Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda.

Juliet Nabyonga-Orem,Rhona Mijumbi

doi:10.15171/ijhpm.2015.52

Abstract

Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making.

Highlights

The need for evidence-informed health policy development is gaining momentum given the growing demand on healthcare resources especially in Low-Income Countries (LICs)
The key thing that the policy-maker needs to do is to decide which evidence is most appropriate for the local context
Preference for local research because it depicts the background of the exact factors – social, biological – of that locality - Local studies may have more relevance to Ugandan’s policy-making - Local-real life research will impact more on decision-makers - You need local evidence about which medicines are effective for the local context - Need for local context data, evidence on costs, implementation feasibility, compliance

Summary

Introduction

The need for evidence-informed health policy development is gaining momentum given the growing demand on healthcare resources especially in Low-Income Countries (LICs). It acknowledges that literature on the research-policy link is increasingly moving away from older assumptions that looked at research to policy as a linear process involving two distinct communities of researchers and policy-makers dealing with a specific set of findings deemed as ‘knowledge’ [7] Instead this linkage is viewed as a dynamic and complex process that is shaped by stakeholder interactions, the political context, the evidence available, and several external factors. Categorizing the quality of evidence is another aspect where researchers and policy-makers hold different views While the former attach a lot of importance to methodological rigor [2,13], the latter look for important information based on quick reflections of the realities of policy and decision-making in political and social contexts [2].

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Discussion

Conclusion