Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project.

Mahdi Mahdavi,Reza Toyserkanmanesh,Reza Majdzadeh,Shahram Ghaffari,Bahareh Yazdizadeh,Elham Ehsani-Chimeh,Haniye Sadat Sajadi,Leila Doshmangir,Javad Sajjadi Khasraghi,Sima Nikooee,Hossein Dargahi

doi:10.34172/ijhpm.2021.142

Abstract

SASHA, which stands for "evidence-informed health policy-making (EIHP)" in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidence-based and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran. This was a qualitative study, which was informed by a literature review of pull efforts' capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method. We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context. To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.

Highlights

During the past decades, there has been a meaningful shift in the view of professionals to the use of research evidence for policy-making
Policy options need to consider three threads for designing capacity building programs: training management teams instead of only training managers, focusing the training on problem-solving skills, and designing dedicated programs based on the needs of target groups
We review the literature to synthesize a taxonomy of pull-type capacity building programs and we propose contextualized strategies to increase the capacity of policy-makers for applying evidenceinformed health policy-making (EIHP) in Iran

Summary

Introduction

There has been a meaningful shift in the view of professionals to the use of research evidence for policy-making. EIHP is defined as “an approach to policy decisions that aims to ensure that decision-making is well-informed by the best available research evidence. It is characterized by the systematic and transparent access to, and appraisal of, evidence as an input into the policy-making process.”[4] Evidence, typically, refers to the scientific outputs of research activities that provide information on the effectiveness of an intervention. Evidence has been viewed in a hierarchy, grading evidence from the results of randomized controlled trials as the gold standard to expert opinion.[5]

Methods

Results

Discussion

Conclusion