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Building capacity to use research evidence in decision making in Africa Dr. Ekwaro A Building capacity to use research evidence in decision making in Africa Dr. Ekwaro A OBUKU on behalf of Prof. Nelson K SEWANKAMBO [email protected] mak. ac. ug The 1 st Africa Evidence Network Colloquium, University of Johannesburg, South Africa 25 th November 2014 “…People who say it cannot be done should not interrupt those who are doing it…” Chinese Proverb Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

OUTLINE OF TALK ü ü ü ü The communication problem The policy pie Why, OUTLINE OF TALK ü ü ü ü The communication problem The policy pie Why, who & what (KT Gospel: John ch. 2006) Recent efforts in Africa Challenges Lessons learned Tell your story Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

The Communication Problem You must be a researcher Where am I? Because what you The Communication Problem You must be a researcher Where am I? Because what you told me is absolutely correct but completely useless Yes, how did you know? Slide courtesy of Martin Mc. Kee You’re 30 metres above the ground in a balloon Yes. How did you know? You must be a policy maker Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming me

Gavin Bennet & Jasreen Nessani, 2011 Africa Centre for Systematic Reviews and Knowledge Translation, Gavin Bennet & Jasreen Nessani, 2011 Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

WHY? Cochrane Review: 1. no significant effect on hospitalisations: risk difference (RD) 0. 15% WHY? Cochrane Review: 1. no significant effect on hospitalisations: risk difference (RD) 0. 15% (95% CI -0. 78 to 0. 91); 2. reduced the time to first alleviation of symptoms by 16. 8 hours ‘‘…no better than paracetamol…” UK: $750 mn, USA: $1. 5 bn, Aus: $192 mn…and Canada, Israel, India… Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

WHY? • Global inequity in health research: The “ 10/90” gap • only 27% WHY? • Global inequity in health research: The “ 10/90” gap • only 27% of 308 researchers in LMICs provided systematic review evidence to their target audience [Lavis et al, 2010] • policy makers were rarely exposed to systematic reviews as a source of evidence [Nabudere et al 2012] Global Forum for Health Research, 2004 Swingler et al 2003 Tugwell et al 2006 Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

WHAT? Mak. CHS Mo. H Lavis et al. 2006 NARO & NAADS NICE Africa WHAT? Mak. CHS Mo. H Lavis et al. 2006 NARO & NAADS NICE Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug 3 RD ELEMENT • Push • Pull • Exchange • Integration

1. The Stakeholder map: (individuals, institutions) Decision makers, Researchers, Civil society, Public 2. Curriculum: 1. The Stakeholder map: (individuals, institutions) Decision makers, Researchers, Civil society, Public 2. Curriculum: under/post graduate 3. Career structure: opportunities in universities and government bodies 4. Multidisciplinary teams: economists Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug Accountability to the public WHO?

RECENT EFFORTS IN AFRICA o UJ-BCURE o SACC – South African Cochrane Centre o RECENT EFFORTS IN AFRICA o UJ-BCURE o SACC – South African Cochrane Centre o SURE – Supporting Use of Research Evidence for Policy in Africa Health Systems o EVIPNet - Evidence Informed Policy Network o SIHCLIC - Supporting Informed Healthcare Choices in Low-Income Countries o KNET – Knowledge Translation Network Africa o AFIDEP - African Institute for Development Policy o APHRC – African Population & Health Research Centre o GESI – Global Evidence Synthesis Initiative MEPI Awardees: Institutions and Countries. $130 mn, 5 yrs Primary research capacity Research synthesis capacity Capacity for Knowledge Translation Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

CHALLENGES • Evidence not valued in decision making 24 publications about capacity building in CHALLENGES • Evidence not valued in decision making 24 publications about capacity building in Africa. Only 2 about KT. • Research in KT not valued or appreciated • Funding is inadequate • Limited or no national programs to monitor and evaluate progress of KT initiatives • Kebede et al (2014). Research output of health research institutions and its use in 42 sub-Saharan African countries J R Soc Med, 107(1 suppl), 105 -114. • Zachariah et al (2014). Research to policy and practice change: is capacity building in operational research delivering the goods? Trop Med Int Health, 19(9), 10681075. Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

LESSONS LEARNED: ↑ R 2 P PROMISING ACTIVITIES BARRIERS • Interaction between researchers and LESSONS LEARNED: ↑ R 2 P PROMISING ACTIVITIES BARRIERS • Interaction between researchers and decision makers • Building research to policy partnership networks and trust • Timing and timeliness of research evidence • Lack of perceived relevance • Training in systematic review use; peer group support; mass mailing a printed bulletin [Murthy et al 2012] • Use of jargon in research evidence Oliver et al 2014 Innvaer et al 2002 of the research • Negative attitude towards use of research evidence • Lack of relevant skills by decision makers to find, read, appraise & interpret research evidence brief write ups • Power and budget struggles among decision makers Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

“…tell me and I'll forget; show me and I may remember; involve me and “…tell me and I'll forget; show me and I may remember; involve me and I'll understand…” The “God Fathers” Building on SURE http: //www. who. int/evidence/sure/en/ $$$$$ The “Holy Spirit” The “Disciples” Mentorship: International Research Chairs Initiative Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug

Nov 2014 – April 2016 34 started phase I • • Rwanda Ethiopia Tanzania Nov 2014 – April 2016 34 started phase I • • Rwanda Ethiopia Tanzania Kenya Uganda Botswana South Sudan August 2013 – Feb 2015 26 reviewers enrolled • • 20 (77%) Completed phase I 24 (92%) Completed phase II 8 (31%) Women scientists Active in phase III: 7 (27%) Introduction to systematic reviews: MSc. CEB/CEU, Mak. CHS 27 th – 31 st October, 2014 Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug 2=Kenya 1=Tanzania 1=Cameroun 1=Botswana 19=Uganda

Ruth Stewart Nelson Sewankambo John Lavis Marie Ingabire Robert Basaza Robert Salata Cissy Kityo Ruth Stewart Nelson Sewankambo John Lavis Marie Ingabire Robert Basaza Robert Salata Cissy Kityo Theopista Obuku Peter Mugyenyi Elly Katabira Edward Ddumba Charles Olaro John Obuku Okullo Epak Kirunda Kivejinja John Kibirigi Thomson Obuku Moses Joloba Francis Adatu David Mafigiri Margaret Mungherera Apollo Epuwatt Nathan Kenya. Mugisha Nelson Kakande Enid Mbabazi David Ndugutse Diana Elbourne Progress with conducting reviews Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University www. chs. mak. ac. ug