Knowledge translation (KT), use of evidence in decision making, diffusion of evidence in policy development, evidence-based decision making… – whatever term you may prefer for it, KT is not really a new phenomenon. Still, realization remains elusive, certainly in many countries in sub-Saharan Africa. Does the current (continent-wide) Universal health Coverage (UHC) agenda call for more or new approaches in this respect or does the UHC drive just underscore the urgent need for countries and governments to get – finally – our KT act together?
In pursuing UHC, emphasis has – perhaps more than before was the case – been placed on country-specific paths, development of context-specific solutions and generation and use of contextualised evidence. Within the WHO African Region (WHO AFRO), since a few years there is a renewed focus on KT, one of the cornerstones of the Regional Transformation agenda. This agenda is geared towards country-specific initiatives and interventions to move the countries in the region towards the achievement of health and health related sustainable development goals and targets. In particular, towards the achievement of UHC, it goes without saying. To turn this commitment into reality, WHO AFRO has embarked on various initiatives to support member countries, on how to implement and take to scale UHC interventions based on their unique contexts. Central to this drive is the generation and use of contextualized evidence. Previous efforts to improve uptake of evidence centered on the establishment of the Regional health observatory at the WHO AFRO level, unfortunately, without concurrent efforts to establish the same at the country level – at least in most countries; knowledge translation platforms under the Evidence-informed policy network (EVIPNet) exist in only 11 countries in the WHO African Region.
The endorsement of a research strategy, Research for health: A strategy for the African Region, 2016-2025 by the 65th WHO African Regional committee in 2016, and a HSS UHC framework, the Health systems and services (HSS) UHC framework by the 67th WHO African Regional committee in 2017, ushered in a new era. The research strategy seeks to provide guidance to member states on how to strengthen their national health research systems to optimize research production and uptake. The HSS UHC framework, on the other hand, seeks to guide member states on what to do, how to do it and how interventions can be sequenced to strengthen their health systems towards UHC. As most of you will know, top leadership in WHO AFRO is currently committed to UHC. Indeed, the Regional Director has made it one of her flagship programs with a clear commitment to attain set health and health-related targets by 2030. The use of evidence to develop unique and context-specific paths towards UHC is underscored in the latest WHO AFRO Strategy
And WHO AFRO is walking the talk: the scaling up of national health observatories in countries and the training of WHO African region office staff in knowledge translation attest to this. At present, 20 countries have established national health observatories serving as one-stop centres for data and evidence on health issues in the country. One may argue that this is only half the story because we need to ascertain that data and evidence are also being utilized; we choose to look at things from the positive (‘glass half full’) side, however, and argue that the starting point in KT is availing data and evidence to the wider audience.
On 6th – 7th June, WHO AFRO also held a workshop in Brazzaville, Congo to orient all technical staff on appraising systematic reviews and developing policy briefs. The workshop was facilitated by the Cochrane Africa team. The main objective of the workshop was to increase awareness of the need for evidence-based health care and build capacity on how to access and use evidence from systematic reviews for policy. The trainees were taken through the principles of evidence-based health care; features of a good systematic review; how to navigate and search the Cochrane Library; the principles of GRADE (in assessing the quality of the evidence), evidence-to-decision frameworks and the purpose and content of evidence-based policy briefs.
The question as to why we need knowledge was also discussed – the wide scope of questions that can be answered was noted, eg. ‘knowing about the problem’, ‘knowing what works’, ‘knowing how to put something into practice’, ‘knowing who to involve’ and, ‘knowing why action is required’. In emphasizing the role of evidence in decision making, facilitators referred to quotes of respected professionals: “Professional good intentions and plausible theories are insufficient for selecting policies and practices for protecting, promoting and restoring health”; “Evidence must be of good quality…” – the latter is indeed a (well-documented) facilitating factor to foster the uptake of evidence. In addressing this, the grading of evidence was a key focus at the workshop, with systematic reviews ranked at the top, and expert opinion at the base of the ladder. Participants reiterated the need for locally generated solutions and tailored paths for each country but in discussing this, the question of how locally generated evidence (much of which can be found in grey literature) rates against systematic reviews (some of which may not include any study from the country where a decision actually needs to be made) was raised. Further, participants remarked that although systematic reviews are the gold standard, real-life concerns also play a vital role in the decision-making process. Put differently, we need to find a balance between a fast-paced decision-making process (with often a very short policy window) and protracted research processes. Indeed, the aspiration of WHO AFRO is framed like this, “Our current focus is to accelerate the consolidation of evidence in implementation of UHC for Member States of the Africa Region”. In real world terms, the watchword at the workshop was: “we are aiming for accelerated production within 3 – 4 weeks of summarized health policy briefs, using various methods to truncate the development process without sacrificing scientific quality”. Perhaps this defines the balance.
The demonstration of commitment at the workshop was most impressive. The hands-on event allowed participants to practice taught skills and a session dedicated to identifying evidence gaps yielded over 25 areas requiring policy briefs which the teams will embark on immediately. The capacity that has been built and the ownership the process engendered send a ray of hope. We envisage evidence-based decision making becoming the norm as opposed to being one-off or erratic within the WHO African region. Within the coming months, policy briefs on various thematic areas will become available to guide policy dialogue for WHO AFRO. Whether this is good enough (or not) may be debatable because similar capacity also needs to be built at the country level. Indeed, this is just the beginning of the story, subsequent steps will be to support countries in this endeavour building on the work already done by EVIPNet.
But as already mentioned, we tend to be glass half full people, and so as far as we are concerned, the KT future in Africa looks bright!