Acting on the evidence
The uptake of research findings into policy is often subject to contextual and political factors. Research from the Evidence for Action research programme illustrates the need to use policy analysis frameworks to understand how research can play a role in policy processes.
Two research trials, showing the benefits of Cotrimoxazole prophylaxis in HIV-infected adults in Côte d’Ivoire in 2000, were rapidly translated into provisional WHO and UNAIDS recommendations. In 2004, evidence from a large longer-term randomised paediatric trial in Zambia endorsed these results despite high levels of bacterial resistance to Cotrimoxazole in the area. Paediatric guidance was updated by WHO, UNAIDS and UNICEF, and detailed definitive guidelines were published in 2006 by WHO.
Building links between the research community and policymaking bodies has the potential to encourage uptake of findings
Although these international recommendations were widely available, at national levels, countries with high burdens of HIV and AIDS show different histories of the uptake and use of Cotrimoxazole prophylaxis. Uganda and Malawi, for instance, incorporated Cotrimoxazole into policy in 2005, while Zambia did not until 2007, despite several trials having been undertaken there.
Evidence for Action compared the uptake of research findings in these three African countries, with in-depth work done so far in Malawi and Zambia. They found that a number of contextual and political factors could help explain the research-to-policy process in each country. Using a model developed by the Overseas Development Institute’s Research and Policy in Development (RAPID) programme, the researchers investigated the nature of the evidence, the context in which policy change was happening, and the key links between influential actors.
Evidence needs to be interpreted against the local context in which the research was carried out. Yet to ensure uptake into policy and practice, findings need to be conceptualised in terms of bringing about policy change. In Zambia, for instance, the findings were initially conceptualised as a clinical matter. Yet, service provision for HIV care is increasingly done by clinical officers (not physicians) who have less freedom to choose their own clinical practice. As such, these health workers found it difficult to use the findings, without endorsement from national guidelines.
Researchers working in health programming (in government or in NGOs) appear to have had a particularly powerful impact on policymaking by sitting in both research and traditional policymaking circles. This is an illustration of how building links between the research community and policymaking bodies has the potential to encourage uptake of findings. Established institutions or practices that bring research findings to policymakers is one such approach, as is having key individuals or ‘policy champions’ working to promote change in the right circles. Researchers who also sit on NGO or government bodies may fit this role particularly well.
The attention paid to antiretrovirals earlier in the decade may have overshadowed Cotrimoxazole. However, in Zambia’s case, later revisions of national guidelines for antiretroviral therapy provided a window of opportunity to get Cotrimoxazole into official policy in 2007.
This study shows:
- the dangers of assuming that policy will follow directly from research findings
- multiple conducive elements are needed for an effective research-to-policy model
- the links between evidence and policy need to be crystal clear
- key actors and mechanisms, including established institutions and policy champions, can link research findings to policy networks with positive results.
Eleanor Hutchinson, on behalf of the EfA Cotrimoxazole project group
Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
T +44 (0) 207 927 2534
eleanor.hutchinson@lshtm.ac.uk
www.lshtm.ac.uk/hpu
The London School of Hygiene and Tropical Medicine is a partner in the Evidence for Action RPC
