Acceptability and utilization of evidence for decision-making: helminth control, sub-Saharan Africa

Abstract

Abstract Background Public health practitioners are part of a larger global health system, responsible for the implementation of disease-specific health interventions, largely financed by external actors through a variety of mechanisms. Emphasis on the need for evidence-informed decision-making often includes rhetoric for the localization of this approach to assist practitioners in resource allocation. In practice its realisation is challenging. This research addresses the following: what are the evidence needs of local public health practitioners? How acceptable are, for example, modeled disease estimates? What decision-making processes occur for implementation? How do evidence and decision-making processes interact? Methods Examining mass drug administration (MDA) for schistosomiasis and soil-transmitted helminths (STH) in the African Great Lakes region (Kenya, Malawi, Tanzania and Uganda), we use qualitative approaches to collect data, including a series of 4 workshops with district- and national-level MoH personnel, key informant interviews and e-survey questionnaires from a sample of relevant local and global organisations including NGOs. Coded data are analysed thematically. Results Preliminary results provide important insights into the sources, types and format of evidence which local public health practitioners find acceptable and useful for decision-making when implementing disease control measures. Conclusions A variety of factors influence local level decision-making with implications for policy aimed at disease control, such as MDA for schistosomiasis and STH, and global health policy and practice more broadly. First, processes of decision-making at different localities are heterogenous and evidence needs of local practitioners are not well understood. Second, evidence development and knowledge synthesis on health interventions are rarely linked in ways that feedback and respond to local implementation, decision-making practices and public health practitioners. Key messages Evidence needs of local public health practitioners need to be accounted for when producing and synthesising evidence. Multiple factors influence local level decision-making with implications for public health disease control policy.