Embedding of research into decision-making …

1 Embedding of research into decision - making processes Adam D Koon, Devaki Nambiar, Krishna D Rao Background paper commissioned by the Alliance for Health Policy and Systems research to develop the WHO Health Systems research Strategy Commissioned by: The Alliance for Health Policy and Systems research / WHOP repared by: Adam D Koon, Devaki Nambiar, Krishna D RaoCorrespondence to: Krishna D Rao Health Foundation of IndiaApril 2012iiTa b l e o f C o n t e n t s1. Introduction Overview Objectives 12. Methods Literature Review Key-informant Interviews 23. Embeddedness & Health research research Embeddedness through the lens of health systems building blocks Conceptual framework for embeddedness in health research Empirical examples of embeddedness in health research 124.

2 Conclusion 17 Works Cited 19 Appendix 1: Interview Guide 22 Appendix 2: Key Informants 24 iii1. OverviewAs health systems have become more complex and public demands for accountability have increased, the salience of overall health system performance for better services and health outcomes has grown. The current international emphasis on evaluating performance has positioned health systems research as an important vehicle for promoting evidence-based policy making . In turn, this emphasis has also encouraged health systems research to become relevant to policy making . The divide between research and policy is substantial in many low and middle-income countries (LMIC).

3 Both supply and demand factors are responsible for this. On the supply side, the limited local pool of human and financial resources has constrained the production of quality research . The result is that many LMICs are characterized by limited institutional capacity to generate research to aid policy making . On the other hand, avenues for research to influence policy are severely limited. One reason for this is the bureaucratization of policy making , in which, researchers and research institutions have only a minor role. Other common obstacles in this regard are centralized decision making and a policy making culture that gives little importance to evidence based research .

4 ObjectivesThis study is concerned with the uptake of research evidence in policy decisions for health and the factors which are conducive for this. Specifically, this study seeks to:(a)Present a conceptual understanding of institutional embeddedness and apply it to the context of research in policy making in health. Further, through a review of the literature, document the institutional arrangements that facilitate the Embedding of research use in the policy- making domain.(b)Present country case studies to illustrate the embeddedness of research use in policy- making and the contextual and institutional factors that create enabling conditions for it.

5 We examine these questions from the perspective of the six WHO building blocks service delivery, health workforce, information, medical products, financing and governance. Information is sourced from the existing literature and from country case studies. Alliance for Health Policy and Systems ResearchEmbedded Health Systems research 12. Literature ReviewLiterature from various disciplines was sourced to develop the idea of embeddedness of research institutions in policy- making for health. We conducted a thorough review of the literature pertaining to the decision making process in health policy, processes of knowledge translation, the generation of research for practical applications in health, and the institutional arrangements that affect these processes .

6 There is also a substantial literature around barriers and facilitators to research utilization in health policy (1-6). The following electronic databases were searched in December 2011: PubMed-Medline (up to December 2011); EBSCO Global Health and Global Health Archive (up to December 2011). Additionally, Google and Google Scholar search engines were used to identify sources not included in the electronic databases. We also attempted to harness evidence from reports, book chapters, and government documents in addition to the peer-reviewed literature. Search terms included a combination of policy-makers , decision makers , evidence-based policy , evidence-based policy- making , policy process , research to policy , data sources , embeddedness , embedded research , social embeddedness , developing countries , and Low and Middle Income Countries.

7 Lastly, we relied on references cited in relevant studies. Key-informant InterviewsThe idea of embeddedness of research was further explored through key informant interviews drawing on decision makers and researchers from India, Mexico, Thailand, Iran, Lebanon, Nigeria, and Cameroon. This data allowed us to empirically reflect upon our conceptual model of embeddedness and examine how research operates in country-specific contexts. Potential key informants were identified and contacted by collaborators at the Alliance for Health Policy and Systems research at the World Health Organisation.

8 The criteria for selection were purposive: informants were to be either high-ranking researchers or national level policymakers or were both, they were to be from countries that are recognized in the literature as having linkages between decision making and evidence (as in Iran, Mexico or Thailand), or where such systems have been created in certain domains of health (as in India and Nigeria). Appendix 2 is a listing of informants contacted and interviewed. Questionnaire developmentInterview questions were developed initially based on a conceptual model of institutional embeddedness that drew from an extensive review of the literature.

9 They were further refined on the basis of discussions and consultations with experts in health policy and systems research in India and abroad to establish credibility. Two iterative versions of the interview guide were piloted with health decision makers in India to arrive at a revised instrument focusing on five major questions (apart from some information on the designation and duration of informants work in health). The guide was structured around four a priori themes used as anchor-points for country case studies on characteristics or processes typifying institutional embeddedness of evidence in decision making .

10 Quantity of relationships, the quality of relationships, the capacity to generate quality health systems research , and the reputation of evidence-generating for Health Policy and Systems ResearchEmbedded Health Systems research 2 Data collectionOnce key informants were selected and initial contact was made, phone or in-person interviews were scheduled by researchers from the Public Health Foundation of India. In most cases (N=10), interviews were conducted on the phone. While some personal informant details (such as designation and institution) were recorded, no names were recorded.