Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda

Abstract

Background: Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. Methods: Using exploratory qualitative methods, we conducted interviews with 51 key informants using an indepth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Results: Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. Implications for policy makers• Policy development requires different types of evidence and there is no single type of evidence agreed upon as the most appropriate. • Different stakeholders attach more importance to different types of evidence. • Policies whose implementations impact on several institutions and systems are likely to require more evidence, compared to those where implementation only requires minimal adjustments in the current practice. •The quality of evidence is a very important aspect which creates more confidence in the results, and increases the likelihood of knowledge translation.• In order to ensure that policy-makers receive evidence that meets their expectations, information on their needs is necessary. This could be in the form of national research agendas and/or, needs assessment findings. Such an initiative would need to be routine and the needs should be updated regularly involving a dialogue between research producers, and policy-makers as research users. Implications for publicMultiple forms of evidence inform policy development and are indeed deemed appropriate by policy actors. In this regard, the community also has information that can guide policy development in the form of community complaints, for example. Structures and mechanisms need to be put in place to enable community participation in forums where different types of evidence are discussed in order to come up with the best policy options.

Evidence-based practice in local public health service in Ghana

“…They rather prioritised their personal local experiences and best practices as the highest form of evidence for health decisions. Preference for local evidence has been reported in a similar study in Uganda, where district health managers prioritised local evidence generated from routine monitoring and evaluation and reports from service providers (Nabyonga- Orem and Mijumbi, 2015). The managers in this study expressed a concern about the methods used to gather research evidence.…”

The role of evidence in nutrition policy‐making in Ethiopia: Institutional structures and issue framing

“…agriculture). There may be differences of opinion on the priority or importance of policy action, clashes in authority between departments, which may vie for ownership of policy and interventions, and a need for co-ordination and co-operation that adds additional levels of complication beyond what would be needed in single-sector policymaking (Pelletier et al, 2012;Hoey & Pelletier, 2011;Trivedi, 2000;Mills, 1990). Health sector respondents certainly stated that, under NNP-I and GTP-I, nutrition was not sufficiently prioritized in the policy-making of other sectors and that nutrition targets were not sufficiently represented in overarching documents.…”

“…However, several case studies, including some from LMICs, have illustrated the difficulties in applying these ideas in practice. Nabyonga‐Orem and Mijumbi (), for instance, reflected on the Ugandan experience of evidence utilization:

“although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in low‐income countries, the definition of what evidence is, and what evidence is suitable to guide decision‐making is still unclear” (p. 285) .

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Does the Narrative About the Use of Evidence in Priority Setting Vary Across Health Programs Within the Health Sector: A Case Study of 6 Programs in a Low-Income National Healthcare System

“…18 To some extent, these strategies have increased the availability and use of evidence, yet there are still circumstances in which evidence is either lacking, inaccessible, underutilized, or lacks credibility. 19 For example, the limited resources that hamper priority setting in LICs may also contribute to a lack of credible evidence. [19][20][21][22] Furthermore, there are reported cases where evidence has been disregarded by decision-makers whose priorities lie elsewhere.…”