Abstract
In many low- and middle-income countries, planning cycles and policy decisions are not always informed by cost evidence, even where relevant and recent cost evidence is available. The Immunization Costing Action Network (ICAN) project was a research and learning community designed to strengthen country capacity to generate immunization cost evidence and to understand and improve the evidence-to-policy linkages for the evidence. We identified key factors that increase the likelihood that health policy makers will use evidence for policy making or planning, which shaped the development of a 6-step evidence to policy and practice (EPP) facilitated process. ICAN used the EPP process in Indonesia, Tanzania, and Vietnam from 2016-2019. The experience resulted in several insights regarding country priorities related to cost evidence and factors that determine uptake. Cost evidence is more likely to be used if it answers a specific policy question prioritized by the immunization program, while the use case is less clear and urgent for routine planning and program management. Nonhealth ministries and subnational stakeholders can provide important perspectives to inform the research and its usability. The use case for evidence should be revisited periodically as divergences from formal planning cycles are common and new policy windows open. Ensuring evidence is available at the right time is critical, even if this requires a sacrifice between rigor and speed. Engaging a small group of stakeholders, rather than an individual, to champion the research may be more effective, and the research has greater legitimacy if it is produced by multidisciplinary country teams. Evidence and messages should be tailored for and packaged targeting different audiences. Going forward, continued support is necessary to bridge the divide between those who generate cost evidence and those who translate evidence for policy and planning decisions.
Highlights
Governments need to understand what it costs to deliver vaccines to reach coverage goals, address health equity, manage the introduction of new vaccines, and ensure efficient use of resources
Each country’s journey is unique, in all 3 project countries, the evidence to policy and practice (EPP) process led to increased recognition of the importance of using cost evidence—an outcome that will most likely be sustained
The EPP facilitated process represents a journey that countries and their development partners can embark on to increase the likelihood that health policy makers will use cost evidence
Summary
ICAN was a research and learning community to increase the visibility, availability, understanding, and use of immunization delivery cost information It was designed such that countries led the agenda, with technical facilitation and coaching from ThinkWell and John Snow, Inc. Country-based research institutions, led by local principal investigators, conducted immunization costing studies addressing challenges at the top of domestic immunization agendas, driving the research from conceptualization to dissemination, and supporting policy translation. We conducted semistructured interviews with key informants and a literature review on other initiatives and research to summarize the existing evidence around factors that influence the uptake of costing evidence This resulted in 8 key factors that increase the likelihood that health policy makers will use evidence for policy making or planning (Box). Policy priorities, and political and administrative structures, as well as the nature of institutions, can support or impede the use of evidence
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