When “Good Evidence” Is Not Enough: A Case of Global Malaria Policy Development

Abstract

This paper presents findings from a case study of two different policy development processes within the WHO's malaria department. By comparing the policy processes for the interventions of intermittent preventive treatment in infants versus children, the findings suggest that “good evidence” from a technical perspective, though important, is not sufficient to ensure universal agreement and uptake of recommendations. An analysis of 29 key informant interviews finds that evidence also needs to be relevant to the policy question being asked, and that expert actors retain a concern over the legitimacy of the process by which technical evidence is brought to bear in the policy development process. Previous findings from the field of sustainable development, that evidence must be credible, salient, and legitimate to be accepted by the public, appears to apply equally within scientific advisory committees. While the WHO has principally focused on technical criteria for evidence inclusion in its policy development processes, this study suggests that the design and functionality of its advisory bodies must also enable transparent, responsive, and accepted processes of evidence review to ensure that these bodies are effective in producing advice that engenders change in policy and practice.

How Useful are Malaria Risk Maps at the Country Level? Perceptions of Decision-Makers in Kenya, Malawi and the Democratic Republic of Congo

“…Stakeholders preferred to develop maps using data and processes that were owned, understood and trusted by the country. As noted in previous studies (20,39,40), the alignment with other sources of information and stakeholder expectations were considered important for stakeholders to have trust in the maps.…”

How useful are malaria risk maps at the country level? Perceptions of decision-makers in Kenya, Malawi and the Democratic Republic of Congo

“…Stakeholders preferred to develop maps using data and processes that were owned, understood and trusted by the country. As noted in previous studies (25,47,49), the alignment with other sources of information and stakeholder expectations were considered important for stakeholders to have trust in the maps.…”

“…More broadly, the literature explores the use of evidence in health planning and indicates there are multiple conceptualisations around evidence and use of evidence (22,23). Some articles focus on scienti c evidence as derived from randomised clinical trials (24,25), while others refer to a more general de nition of evidence which includes information and data (26). Literature on the quality and use of routine health data, surveillance data and survey data at national and district levels in low and middle-income countries (LMIC) is expanding (26)(27)(28)(29)(30), as is the use of health information in humanitarian settings (31).…”

Towards a Systematic Understanding of How to Institutionally Design Scientific Advisory Committees: A Conceptual Framework and Introduction to a Special Journal Issue

“…D'Souza and Parkhurst highlight the importance of ensuring SAC design and functionality actually enable transparent, responsive and credible review of scientific evidence . D'Souza and Parkhurst undertake a comparative study of two different policy development processes within the WHO Global Malaria Program.…”