Developing evidence-informed policies
A profile of EVIPNet
In a perfect world, health policy would be informed by the best available evidence. Country control programmes and health ministries would both initiate and be involved in research based on their needs, and the final results would be provided in an easy-to-read format so that the fruits of research would be available to all.
As it is, however, health systems in all countries struggle to effectively implement evidence-informed interventions. In low- and middle-income countries, this is a particular problem because often there is no process in place to ensure that the scientific evidence generated by research is accessible and translated within the context to the programme managers and policy-makers who need them.
Take, for example, insecticide-treated nets (ITNs). Long a cornerstone of malaria control, ITNs are a proven method of prevention, and numerous studies have investigated their implementation. Yet just 35% of children in sub-Saharan Africa were sleeping under an ITN in 2010, far below the World Health Assembly (WHA) target of 80% (WHO figures).
The start of EVIPNet
That gap between research and practice prompted the 58th WHA, held in 2005, to issue a resolution urging member states “to establish or strengthen mechanisms to transfer knowledge in support of evidence-informed public health and healthcare delivery systems and health-related policies.” The Evidence-Informed Policy Network (EVIPNet), a WHO knowledge transfer initiative, emerged as an innovative response to that resolution.
EVIPNet works to strengthen health systems and improve health outcomes by promoting a network of partnerships at the national, regional and global levels. And central to that effort is the “country team” — a group of policy-makers, researchers, civil society representatives and other stakeholders tasked with identifying and negotiating the context-specific challenges of translating knowledge into practice.
“When we started out, there were no other initiatives of this kind,” says Ulysses Panisset, coordinator of the global secretariat of EVIPNet in the WHO’s Knowledge Management and Sharing Department. The programme began with TDR help. “We needed to test our tools and methodologies,” said Panisset, “and with TDR support through its capacity building programme we were able to do that.”
We needed to test our tools and methodologies, and with TDR support through its capacity building programme, we were able to do that.
Ulysses Panisset, coordinator of the global secretariat of EVIPNet
In February 2008, TDR helped the fledgling organization convene seven country teams — from Burkina Faso, Cameroon, Central African Republic, Ethiopia, Mozambique, Tanzania and Zambia — for the first EVIPNet Policy Brief Workshop in Addis Ababa. Participants “learned by doing,” says Panisset, as each team developed a draft policy brief with a set of evidence-informed options and implementation strategies for addressing an issue all felt was the most pressing in their respective countries: the scale up of artemisinin-based combination therapy (ACT) for the treatment of uncomplicated falciparum malaria at the community level.
TDR-funded research had previously shown that when distributed by community health workers, ACTs are safe, effective, feasible and acceptable. And earlier that year, TDR, in collaboration with Roll Back Malaria (RBM), had launched a set of lessons learned for treatment with ACTs at the community level. “So we were able to work with them to set this up,” says Franco Pagnoni, a specialist in malaria who helped bring to the workshop scientists who had been funded by TDR to work on community case management of malaria.
“Translating research findings into policy is a major challenge, and one that we know well,” Pagnoni adds. “When you go to a policy-maker with your results, they listen to you, and then they put your 15-page manuscript in a drawer. It’s a problem of language and a problem of length, and that’s why teaching researchers to write an evidence brief for policy is so important. If they can fill this gap in communication, EVIPNet will have accomplished quite a lot.”
According to Panisset, six of the evidence briefs for policy drafted in the workshop were later used by the ministries of health—proof positive, he says, that through capacity development, EVIPNet can empower countries to execute this process by themselves.
Growth and progress
Since this beginning, the programme has dramatically expanded to include 25 country teams and 6 regional networks. In addition, 450 people have been trained to lead this type of process, which has resulted in 35 evidence briefs for policy. There are now 30 master trainers in evidence informed policy-making so EVIPNet can support scale-up at national and district levels.
We are in a hurry to do things, and if we don’t get the information we need, we have to go elsewhere.
Minister of Health of Zambia Dr Joseph Kasonde
Isabelle Wachsmuth of the global secretariat of EVIPNet says they have also used TDR project management tools specifically for the development of the global EVIPNet strategic plan and also for its dissemination to EVIPNet country teams. “This has been a valuable partnership,” says Ms Wachsmuth. “The tools have helped expand our programme to more countries, in a customized way for the countries.”
At this year’s WHA, the African network provided an update on what they have accomplished. Dr Bocar Kouyate, on behalf of the Minister of Health for Burkina Faso, told a packed meeting room that the network now has 12 countries, with work on areas such as malaria, maternal and child health and allocation of financial resources. They have also piloted a system for developing rapid evidence briefs for policy requests which has been well received. Countries are sharing and learning from each other so that high quality networks are increasing.
Minister of Health of Zambia Dr Joseph Kasonde reinforced the value of the rapid responses. “We are in a hurry to do things,” he said, “and if we don’t get the information we need, we have to go elsewhere.” He also called for more research to be published in national journals for easier access, and referred to a database he is trying to create of all national research and institutions.
Research evidence is not a luxury. It is critical to being able to prioritize needed services.
WHO Assistant Director General for Health Systems and Innovation Marie-Paule Kieny
WHO Assistant Director General for Health Systems and Innovation Marie-Paule Kieny captured the feelings of those involved. “Research evidence is not a luxury. It is critical to being able to prioritize needed services. EVIPNet is for you, and WHO is very happy to be supporting this growing and important service.”
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