Sara Bennett

Johns Hopkins School of Public Health

Quotes from yesterday We need new ways of facilitating rapid learning

between countries and within countries

“Adaptive governance” - building learning within the system itself

Knowledge translation is the driver behind the shift from knowledge to policy to practice

The evidence-accountability continuum is a powerful tool

There is an unwillingness to listen to scientific evidence

Why evidence/learning is key to this discussion Health systems – and the organizations within them - need to be

intelligent and adaptive ones able to identify, analyse and respond to emergent behaviors, phase

transitions, feedback loops understand and predict pathways of change

Shift from two player (policy maker and researcher) to “multi-player” systems in E-to-P Complex policy problems - any one actor alone unlikely to have

sufficient resources to address Role of non-government players in examining evidence, asking the

questions, enforcing accountability

Social system innovation - rise of non-traditional players:innovationmay come from BRICs Commercial sector actors

Policy Networks Resources of multiple players are required to address policy

issue (technical knowledge, financial resources, organizational capacity, legitimacy, political power)

Networks take varied forms from: Small tightly integrated communities capable of collective

action (policy community); to Extensive, loosely-affiliated “issue networks” Epistemic communities (experts) Advocacy coalitions (shared beliefs)

Audiences for evidence will depend on the issue to hand, may include: multiple govt departments, service providers (public/private), advocacy NGOs, international agencies

Each of these groups needs skills to acquire, assess and apply evidence (not necessarily collect it)

What are the right institutions to promote learning across networks? Growth of entities seeking to promote synthesis and

sharing of learning

Health systems observatories

Learning platforms

Knowledge translation platforms

Think tanks/health policy analysis institutes

Health technology assessment units

Rapid response units

1000 flowers blooming…but little learning

Will try to divide by.. Regional – country to country learning

Largely policy related

National policy related learning

Sub-national practice related

Regional institutions for learning Demand – real demand for learning from other countries, typically

government to government particularly “reference countries” Opportunity to discuss how to manage change (which researchers often

don’t document)

Supply In many regions primary mechanisms are informal – sharing of TA Formal include:-

study tours: regional observatories/learning platforms

Questions Need to get reference countries right How to create conditions that inspire trust and openness How much do we really understand policy maker evidence needs How to sustain communities of practice Too government focussed

National Policy Demand - clear evidence on what policy makers value

Personal contact and trust Timeliness and relevance of findings Clear summary messages

Supply Think tanks/Health policy analysis insitutes (about 78 in LMICs) Health technology asssessment units (small but growing movement) Knowledge translation platforms (small but growing)

Questions Unclear how stable many of these bodies are – HPAIs often “surviving on a shoe

string” Optimal institutional arrangements unclear

what is the appropriate distance from government? Are different types of institutions better able to offer real time learning?

Existing HPAIs good at conducting and communicating research – but not good convenors

How to build trust with government while still engaging a broader set of actors?

Practice Demand

Perhaps less clearly articulated than at policy level Investments in information systems often identify lack of

“evidence-informed culture” as obstacle

Supply Localized efforts largely in public sector to promote use of evidence

among practitioners (eg. TEHIP) Very isolated efforts to create learning communities across different

actors No clear institutional body involved – though many could be

Questions How do we weight different types of learning – particularly formal

and tacit? What kind of mechanisms can be used effectively to bring together

actors who may be mutually distrustful How can interventions, slowly over time build trust?

Take away messages Need to invest more in local institutions that support learning

and advocacy:- Should be part of all health research grants Capacity development within institutions Preferably existing rather than new institutions

We need a much better evidence base to guide investments in this field :- What types of institutional structures are best suited to different

types of learning and evidence dissemination across networks? What types of mechanisms are best suited to transferring learning

Social networks (web based) Moving away from hub and spoke networks to true S-S networks Mixing face-to-face with internet based learning platforms.

Focus more on the practice level - working across a range of traditional and non-traditional actors to promote social innovation