Influencing policy and practice

IHPSR Presentation 9

www.hpsa-africa.org

@hpsa_africa

www.slideshare.net/hpsa_africa

Introduction to Health Policy and Systems Research

Should researchers actively seek to influence policy?

• No -- science as neutral, factual, ‘disinterested’

• Yes -- knowledge as contestable, researchers as ‘engaged’

HPSR …

… is an ‘applied’ research field

by definition, it

promotes work that seeks to influence policy (ultimately)

seeks better to understand the power and process in policy-making and implementation

HPSR, by the very nature of the

constituency it serves, cannot

adopt the position of a

disengaged and distanced

supplier of knowledge.

(Mills et al., 2008)

WHO, 2012

What is the policy-making process?

A rational, linear process: policy-makers gather evidence and make policy

Muddling through (incrementalist): problems tackled a bit at a time, many

influences

Garbage can: complex, messy, opportunistic

Models of research-policy diffusion

Walt, 1994

Ideal model of natural sciences

• Researchers do good research and disseminate findings

• Policy-makers read, understand and act on findings

Models of research-policy diffusion

Walt, 1994

Policy enlightenment model

• Policy change is the result of accumulation of evidence, information and knowledge that slowly drips into policy environment through information exchange between people, with unpredictable impacts

It takes time!

Need for networks bringing researchers and policy makers together

Can’t predict impacts

How to judge if research has influenced policy? Lavis, Ross & Hurley, 2002

Direct influence:support the writing of documents, changes in practice

Indirect influence:changes in ideas, levels of knowledge,

understanding or attitude

Symbolic influence:used to justify a position or action already taken

• What are the barriers between research and its use for policy and practice?

WHO, 2012

• Lack of demand

• Lack of engagement

• Different characteristics of research and policy making

• Suspicion of each other

Why does research NOT influence policy?

• Policy-maker perspectives

– relevant research not available or known or clear

– research takes too long

– researchers don’t understand policy world

– do not trust research or researchers

• Researcher perspectives

– policy-makers don’t listen, act on other bases

– policy-makers don’t make time to engage with researchers

– policy-makers focus on current problems only

Green & Bennett, 2007

Green & Bennett, 2007

Green & Bennett, 2007

Brainstorm

• What should you think about when planning a research project, to support policy engagement and influence?

Stakeholder engagement• Who are the critical stakeholders?• How might the research design take into consideration the needs of

end users?• How could you encourage on-going engagement with stakeholders

throughout the project?

Capacity building• Does your team have the capacity to communicate research

effectively?• Will an assessment be made of external capacity to make use of

research results?• What sort of capacity building approaches might be proposed?• Does the programme team have the capacity to implement their

capacity building strategy?

Communicating• Will you carry out research synthesis during the inception phase

and/or later?• Will outputs be published in peer review journals? Will you make the

outputs open access?• Is there a plan to package and communicate findings to non-specialist

audiences?

Thinking beyond projects to ...

• Programmes, organisations and networks

and

• Embededdness

• Capacity for evidence-informed policy

Networks of engagement that:

• Help researchers identify the nature of demand

• Accelerate the speed at which research evidence can be made available to decision-makers

• Allow close connectivity while maintaining scientific independence

• Are built on trust between decision-makers and researchers

• Have sufficient capacity to address the demand for in-depth and high quality research

Create an environment which fosters connections between evidence and policy-making, encouraging sustainable changes in the institutional mindset.

Implicit, in this new mindset, is the need for HPSR to become embedded in the ecosystem in which the decision-makers operate

Embededdness

• Being part of an organisational network within a decision-making context, with potential for having influence because its members have a strong reputation and are deemed trustworthy

Koon et al., 2013

Green & Bennett, 2007

WHO, 2012

Green & Bennett, 2007

Green & Bennett, 2007

Our own experience

Consider …

• For your organisation, country:– What can you do to strengthen evidence

informed policy-making?• Review Sound Choices, Box 8.1

• For yourself, what does this mean for how you work and what capabilities do you need?

• Review Sheikh, George & Gilson, 2014

Useful resources

• http://www.drussa.net/

• http://www.health-policy-systems.com/supplements/7/s1

Copyright

Funding

You are free:To Share – to copy, distribute and transmit the work

To Remix – to adapt the work

Under the following conditions:Attribution You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work).

Non-commercial You may not use this work for commercial purposes.

Share Alike If you alter, transform, or build upon this work, you may distribute the resulting work but only under the same or similar license to this one.

Other conditionsFor any reuse or distribution, you must make clear to others the license terms of this work.

Nothing in this license impairs or restricts the authors’ moral rights.

Nothing in this license impairs or restricts the rights of authors whose work is referenced in this document.

Cited works used in this document must be cited following usual academic conventions.

Citation of this work must follow normal academic conventions. Suggested citation:

Introduction to Health Policy and Systems Research, course presentation, Presentation 9. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014, www.hpsa-africa.org www.slideshare.net/hpsa_africa

This document is an output from a project funded by the European Commission (EC) FP7-Africa (Grant no. 265482). The views expressed are not necessarily those of the EC.

The CHEPSAA partners

University of Dar Es SalaamInstitute of Development Studies

University of the WitwatersrandCentre for Health Policy

University of GhanaSchool of Public Health, Department of Health Policy, Planning and Management

University of LeedsNuffield Centre for International Health and Development

University of Nigeria Enugu Health Policy Research Group & the Department of Health Administration and Management

London School of Hygiene and Tropical MedicineHealth Economics and Systems Analysis Group, Depart of Global Health & Dev.

Great Lakes University of KisumuTropical Institute of Community Health and Development

Karolinska InstitutetHealth Systems and Policy Group, Department of Public Health Sciences

University of Cape TownHealth Policy and Systems Programme, Health Economics Unit

Swiss Tropical and Public Health InstituteHealth Systems Research Group

University of the Western CapeSchool of Public Health