Investment In Capacity Building Research Articles

Advances, gaps and way forward in provision of climate services over the Greater Horn of Africa

The Greater Horn of Africa is prone to extreme climatic conditions, thus, making climate services increasingly important in supporting decision-making processes across a range of climate sensitive sectors. This study aims to provide a comprehensive review of the recent advances, gaps and challenges in the provision of climate services over the region, for each of the components of the Global Framework for Climate Services. The study explores various milestones that have been achieved toward climate service delivery. The achievements include improvement of station network coverage, and enhancing the capacity of member states to utilize various tools in data analysis and generate routine climate products. The advancement in science, and availability of High-Performance Computing has made it possible for forecast information to be provided from nowcasting to seasonal timescales. Moreover, operationalizing of the objective forecasting method for monthly and seasonal forecasts has made it possible to translate tercile forecasts for applications models. Additionally, innovative approaches to user engagement through co-production, communication channels, user-friendly interfaces, and dissemination of climate information have also been developed. Despite the significant progress that has been made in the provision of climate services, there are still many challenges and gaps that need to be overcome in order to ensure that these services are effectively meeting the needs of users. The research of the science underpinning climate variability, capacity building and stakeholder engagement, as well as improved data management and quality control processes are some of the gaps that exist over the region. Additionally, communication and dissemination of climate information, including timely warnings and risk communication, require improvement to reach diverse user groups effectively. Addressing these challenges will require strengthened partnerships, increased investment in capacity building, enhanced collaboration between the climate information producers and stakeholders, and the development of user-friendly climate products. Bridging these gaps will foster greater resilience to climate-related hazards and disasters in the Greater Horn of Africa and support sustainable development in the region.

Leveraging international education to advance women’s leadership: reflections of Indonesian alumnae of their Australian education experiences

ABSTRACT The link between international education and the extent to which it enhances women’s leadership aspirations calls for a more situated and nuanced approach to internationalisation theory and practice. Although international education is a significant capacity-building investment and is typically assumed to advance individual and collective leadership, there is scant attention to modalities of leadership aspirations and experiences of women post-international study. The paper draws on our research exploring post-study experiences of a cohort of Indonesian women to highlight the complexities and challenges of navigating leadership post-study in Australia. The study design incorporated a mixed-method approach of individual semi-structured interviews, focused group discussions and an online survey of a diverse cohort of alumnae. The findings show that international education has the potential for advancing women’s leadership aspirations where culture and individual women’s characteristics and circumstances are considered. Indeed, alumnae report that consolidating and advancing leadership calls for successfully navigating between societal norms, family pressures and institutional contexts whilst also tapping into their international education experience.

Modeling for a Sustainable Electricity Supply in Uzbekistan

For nations to achieve mobility as well as economic and social growth, a steady supply of electric power is crucial. Investments in capacity building and raising operational standards are necessary for the reliability and consistency of the delivery of electricity. A decision-making in the sector has become difficult for investors and policymakers, due to challenges associated with the electricity sector including delays in generation and infrastructure construction, R&D, natural gas supply, fluctuations in demand and environmental concerns. Additionally, the power sector is dynamic and perpetually changes overtime. Electricity supply and demand is highly complex and dynamic in Uzbekistan. Understanding the causal linkages between major system variables that exist Uzbekistan’s electricity system is crucial for making systematic and long-term policy decisions. This work proposes a computer simulation model based on system dynamics technique. The simulation outcomes revealed that investments in power generation capacity and efficiency enhancement are required in the country to provide a sustainable electricity.

Knowledge and Perception of Healthcare Workers about Safe Water Supplies and Antibiotic-Resistant Bacteria at Primary Health Care Facilities in Gaza, Palestine

Background: While concerns about the spread of Antimicrobial resistance (AMR) in HCF have long been identified, the links with environmental issues - such as water, sanitation, and hygiene (WASH) - are much less well understood. Indeed, misperceptions of links between WASH and AMR are identified as one of the hindrances of infection control programs. This study assessed the gap in knowledge in healthcare facilities (HCFs), by analyzing the perceptions of healthcare workers. Methods: A cross-sectional survey was conducted in governmental primary healthcare facilities in Gaza, Palestine between April and August 2022. Out of 1802 workers, 322 were randomly recruited to fill out a self-administer questionnaire. The workers were representing both genders (50.3% females) and aged between (19- 60 years). Data was analyzed using Statistical Package for Social Sciences (SPSS) software, version 23. Results: About half of the respondents (52.5%) did not know what the “WASH” term stands for, and nearly a quarter (22.7%) were unable to define AMR bacteria correctly. The perception of water safety was higher for domestic (66.1%) than for drinking water (54.7%) with a lower perception among females (p value=0.005) and medical staff (p value=0.000). At HCFs, only 40.7% of respondents had the perception that regular water safety monitoring occurs and 30.4% declared that water pollution was reported at their facilities. Only 20.0% of health workers think that they play a role in monitoring water safety and 24.8% think that they play a role in preventing and controlling AMR bacteria. Conclusion: Hybrid educational and awareness programs about water safety and prevention of AMR bacteria need to be implemented within the context of the One Health approach. The investment in WASH infrastructure at HCFs requires parallel investment in capacity building and raising awareness of workers.

Indigenous chicken market participation and smallholder farmers’ well-being outcomes in Chiredzi and Mwenezi Districts of Zimbabwe

Climate change and extreme weather conditions remain major threats to the attainment of well-being outcomes such as food security in sub-Saharan Africa. Thus, it is critical to identify and promote resilient value chains in order to ensure food security in the wave of extreme weather conditions such as drought. This study seeks to evaluate the effects of participating in indigenous chicken markets on smallholder farmers’ food and nutrition security in terms of household dietary diversity score. Cross-sectional data collected from 215 randomly selected farmers in Chiredzi and Mwenezi districts, Zimbabwe was used in this study. The endogenous treatment effect model was employed to determine the effects of market participation on household dietary diversity score. The findings showed that 76% of interviewed farmers participated in indigenous chicken markets. On average, participating in indigenous chicken markets increases the likelihood of having a higher household dietary diversity score by about 60%. This suggests that engagement in indigenous chicken value chain strengthens smallholder farmers’ resilience through attainment of food and nutrition security. Therefore, investment in capacity building of smallholder farmers to engage in indigenous chicken value chains should be prioritised and to support market engagement, indigenous chicken production contract arrangements with private firms should be promoted.

Capacity Building in Remote Facilitation of Newborn Resuscitation.

The past decade has been notable for widespread dissemination of newborn resuscitation training in low-resource settings through simplified training programs including Helping Babies Breathe. Since 2020, implementation efforts have been impacted by restrictions on travel and in-person gatherings with the SARS-CoV-2 pandemic, prompting the development of alternative methods of training. While previous studies have demonstrated feasibility of remote neonatal resuscitation training, this perspective paper covers common barriers identified and key lessons learned developing a cadre of remote facilitators. Challenges of remote facilitation include mastering videoconferencing platforms, establishing personal connections, and providing effective oversight of skills practice. Training sessions can be used to support facilitators in acquiring comfort and competency in harnessing videoconferencing platforms for effective facilitation. Optimization of approaches and investment in capacity building of remote facilitators are imperative for effective implementation of remote neonatal resuscitation training.

Rebooting India-GCC Energy Partnerships: Hydrogen as a Fuel for the Future

The Gulf Cooperation Council (GCC) States have over the decades proved to be dependable partners in India’s energy security. However, the energy transition necessitates examining its impact on the India-GCC energy partnership. Will India-GCC energy partnership last the transition from hydrocarbons to renewables? What will be its medium- and long-term impact? Can hydrogen replace hydrocarbons as the vehicle for India-GCC energy cooperation? This article answers some of these questions based on a systematic study of innovation in the field of hydrogen as a fuel, India’s National Green Hydrogen Mission and the growing investments in capacity building in hydrogen production in the GCC States.

HPV Vaccination and Cervical Cancer Screening Policies and Practices in 18 Countries, Territories and Entities across Eastern Europe and Central Asia.

To assess readiness to achieve the WHO Global Strategy targets for HPV vaccination and cervical screening and to guide capacity building, the current status of these services in 18 Eastern European and Central Asian countries, territories and entities (CTEs) was evaluated. In order to assess the current status of HPV vaccination and cervical cancer screening in these 18 CTEs, a 30 question survey tool was developed, covering: national policies, strategies and plans for cervical cancer prevention; status of cancer registration; status of HPV vaccination; and current practices for cervical cancer screening and treatment of precancerous lesions. As cervical cancer prevention comes within the mandate of the United Nations Fund for Population Development (UNFPA), the UNFPA offices in the 18 CTEs have regular contact with national experts who are directly involved in cervical cancer prevention actions and are well placed to provide the data required for this survey. Working through the UNFPA offices, the questionnaires were sent to these national experts in April 2021, with data collected from April to July 2021. All CTEs returned completed questionnaires. Only Armenia, Georgia, Moldova, North Macedonia, Turkmenistan and Uzbekistan have implemented national HPV vaccination programmes, with only the last 2 of these reaching the WHO target of 90% of girls fully vaccinated by age 15, while rates in the other 4 range from 8%-40%. Cervical screening is available in all CTEs but only Belarus and Turkmenistan have reached the WHO target of 70% of women screened once by age 35 and again by age 45, while rates elsewhere range from 2%-66%. Only Albania and Turkey follow the WHO recommendation to use a high-performance screening test, while the majority use cervical cytology as the main screening test and Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan use visual inspection. No CTEs currently operate systems to coordinate, monitor and quality assure (QA) the entire cervical screening process. Cervical cancer prevention services in this region are very limited. Achieving the WHO Global Strategy targets by 2030 will require substantial investments in capacity building by international development organisations.

Risk communication during health emergencies in Nigeria: What are its challenges?

Although globalization has been advantageous in facilitating the free movement of people, goods, and services, the ease of movement of cross-border pathogens has increased the risk of international public health emergencies in recent years. Risk communication is an integral part of every country's response during public health emergencies such as the coronavirus disease (COVID-19) pandemic. To effectively increase adherence to guidelines during health emergencies, it is essential to understand the impact of social, cultural, political, and environmental factors on people's behaviours and lifestyles in any given context, as well as how these factors influence people's perception of risks. During the recent response to the COVID-19 pandemic in Nigeria, the need to comprehend these influences was pronounced, and these influences ultimately shaped risk communication in Nigeria. We have identified risk communication challenges in Nigeria based on sociocultural diversity, the complexity of the health system, the impact of social media on communications, and other contextual factors surrounding multisectoral partnerships. To achieve global health security, these challenges must be addressed in resourceconstrained countries like Nigeria. In this paper, we emphasize the need to contextualize risk communication strategies in order to improve their effectiveness during health emergencies. In addition, we urge increased country commitment to a multi-hazard and multisectoral effort, deliberate investment in subnational risk communication systems, and investments in capacity building for risk communication activities.

Implementation challenges and lessons learned from the STREAM clinical trial—a survey of trial sites

BackgroundDesign and implementation of multi-country clinical trials for multidrug-resistant tuberculosis (MDR-TB) are complex for several reasons, including trial duration, varying levels of experience and infrastructure across settings, and different regulatory requirements. STREAM was an MDR-TB clinical trial that recruited over 1000 participants. We documented challenges and best practices/lessons learned from the site perspective to improve implementation of future trials.MethodsWe conducted a voluntary survey of trial staff at all sites to obtain information on challenges encountered and best practices/lessons learned from implementation of the STREAM trial. Respondents were asked to identify substantive aspects of trial implementation from a list that included: trial administration, laboratory strengthening/infrastructure, pharmacy and supply chain management, community engagement, regulatory and ethics requirements, health economics, and other (respondent designated) about which a practical guide would be useful to improve future trial implementation. For each aspect of trial implementation selected, respondents were asked to report challenges and best practices/lessons learned during STREAM. Lastly, respondents were asked to list up to three things they would do differently when implementing future trials. Summary statistics were generated for quantitative data and thematic analysis was undertaken for qualitative data.ResultsOf 67 responses received from 13 of 15 sites, 47 (70%) were included in the analyses, after excluding duplicate or incomplete responses. Approximately half the respondents were investigators or trial coordinators. The top three aspects of trial implementation identified for a best practices/lessons learned practical guide to improve future trial implementation were: trial administration, community engagement, and laboratory strengthening/infrastructure. For both challenges and best practices/lessons learned, three common themes were identified across different aspects of trial implementation. Investment in capacity building and ongoing monitoring; investment in infrastructure and well-designed trial processes; and communication and coordination between staff and meaningful engagement of stakeholders were all thought to be critical to successful trial implementation.ConclusionsExisting practices for clinical trial implementation should be reevaluated. Sponsors should consider the local context and the need to increase upfront investment in the cross-cutting thematic areas identified to improve trial implementation.

Digital agriculture in Europe and in France: which organisations can boost adoption levels?

This paper presents the way the digital transformation of the agricultural sector is implemented in Europe and in France. It describes the main European and national strategies, the structure of research and innovation initiatives, and the investment in capacity building to foster innovation, adoption and use. More specifically, the French research and innovation ecosystem on digital agriculture is described. The actors involved come from different organisations, such as research and higher educational institutes, government agencies, agricultural technology (AgTech) companies, farmer unions etc., and work together by means of associations (e.g. Robagri), networks (e.g. RMT Naexus, DigiFermes, Fermes Leader), or living labs (e.g. Occitanum) on both digital technology assessment and co-design. Additionally, support is devoted to capacity building (e.g. Le Mas numérique, Mobilab) and a better understanding of the drivers of adoption and use of digital technologies (e.g. FrOCDA). Among these various organisations, #DigitAg, the Digital Agriculture Convergence Lab, has been created to foster interdisciplinary research on digital agriculture. All these initiatives aim to use digital technologies to support the European Green Deal, Farm-to-Fork and Biodiversity strategies as well as the French orientation towards more agroecological practices for safer and more sustainable food systems. Even though this organisational ecosystem is developing fast, the objective of encouraging the coevolution of both digital and green transformations is not without challenges that still need to be overcome, either through new research, innovations, initiatives or collaborations between the actors involved.

Search and Rescue Capacity Building of Nepal’s Security Forces for Effective Response

Capacity building encompasses the training, knowledge, skills, abilities, processes, and resources. The present paper highlights Nepal’s security forces integral role in disaster response and its need of the capacity building in search and rescue. Responding to disasters is a special task that demands a high level of training, knowledge, skills, and types of tool, equipment, and accessories. During the study, trained manpower for search and rescue within the Nepali Army, Nepal Police, and Armed Police Force, Nepal, and their capabilities and challenges were analyzed. The study suggests need for investment in capacity building of security forces towards highly-trained manpower in search and rescue as per the international standard. Well-prepared human resource in sufficient number is key to effective response and integrated effort with sound coordination mechanism always gives the net positive results.

Tackling the mangrove restoration challenge.

Mangroves have been converted and degraded for decades. Rates of loss have declined over the past decades, but achieving resilient coastlines requires both conservation and restoration. Here, we outline the challenges for the global restoration of mangroves and what actions could enhance restoration. Ambitious global targets for mangrove restoration, if successful, could deliver global benefits of carbon sequestration, fisheries production, biodiversity, and coastal protection. However, large-scale mangrove planting efforts have often failed, and smaller projects may not deliver landscape-scale benefits, even though they are more suited to community management. Solutions to achieving global targets include reducing risks of large projects and increasing the uptake and effectiveness of smaller projects. Sustainable mangrove restoration requires investment in capacity building in communities and institutions, and mechanisms to match restoration opportunities with prospective supporters and investors. Global reporting standards will support adaptive management and help fully understand and monitor the benefits of mangrove restoration.

Achieving and Sustaining Change Through Capacity Building Train-the-Trainer Health Initiatives in Low- and Middle-Income Countries: A Systematic Review.

Given the anticipated health challenges, forecasted deficiencies in the global health workforce, and steady demands to work through resource constraints, effective and efficient training approaches to build capacity are direly needed. Although train-the-trainer (T3) is not a new approach, there has been considerable interest in using it to develop and sustain capacity, particularly in low- and middle-income countries. This systematic review aimed to better understand the factors to achieve and sustain change across multiple countries and levels through T3 approaches. A literature search was conducted of six scholarly, peer-reviewed, and gray literature databases. Data were extracted for the study method, design, characteristics, and implicit or explicit factors related to maximizing the likelihood of achieving and sustaining change. An existing conceptual framework for T3 interventions in global health guided the thematic analysis. The framework consisted of five factors pertinent to capacity building T3 initiatives: Talent, Resources, Alignment, Implementation, and Nurture and Development. Twenty-two studies met the inclusion criteria. The T3 training spanned all geographical regions, but interventions were most prevalent in sub-Saharan Africa (46%). Nearly all studies (68%) quantitatively examined change at the individual level (95%), but some studies also explored change at the organizational (77%) and institutional (23%) levels. Implementation and Nurture/Development were the two most salient factors in achieving and sustaining change. The greatest hindrances involved Resources and Context , an additional theme that the data identified. The findings and recommendations from this first systematic review exploring antecedents influencing change through health-related T3 interventions can inform training and capacity-building investments, improve existing T3 initiatives, and steer planning for future approaches.

Health system bottlenecks hindering provision of supportive and dignified maternity care in public health facilities.

Mistreatment with women during childbirth is prevalent in many in low- and middle-income countries. There is dearth of evidence that informs development of health system interventions to promote supportive and respectful maternity care in facility-based settings. We examined health systems bottlenecks that impedes provision of supportive and respectful maternity care in secondary-level public healthcare system of Pakistan. Using a qualitative exploratory design, forty in-depth interviews conducted with maternity care staff of six public health facilities in southern Pakistan. Development of interview guide and data analyses were guided by the WHO's six health system building blocks. A combination of inductive and deductive approach was used for data analyses. Our study identified range of bottlenecks impeding provision of RMC. In terms of leadership/governance, there was lack of institutional guidelines, supervision and monitoring, and patient feedback mechanism. No systematic mechanism existed to screen and record patient psychosocial needs. Health workforce lacked training opportunities on RMC that resulted in limited knowledge and skills; there were also concerns about lack of recognition from leadership for good performers, and poor relationship and coordination between clinical and non-clinical staff. Regarding the domain of service delivery, we found that patients were perceived as un-cooperative, non-RMC manifestations were acceptable and normalized under certain conditions, and restrictive policies for active engagement of companions. Finally, lack of cleanliness, curtains for privacy, seating arrangement for companion were the identified issues infrastructural issues. A service-delivery intervention package is needed that effectively uses all six components of the health system: from investments in capacity building of maternity teams to creating a conducive facility environment via proper governance and accountability mechanisms. Such interventions should not only focus on provision of maternity care in a respectful and dignified manner, but also ensure that care is responsive to the psychosocial needs of pregnant women without any discrimination.

Detection and follow-up of chronic health conditions in Rio de Janeiro \u2013 the impact of residency training in family medicine

BackgroundThere is a need for evidence that residency training in family medicine can benefit the care of patients in primary care in low- and middle-income countries. We tested the hypothesis that two years of residency training in family medicine enables doctors to better detect chronic health conditions while requesting fewer laboratory tests and providing more follow-up visits.MethodsWe performed a retrospective longitudinal observational analysis of medical consultations from 2013 to 2018 in primary care in Rio de Janeiro, comparing doctors without residency training in family medicine (Generalists) versus family physicians (FPs). Multivariate multilevel binomial regression models estimated the risks of patients being diagnosed for a list of 31 chronic health conditions, having a follow-up visit for these conditions, and having laboratory tests ordered from a list of 30 exams.Results569.289 patients had 2.908.864 medical consultations performed by 734 generalists and 231 FPs. Patients seen by FPs were at a higher risk of being detected for most of the chronic health conditions, at a lower risk of having any of the 30 laboratory tests requested, and at a higher risk of having a follow-up visit in primary care.ConclusionsResidency training in family medicine can make physicians more skilled to work in primary care. Policymakers must prioritize investments in capacity building of healthcare workforce to make primary care truly comprehensive.

The Longitudinal Effects of School Improvement Grants

School Improvement Grants (SIGs) exemplify a capacity-building investment to spur sustainable changes in America’s persistently lowest-performing schools and stimulate the economy. This study examines both short- and longer-term effects of the first two cohorts of SIG schools from four locations across the country. Dynamic difference-in-differences models show that SIGs’ effects on achievement in Grades 3 to 8, as measured by state test scores in math and English language arts, gradually increased over the three reform years and were largely sustained for 3 or 4 years afterward. Evidence on high school graduation rates, though less robust, also suggests SIGs had positive effects. SIGs’ effects on students of color and low-socioeconomic-status students were similar to or significantly larger than the overall effects.

Science for conserving Amazon freshwater ecosystems

Abstract The Amazon Basin is being degraded at unprecedented rates, yet conservation efforts have implemented protected areas to curb deforestation, leaving freshwater ecosystems vulnerable to degradation. Amazon freshwater ecosystems are largely unprotected because a terrestrial bias has limited the ability of science to affect policy. Overcoming this bias requires increasing exchange of information among stakeholders across the basin to raise awareness of threats to Amazon freshwater ecosystems and promote discussions and access to conservation solutions. To help address this need, this Special Issue collates 15 synthetic articles that advance knowledge and identify conservation solutions. Three articles highlight the importance of considering the hydrological and limnological processes that control the integrity of these freshwater ecosystems and offer new insights on how to extrapolate them across the basin. Three articles on crocodilians, aquatic mammals, and migratory fishes document threats and knowledge gaps, and identify the missing role of governments as an impediment to conservation of their populations. Three articles evaluate the multi‐faceted effects of hydropower dams on fish, birds, and floodplain trees. They reinforce perceptions that dams are key environmental threats and offer guidance for improving protocols for dam site selection and impact assessment. Three articles assessing the effectiveness of protected areas to safeguard fish and aquatic invertebrates show there is an urgent need to redesign the Amazon protected area network to adequately protect freshwater biota. Three forward‐looking articles show that: (i) conservation initiatives by local communities are ‘bright spots’ for freshwater conservation; (ii) microchemistry analyses of the ear bones of fishes could boost the knowledge base needed to conserve them; and (iii) strengthening the Amazon conservation framework requires a reversal of Brazil's current governmental priorities, remobilization of stakeholders, investments in capacity building, and expanding protections to terrestrial and freshwater ecosystems.

Expanding molecular diagnostic capacity for COVID-19 in Ethiopia: operational implications, challenges and lessons learnt.

Efforts towards slowing down coronavirus (COVID-19) transmission and reducing mortality have focused on timely case detection, isolation and treatment. Availability of laboratory COVID-19 testing capacity using reverse-transcriptase polymerase chain reaction (RT-PCR) was essential for case detection. Hence, it was critical to establish and expand this capacity to test for COVID-19 in Ethiopia. To this end, using a three-phrased approach, potential public and private laboratories with RT-PCR technology were assessed, capacitated with trained human resource and equipped as required. These laboratories were verified to conduct COVID-19 testing with quality assurance checks regularly conducted. Within a 10-month period, COVID-19 testing laboratories increased from zero to 65 in all Regional States with the capacity to conduct 18,454 tests per day. The success of this rapid countrywide expansion of laboratory testing capacity for COVID-19 depended on some key operational implications: the strong laboratory coordination network within the country, the use of non-virologic laboratories, investment in capacity building, digitalization of the data for better information management and establishing quality assurance checks. A weak supply chain for laboratory reagents and consumables, differences in the brands of COVID-19 test kits, frequent breakdowns of the PCR machines and inadequate number of laboratory personnel following the adaption of a 24/7 work schedule were some of the challenges experienced during the process of laboratory expansion. Overall, we learn that multisectoral involvement of laboratories from non-health sectors, an effective supply chain system with an insight into the promotion of local production of laboratory supplies were critical during the laboratory expansion for COVID-19 testing. The consistent support from WHO and other implementing partners to Member States is needed in building the capacity of laboratories across different diagnostic capabilities in line with International Health Regulations. This will enable efficient adaptation to respond to future public health emergencies.

Use of real-world evidence in cancer drug funding decisions in Canada: a qualitative study of stakeholders' perspectives.

Real-world evidence (RWE) can provide postmarket data to inform whether funded cancer drugs yield expected outcomes and value for money, but it is unclear how to incorporate RWE into Canadian cancer drug funding decisions. As part of the Canadian Real-World Evidence Value for Cancer Drugs (CanREValue) Collaboration, this study aimed to explore stakeholder perspectives on the current state of RWE in Canada to inform a Canadian framework for use of RWE in cancer drug funding decisions. This was a qualitative descriptive study. Qualitative semistructured interviews were conducted from April to July 2018. Participants were Canadian and international stakeholders who had experience with RWE and drug funding decision-making. Thematic analysis was used to analyze data. Thirty stakeholders participated in the study. Five themes were identified. Stakeholders indicated that RWE had value in cancer drug funding decisions. However, a cultural shift is needed to adopt RWE in decision-making. Further, the Canadian infrastructure for real-world data is currently inadequate for decision-making, and there is a need for committed investment in building capacity to collect and analyze RWE. Finally, there is a need for increased collaboration among key stakeholders. The findings of this study suggest that if RWE is to be used in drug funding decisions, there is a need for a cultural shift, improved data infrastructure, committed investment in capacity building and increased stakeholder collaboration. Together with local stakeholder engagement, application of these findings may contribute to optimizing implementation of RWE.