Abstract
BackgroundThe need for evidence-based decision-making in the health sector is well understood in the global health community. Yet, gaps persist between the availability of evidence and the use of that evidence. Most research on evidence-based decision-making has been carried out in higher-income countries, and most studies look at policy-making rather than decision-making more broadly. We conducted this study to address these gaps and to identify challenges and facilitators to evidence-based decision-making in Maternal, Newborn and Child Health and Nutrition (MNCH&N) at the municipality, district, and national levels in Mozambique.MethodsWe used a case study design to capture the experiences of decision-makers and analysts (n = 24) who participated in evidence-based decision-making processes related to health policies and interventions to improve MNCH&N in diverse decision-making contexts (district, municipality, and national levels) in 2014–2017, in Mozambique. We examined six case studies, at the national level, in Maputo City and in two districts of Sofala Province and two of Zambézia Province, using individual in-depth interviews with key informants and a document review, for three weeks, in July 2018.ResultsOur analysis highlighted various challenges for evidence-based decision-making for MNCH&N, at national, district, and municipality levels in Mozambique, including limited demand for evidence, limited capacity to use evidence, and lack of trust in the available evidence. By contrast, access to evidence, and availability of evidence were viewed positively and seen as potential facilitators. Organizational capacity for the demand and use of evidence appears to be the greatest challenge; while individual capacity is also a barrier.ConclusionEvidence-based decision-making requires that actors have access to evidence and are empowered to act on that evidence. This, in turn, requires alignment between those who collect data, those who analyze and interpret data, and those who make and implement decisions. Investments in individual, organizational, and systems capacity to use evidence are needed to foster practices of evidence-based decision-making for improved maternal and child health in Mozambique.
Highlights
The need for evidence-based decision-making in the health sector is well understood in the global health community
Study design This study is based on a combination of case studies that capture the diversity of experiences of evidence-based decision-making processes about MNCH&N at different levels where decisions about health policy and interventions are made in Mozambique, and at different performance levels on select maternal and child health indicators over time
The National Evaluation Platform (NEP) is an example of efforts to improve evidence-based decision-making at the national level, while Sofala is a similar example at the provincial, district and facility levels
Summary
The need for evidence-based decision-making in the health sector is well understood in the global health community. The cited facilitators were: [1] “availability and access to research”, [2] “collaboration between researchers and policymakers”, [3] “clarity”, “reliability” and “relevance of research findings”, [4] research evidence “relationship with policymakers”, and [5] research evidence “relationship with researchers”. These findings are consistent with those found elsewhere [1, 6,7,8], and most have been found in Mozambique [9,10,11,12]. Most research on evidence-based decision-making has been carried out in higher-income settings, and most studies look at policymaking rather than decision-making more broadly
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