Governments in Kenya, Malawi, Rwanda, and Uganda are making health policy decisions without knowing whether the scientific advice they receive is reliable, relevant, or even reaching them at all. This project will map how each country’s “evidence advisory system” actually works—the institutions, relationships, and cultures that determine what research gets used and what gets ignored. The problem is that many lower-income countries lack the capacity to build effective systems for turning scientific evidence into policy. Without this, health spending can be misdirected, disease outbreaks poorly managed, and reforms like Universal Health Coverage undermined. The researchers will work directly with government stakeholders to co-produce a framework for evaluating these systems, then test it against two very different policy challenges: COVID-19 and Universal Health Care. If successful, the project could lead to concrete institutional changes—new procedures, better coordination between ministries and researchers, and more systematic use of evidence in health planning. The impact would be felt not in a single clinic or hospital, but in the quiet machinery of government that shapes how billions of pounds in health funding are allocated across Africa.
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Research Question This research aims to investigate the structure and functioning of evidence advisory systems (also called evidence ecosystems) serving to provide policy-relevant scientific evidence and advice to national government to inform health policy responses in Africa. It aims to work directly with local government stakeholders to co-produce research questions, establish locally-relevant normative conceptual frameworks of analysis, and ultimately coordinate activities which may lead to institutional improvements in evidence systems in Africa. Background For almost all aspects of health policy and planning, there is a need to inform policy decision with robust and policy appropriate evidence. It is therefore critically important for countries to build effective systems of evidence provision which can serve these needs. This is a particular challenge, however, for lower income settings, which may have limited capacity, but which could benefit greatly from robust uses of scientific research, evidence, and innovation. Aims and objectives This study aims to study and develop domestic evidence advisory systems informing health policymaking, through a comparative analysis of how these systems function and can be improved in four case study countries – Kenya, Malawi, Rwanda, and Uganda. Specific Objectives include: 1) Mapping national evidence advisory systems, institutional arrangements, and cultures of evidence; 2) Conceptual development of a framework on which to judge and evaluate the structure and function of these systems, co-produced with key stakeholders; 3) Comparative analysis of the operation of these systems in relation to two contrasting health policy challenges (Universal Health Care and COVID-19); 4) Development and monitoring of action plans for national stakeholders working to improve evidence systems for health. Methods We will utilise a range of methods in line with our project objectives. These include: Mapping through key informant interviews and document reviews; combined with the use of Q-Methodology (Objective 1); literature review and stakeholder engagement meetings (Objective 2); qualitative process tracing methods (Objective 3); and facilitation of peer-to-peer learning and engagement sessions for national stakeholders (Objective 4); Timelines for delivery This research will run for three years. In the first year we plan to recruit our research team, hold preliminary meetings, and undertake the first phase of work consisting Objectives 1 and 2. The second year will primarily involve fieldwork to achieve Objective 3, while the third year will consist of analysis, writing, and dissemination of work from these objectives. Finally, Objective 4 will be pursued throughout the three year period through ongoing engagements. Anticipated impact and dissemination We anticipate a range of outputs and impacts. From an academic perspective our work will contribute to publications in the field of evidence-informed policymaking, health policy, and the broader public policy and African politics literature. Our project also aims to engender institutional changes at country level where feasible – encouraging local stakeholders to learn from each other, and from the project, to inform how they can change their systems and structures of evidence provision to ultimately improve the health policymaking process.
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