our Hewlett colleagues – the opportunity to bring one of our largest investors along with our ideas was too great to be missed. The collective progress is not mine to share, but our Hewlett hosts before too long will circulate a draft of our discussions and proposed actions. I’ll be sure to share these with AEN colleagues for their inputs.

I left Bellagio feeling encouraged: encouraged that my work, and the work of the AEN, has a future. There is momentum in what we are doing. Funding is available. The field is growing. As we look forward to our conference and start to plan for future activities, we should know that we are not alone. The future is bright: the future is evidence.

 

Footnote: Last but not least, in my personal journey to live my life in an evidence-informed way, I had my 4-month old son with me: I am still exclusively breastfeeding. This was only possible because of the willingness of our Hewlett convenors to accommodate me, the thoughtfulness of our Rockefeller hosts to give me private space to express milk and to allow my son to join us each lunch time, and to my parents to baby sit over long days and late evenings. Thanks to all!