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How the K2P Center revolutionized policy-making in Lebanon

By on May 3, 2019

Olivia Biermann is a PhD student at Karolinska Institutet, Sweden. She wrote this piece together with Diana Jamal (Program manager, K2P Center, Lebanon), Racha Fadlallah (Evidence lead specialist and systematic reviewer, K2P Center, Lebanon), Lama Bou Karroum (Evidence lead specialist and systematic reviewer, K2P Center, Lebanon) and Fadi El-Jardali (Director, K2P Center, Lebanon).

This blog describes the journey of the Knowledge to Policy (K2P) Center, a knowledge translation platform established in a middle-income country, in revolutionizing policy-making. Learn more about K2P’s successes, challenges and transformations, and how it paved the way towards a world in which the best available evidence informs health policy-making. 

K2P today

The K2P Center at the American University of Beirut (AUB), has transformed the policy-making landscape in Lebanon by promoting and institutionalizing the use of research evidence, data and tacit knowledge in national policies, decisions and practices.

K2P has addressed priorities ranging from contributing to the incorporation of patient safety goals and indicators in the national accreditation system in Lebanon, to informing the Ministerial decision related to financial coverage and integration of palliative care into the health system, to supporting the Parliament with evidence on the legalization of cannabis, to influencing the implementation of a law on salt fluoridation in the country and many more. Through better informed decision-making, the prospect of better health and social outcomes becomes more tangible.  

K2P has been proactively shaping the policy agenda and responding to policy-makers’ and stakeholders’ priorities and demand for evidence. It has become a catalyzing platform for regular exchange between researchers, policy-makers and other stakeholders, and has recently started including citizens in defining policy problems and developing options to address existing challenges. K2P has institutionalized those efforts to support the use of evidence in policy and practice. There are still few countries in the world today that 1) transparently and systematically use evidence to inform health policy-making, and moreover, 2) do so in a sustainable manner.

Changing the culture for knowledge translation at the university

K2P contributed to changing the knowledge translation culture at the Faculty of Health Sciences at AUB. While most universities worldwide still incentivize their researchers and students to (mainly) publish in peer-reviewed journals, the Faculty has revised its promotion system to include knowledge translation (e.g. producing policy briefs) as an element in its annual performance review. In 2019, a new course on knowledge translation became a core requirement for all students enrolled in the master’s in public health programme. Furthermore, researchers at AUB are increasingly incorporating a knowledge translation component into their grant proposals and collaborating with K2P to bring about policy impact.  

At the university level, AUB is initiating work on institutionalizing the link between the university and governmental entities to support the use of evidence to inform and guide public policy-makingand make a positive impact in the communities and broader society that the University serves.

Looking back to look forward

K2P has been a long time coming. The first-ever knowledge translation workshop broke new ground in the Eastern Mediterranean Region in 2010. The workshop set the wheels for knowledge translation in motion and formed the basis for the implementation of a large study on the use of health systems and policy research in policy-making in the Region (1-3).

The findings clearly demonstrated the need for knowledge translation and evidence-informed policy-making in the Region and provided the rationale for establishing the K2P Center at the Faculty of Health Sciences. This would not have been possible without seed funding from the International Development Research Center in Canada. The funding allowed a small team at AUB, led by Fadi El-Jardali, Director of the Center, to subsequently start its work in knowledge translation in 2013. The K2P Center was modeled after the McMaster Health Forum in Canada which has been a close collaborating partner ever since.  

The K2P team worked on raising awareness, building capacity and establishing relationships with relevant policy-makers and stakeholders from the very start. Before K2P’s official launch in 2015, preparatory activities included the development of different knowledge translation products. For example, the team identified the pressing issues of securing access to quality mental health services in primary healthcare and of promoting access to essential health care services for Syrian refugees, and so embarked on synthesizing and packaging global and local evidence on these topics. The resulting briefing note and policy brief would later serve as K2P’s first, ready-to-use products for policy-makers.

Overcoming challenges

The institutionalization of K2P at AUB, as well as the institutionalization of its relationship with policy-making institutions, were both crucial for sustainability in an ever-changing policy environment. The institutionalization required political commitment, which K2P gained over the years by continuously demonstrating impact, thus proving its added value. K2P’s sustainability also necessitated securing financial and human resources. Over the years, the team has expanded to comprise skills and experience spanning from evidence synthesis, to policy writing and analysis, data visualization, citizen engagement, communications and advocacy. The Center collaborates with a growing network of content-related and knowledge translation experts nationally, regionally and internationally, and leverages the skills of graduates and interns who volunteer at K2P.

K2P continuously works on making the case for knowledge translation and evidence-informed policy-making, through its communication and advocacy, its products, capacity building activities and stakeholder engagement. It was and continues to be important to distinguish knowledge translation from communication, and knowledge translation products from research studies, for people to really understand how K2P can contribute to health policy-making. In addition, the team’s activities not only increased K2P’s visibility, but also helped establish its credibility and trust among stakeholders.

Major transformations

Since 2015, K2P has undergone major transformations as part of its continuing efforts to promote the use of evidence in policy and practice. The changes comprise:  

  1. Becoming more inclusive in policy-making processes by engaging stakeholders such as non-governmental organizations, citizens and the media;
  2. Scaling up its activities beyond preparing policy briefs and conducting policy dialogues to encompass a range of innovations including rapid response services, evidence-based advocacy, citizen consultations, media engagement and data visualizations;
  3. Strengthening multi-sectoral collaboration by involving the health, environment, education and social sectors; and
  4. Making knowledge translation efforts more sustainable by moving from individual to institutional capacity-building, and by institutionalizing the use of evidence in public entities.

Moreover, K2P’s proactive, impact-oriented approach, as well as the choice of high-priority topics paved the Center’s way to success. Depending on the topic – be it palliative care, antimicrobial resistance or child protection – the K2P team would flexibly select the appropriate knowledge translation approach and product to tackle the issue, and work on it iteratively while engaging key stakeholders throughout the process. Their approach is thus flexible and displays iterative adaptation.

Scaling up to global levels

K2P is also becoming a global leading entity for supporting evidence-informed policy-making. It has recently been re-designated by the World Health Organization (WHO) as a Collaborating Center for Evidence-Informed Policymaking and Practice for another 4-year term. This re-designation renders K2P as the first and only of its kind in Lebanon and the Region, and the second of its kind globally after McMaster Health Forum.

Through its Mentorship Program, the Center is leading the development of sustainable institutional capacity for evidence-informed policy-making in six mentee institutions, strategically selected to represent the six WHO regions. The program will build a cadre of policy-making and research/knowledge institutions that champion the use of evidence in decision-making in health in each WHO Region. 

Last but not least, in collaboration with the Mohammed bin Rashid School of Government in Dubai, the K2P Center will co-host the Sixth Global Symposium on Health Systems Research (HSR 2020) – the world’s largest gathering on health systems research which is taking place for the first time in the Eastern Mediterranean Region. HSR 2020 will welcome over 2,000 policy-makers, researchers, practitioners and funders from more than 100 countries in Dubai from 8-12 November 2020 to learn and exchange ideas to advance the field of health policy and systems research.

Way forward

The experience of the K2P Center demonstrates that knowledge translation platforms can play important roles in supporting evidence-informed policy-making and achieving health and social impact. The establishment of platforms like K2P can strengthen the use of evidence in policy and practice. The K2P Center is willing to provide support to those interested in embarking on a similar journey.

There is also a need for a change in culture and mindsets in both academia and government. Academia needs to rethink its role and move beyond the tradition of education and research towards (also) a ‘third mission’ related to their ability to collaborate with governments and communities to achieve societal impact (4). As illustrated by K2P’s experience, universities can provide a safe haven to support and nurture knowledge broker entities who can assume such a role. Governments and other stakeholders need to acknowledge and reinforce the role of evidence in informing policy-making and practice, and the potential of knowledge translation platforms to leverage different types of knowledge translation activities to inform the policy-making process for better impact.

Evidence-informed policy-making is all about the people who lead and drive change – and that is not only people pushing the knowledge translation agenda, but those who get involved in knowledge translation processes, from policy-makers to citizens.

References

  1. 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 Services Research 2012, 12:200
  2. El-Jardali F, Lavis JN, Ataya N, Jamal D, Use of Health Systems and Policy Research Evidence in the Health Policymaking in Eastern Mediterranean Countries: Views and Practices of Researchers, Implementation Science 7:2, 2012
  3. El-Jardali F, Lavis JN, Jamal D, Ataya N, Dimassi H. Evidence-Informed Health Policies in Eastern Mediterranean Countries: Comparing Views of Policymakers and Researchers, Evidence & Policy Journal, 2014, 10:3
  4. El-Jardali, Fadi, Nour Ataya, and Racha Fadlallah. “Changing roles of universities in the era of SDGs: rising up to the global challenge through institutionalising partnerships with governments and communities.” Health research policy and systems 16.1 (2018): 38.
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