Evaluating Initiatives to support evidence-informed health system policy-making in Cameroon and Uganda: Case studies of EVIPNet Cameroon and REACH-PI Uganda

Abstract

Background: During the last twenty years, fostering evidence informed health system policymaking (EIHSP) in low- and middle- income countries (LMICs) has been a priority for national and global health players with the aim to bridge the “know-do” gap that undermines progress towards effective, equitable and resilient health systems. Amongst the efforts are the knowledge translation platforms (KTPs) considered as social innovations that bring together policymakers, researchers and civil society representatives for evidence-informed processes, policies and practices to address health system priorities. The premise underlying KTPs is that the use of research evidence for health system policymaking (HSP) will yield positive public health and social impacts. Yet, there is a dearth of empirical evidence about the climate for, development of, and actual influence of KTPs in sub-Saharan countries, which are settings often taken to be synonymous with scarcities and where policymaking is reputedly much more opaque or less studied than in the democracies in which the models elucidating evidence-to-policy linkages were developed. Aim: This doctoral dissertation documents KTPs through three studies that substantiate three peer-reviewed published manuscripts investigating the climate for EIHSP, the development and influence of two KTPs in two countries -- Cameroon and Uganda -- hosting pioneering KTPs (Evidence Informed Policy Network EVIPNet-Cameroon; Regional East African Community Health Policy Initiative REACH-PI-Uganda) in government-affiliated institutions since 2006. Methods: A structured documentary review (study 1) and a series of case studies – two about the KT platforms (study 2) and four about policymaking processes the KT platforms sought to inform (study 3) -- that themselves draw on key informant interviews and documentary analyses provide the empirical basis for the doctoral dissertation. Results: This dissertation presents i) the development of a framework combining health policy analysis and political science variables (e.g.; Institutions, Interests, Ideas and External factors also called 3I+E framework) and interactive knowledge translation perspectives guiding this enquiry; ii) the changes in the climate for EIHSP in both countries through a content analysis of governmental policy documents during a 12-year period that include before and after the establishment of the KTPs in 2006; iii) the comparative analysis of the genealogy of EVIPNet-Cameroon and REACH-PI-Uganda and their achievements in terms of capacity building, management of policy-relevant evidence, and linkage and exchange; and iv) the pathways of and the actual influence of the multifaceted efforts undertaken by both KTPs (e.g., co-produced evidence briefs, inclusive evidence-informed stakeholder dialogues, capacity building activities to demand and use policy-relevant evidence, maintaining clearinghouse of policy-relevant evidence, etc.) on four health system policy processes aiming to support the achievement of the health MDGs (e.g., health governance and malaria control in Cameroon, task shifting and skilled birth attendance in Uganda) and HSP at large; and the perceived influence of KTPs on the general climate for EIHSP. Conclusion: As a whole, this dissertation provides a robust set of answers to the research questions posed at the beginning of the research work in 2011. First, the climate for evidence informed decision policy-making has improved both in terms of discourse in governmental policy documents and resource allocation and stakeholders’ perceptions. Second, EVIPNet Cameroon and REACH-PI Uganda emerged as pioneering KTPs founded on local strengths and buttressed by international partnerships altogether boosted by the global push for EIHSP triggered by the 2015 agenda relating to the health MDGs. Third, both KTPs by intersecting with decisive contextual factors of HSP were instrumental in reinforcing the conducive climate for EIHSP especially in terms of enhancing community and civil society participation to health policy debates and consistent integration of equity considerations. Fourth, this study uncovers features of the intricacy of politics and organizational and individual factors pertaining to the research-to-policy interface in two African countries striving to achieve the health MDGs. Fifth, KTPs have both direct and indirect influences on all four policymaking processes and decisions through pathways of interest groups interaction and research-based ideas