Putting evidence on the table and increasing its uptake for effective policy and programming in Malawi

By Dr Collins Mitambo (Ministry of Health) and Nissily Mushani (AFIDEP)

Training on Champions on Use of research evidence in decision making-Malawi

Training on champions on use of research evidence in decision-making

Globally and within Malawi, there is often disconnect between the work of policymakers, researchers and frontline clinicians. Without institutionalized exchange and collaboration, researchers are often unable to meet the needs of policymakers, who in turn miss key opportunities to utilize research evidence in policy discussions and incorporate best practices in order to have evidence informed policy .

Over the last decade or so, there has been increasing attention at the international level to increase the utilisation of research evidence in policy and programme formulation and implementation in the health sector. In 2005 during the World Health Assembly summit, the Director General for the World Health Organization (WHO) highlighted how the organization will help “to assist in the development of more effective mechanisms to bridge the divide between ways in which knowledge is generated and ways in which it is used, including the transformation of health research findings into policy and dialogue[1]. Thus Evidence Informed Policy Network (EVIPnet), a WHO sponsored network, whose objective is to assist country teams in the formation of knowledge translation platforms was established.

The term evidence-based policy is used in the literature, yet largely related to only one type of evidence – research. Using the term “evidence-influenced or evidence-informed” reflects the need to be context sensitive and consider use of the best available evidence when dealing with everyday circumstances[2].

In Malawi, the Ministry of Health (MoH)’s commitment to promote uptake of research evidence has been demonstrated by the establishment of the Research Unit and the recent institution of the Malawi Knowledge Translation Platform (KTP). The KTP initiative  has been supported and strengthened through partnering with stakeholders to implement several programme that promote evidence based policy making such as the Strengthening Capacity to Utilize Research Evidence in the Health Sector (SECURE Health)  being championed by African Institute for Development Policy (AFIDEP).

Under the KTP, key stakeholders such as policy makers, researchers and representatives from other sectors other than health (for instance: education, science & technology, National Assembly, civil society organizations, media, topic experts, etc.) are brought together to identify and address priority topics where a supposed need to strengthen the systematic use of research evidence to inform decisions about policies for the health sector has been identified[3]. The topic is selected using a structured prioritization exercise which result in production of policy briefs.

Literature points out the advantages of using evidence in decision making. These cannot be overemphasized, such as:

a)      ensuring that policies are responding to the real needs of the people, leading to better outcomes for the population in the long term;

b)      highlighting the urgency of an issue or problem, which requires immediate attention;

c)      securing funding and resources for the policy to be developed, implemented and maintained;

d)     enables information sharing amongst other members of the public sector, in regard to what policies have or have not worked;

e)      reduces government expenditure, which may otherwise be directed into ineffective policies or programs which could be costly and time consuming;

f)       Produces an acceptable return on the financial investment that is allocated toward public programs by improving service delivery and outcomes for the community;  and

g)      Ensures that decisions are made in a way that is consistent with democratic and political processes, which are characterized by transparency and accountability.

Resonating with the above, in the recent 2014 Needs Assessment study conducted by the MoH through the SECURE Health programme, most of the respondents in the MoH and Parliament recognize the importance of using research evidence and data to inform policy, legislative and programme.

Taking a quick glance at some of the policies being implemented in the health sector, there is an indication that evidence was used during formulation processes.  For instance, the 2011 Malawi Guidelines for Clinical Management of HIV in Adults and Children were formulated after the WHO had released the 2010 recommendations for ART and PMTCT in resource limited settings “based on current research evidence and aimed at increasing access to quality ART and PMTCT services”[4]. Evidence used ranged from programmatic data from the department of HIV and research studies (both local and international) on the implementation of Options A and B in low income countries. The guidelines specifically refer to Van Lettow et al. (2010) and Hargrove et al. (2010) as part of rationale that lifelong ART for pregnant and breast feeding women reduced post-partum mortality in HIV positive women.

The other remarkable scenario where research was used to inform policy was during the development of Malaria Treatment guidelines. The main change in the 2007 Malaria Treatment guidelines from first line drug Sulfadoxine Pyrimethamine (SP) to Lumefantrine Artemether (LA) was partly based on the findings of the drug efficacy trials that are conducted every two years in the country.

Similarly, the revision of the 2002 Sexual and Reproductive Health policy, was informed by Malawi Demographic and Health Survey, Multiple Indicators Cluster Survey, Behavior Surveillance Survey, emergency obstetric care assessment, district routine data and reports.

In Malawi, the window of opportunities in getting evidence into policy formulation process is strengthened through the systems that are in place. These include Technical Working Groups, steering committees, technical committees, trainings for officers, consultative workshops as well as validation workshops. Furthermore, availability of capacitated human resource like Technical Assistants, apart from permanent staff, enables increased consideration of evidence to inform policy.

Despite the notable advantages of utilizing research evidence in policy making, it is worth noting that Evidence-Informed policymaking is a process that requires both sustained attention and resources. Notwithstanding indications of evidence being utilized in policy formulation, the 2014 Needs assessment and literature search showed a number of constraints to research use  as follows:

a)      Time constraints within which to come up with a policy or programme ;

b)      Influence of interest groups that would be negatively affected by policy change;

c)      Inadequate communication between the researchers and policy makers (some policy makers clearly state that as a programme, they only recognize research with which they have been involved from the beginning);

d)     vested interests of those that fund policy making and implementation;

e)      unavailability of the evidence on emerging issues; and

f)       lack of standardized data collection tools resulting in different organization having different sets of data according to their needs. Further to this, these data collection methods are not sustainable as they only last as long as the organization is implementing the project.

In conclusion, Evidence Informed Policy Making (EIPM) is critical in ensuring  that designed and implemented policies, strategies and programmes achieve the set goals and objectives. Although Malawi’s health sector is applying evidence, there is still more that needs to be done to make evidence to be put on the table for consideration in policy making.

 


[1] WHA. Resolution on Health Research, 2005, (available from http://www.who.int/rpc/meetings/58th_WHA_resolution.pdf, accessed 1st July 2014

[2] Bowen S, Zwi AB (2005) Pathways to “evidence-informed” policy and practice: A framework for action.

[3]Knowledge Translation Platform Malawi (KTP Malawi) Inaugural Steering Committee Meeting Report, June, 2013

[4] Malawi Ministry of Health 2011:1