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Decision-makingdesire to publish. The core of the issue in using evidencedifferently lies in the differences in decision-makingimperatives. Not only might scientific evidence conflict withvalues and beliefs of policy-makers, but the policy-makeruses evidence in the battle to control problem definition andpolicy solutions. Policy-makers thus look for evidenceto support their claims, and thus systematic bias occurs inthe way that policy-makers look for and use data. Anotherfacet of this issue is that policy-makers are often concernedthat highlighting knowledge gaps will reduce supportfor their programmes. They thus end up making uninformeddecisions.Further complicating the issues are the weaknesses in logicin both scientific and policy-making approaches to settingpriorities and achieving outcomes. Science and policy-makingare chaotic in different ways. Most scientific research isderivative, and unhelpful from a policy perspective. The 23rdpaper on smoking and a certain disease may still bepublished, but it is not really advancing science unless thestudy is somehow markedly better than previous studies; toooften, it is not. In other words, there is a lot of indifferent or“junk” science out there, and policy-makers are cleverenough to recognize this. Policy-making is built on a historyof related policies, but is also reactive to numerous andcompeting stakeholder demands. At the end of the day,policies are the result of compromises and are constantlyframed and re-framed in response to changing contexts.Also, researchers are always wanting to hedge theirfindings – they recognize the limitations of their data and arestriving to provide proof “beyond reasonable doubt” –however, policy-makers need a simple one-line answer towhat are often, at least to the researchers, complex issues. Inpresenting their results, researchers traditionally rely on somany caveats that policy-makers do not know what tobelieve. Policy-makers frequently have to exercise moralFacilitatorsNumber of studiesPersonal contact between researchersand policy-makers 13Timeliness and relevance of the research 13Research that includes a summary withclear recommendations 11Research that confirms current policy orendorses self-interest 6Good quality research 6Community pressure or client demand for research 4Inclusion of effectiveness data 3TOTAL studies 24BarriersNumber of studiesAbsence of personal contact betweenresearchers and policy-makers 11Lack of timeliness and relevance of research 9Mutual mistrust between researchers and policy-makers 8Power and budget struggles 7Poor quality of research 6Political instability or high turnover of policy-making staff 5TOTAL studies 24Table 2: Facilitators and barriers to use of research by policymakers,identified in a systematic review of 24 interview studies(tabulation of data provided by Innvaer et al., 2002 7 )judgements in the face of uncertainty, so decisions are taken“on the balance of probabilities”. They usually have plenty ontheir plates, and gravitate towards evidence that speaks totheir own experiences, or that of their constituents. They seeka “one size fits all” or “cookie cutter” approach. Policy-makerswant a “bottom line”, but researchers are uncomfortablegiving one.Researchers and policy-makers also tend to have differentaccountability mechanisms. Researchers are essentiallyaccountable to editors of peer-reviewed journals, fellowresearchers and those who fund their research. They may beinterested in policy but, at the end of the day, are not requiredto focus on issues that have policy relevance or application.On the other hand, policy-makers are usually accountable topolitical parties, government and taxpayers, if not the voters,and must focus on things that are consistent with politicalagendas. Complicating this however is the increasingpressure on researchers to comply with views of governmentsthat are increasingly responsible for setting priorities in theway research funds are allocated. So smart researchers willhave their research proposals reviewed by policy-makersbefore submitting their grant proposals.There is unfortunately no correlation between the quality ofscience and the policy derived from it. Good science does notalways guarantee good policy; bad or even no science doesnot necessarily lead to bad policy. It is true that good policydoes not always depend on waiting for good evidence. Forexample, condom promotion makes good common sensewhen setting policies to tackle sexually transmitted diseases.On the other hand, having a policy, no matter how carefullythought out, is no guarantee that it works. Having a policy forclean water, for example, does not necessarily make the waterclean. It must be realized that science is needed both to helpdevelop the policy and to evaluate the policy.Another issue is related to the public image. Researchersare often respected as “wise and objective people”, free frompolitical and economic interests and pressures. Policy-makersare often regarded as “powerful people”, but are notnecessarily respected. It is not that either researchers orpolicy-makers are “wrong” or “bad”. One responds toscientific rationality, while the other responds to politicalpressures. Furthermore, the societies within which they workalso have norms and expectations, which might beconsidered “cultural rationality”. The coming together of thesecompeting rationalities is necessary to resolve the seemingincompatibilities and ultimately ending up with the adoptionof evidence-based health policies.Some suggestions on bridging the gapHow can we bridge this chasm and gap between researchersand policy-makers? Arguably, a key first step might be anattempt to understand what may be the predictors of success(and failure) in the way researchers and policy-makerscommunicate and value each others’ efforts. Innvaer et al.reviewed 24 interview studies with health policy-makers (atotal of 2041 interviews) concerning their perceptions of theuse of research evidence in health policy decisions 7 . The mostcommonly reported facilitators were personal contact (13/24156 ✜ Global Forum Update on Research for Health Volume 4
Decision-makinginterview studies), timely relevance (13/24), and theinclusion of summaries with policy recommendations(11/24) (Table 2). The most commonly reported barriers wereabsence of personal contact (11/24), lack of timely relevanceof research (9/24), and mutual mistrust (8/24). The questionthen is how to fully recognize the incompatibility problemsand to promote successful experiences in the collaborationbetween researchers and policy-makers, i.e. promotefacilitators and suppress barriers. Also, the solutions to thequestions run deeper than simply putting the researchers andpolicy-makers in personal contact, or just asking researchersto provide timely and relevant findings. Some specificsuggestions can be proposed.Knowledge brokersGiven the differing values, perspectives and languagedescribed above, a suggestion has been made that onepossible mechanism to consider is the development of acadre of knowledge “brokers” or “facilitators” 2,4,8 . Suchknowledge brokers may serve as a catalyst to look for, andnurture if possible, the relationship between the two groups.In other words, they can ensure that policy-makers areemploying “the right science”, and that researchers are doing“the science right” 3 . For example, by integrating andsynthesizing scientific information into more accessibleformats, good knowledge brokers may be able to say to thepolicy-makers who are swamped with information, “Here isthe list of the top 10 major issues in this country according tocurrent knowledge”. The knowledge broker may then turn tothe researchers, “Give me the science on what works to tacklethese issues” and then produce an inventory of evidencebasedbest practices. The demand for evidence andinformation should, ideally, come from the policy-makersthemselves but this often does not happen. A critical role ofthe knowledge broker is to “translate” this demand and “retranslate”information which comes from the researchcommunity – in a way which is understandable andtransparent, including evidence which is “in conflict” withwhat policy-makers have already decided. Knowledgebrokerage can also be seen as initiatives to simplify andpresent the information in a way that is more attractive topolicy makers – a good example is the Health EvidenceNetwork set up recently by the World Health Organization(WHO), which goes a step beyond Cochrane style systematicreviews and tries to come up with one-page policy briefs inresponse to questions posed by policy-makers 9 . Anothervariation on this theme is the idea of “trading places”,a temporary “job exchange” programme where policymakersand researchers take each others’ places for a periodof time to enable them to obtain insights into the other’s pointof view. This practice has been tried, for example, betweenchief executives and lobbyists in Canada.Better incentivesResearch funding does not usually provide for informationdissemination to policy- and decision-makers. Engagementwith the public and with policy-makers, is not rewarded.Incentives are also needed to encourage policy-makers toacquire a higher level of scientific training than is the presentnorm. Scientific thinking and results can be dumbed downonly so much before becoming meaningless. On the otherhand, at least some researchers need to develop a sense ofthe “big picture” and work on ways to make scientific workunderstandable and usable by intelligent lay people.Unfortunately, none of these will happen unless there areincentives for them. The current reward mechanisms simplydo not work optimally to encourage policy-makers andresearchers to work together. However, what incentives arethere for this partnership? New incentives may have to becreated in order for changes to take place. An obvious startingpoint would be to include links to policy as another criteria inacademic promotion, instead of solely relying on the numberof papers published.Building organizational capacity and embedding researchinto implementationAttempts should also be made to include mechanisms,processes and structures within organizations to ensure thereis input from researchers and policy-makers. For example, theAmerican Association for the Advancement of Science (AAAS)has a programme where researchers are actively encouragedto enter the policy-making arena 10 by putting them into staffroles at the federal and local levels thus creating a cohort ofpolitically informed citizens-researchers. A range of possibleworkforce development approaches and appointmentstrategies could be considered, e.g. requiring diverse skills,secondments, job rotations, dual appointments, liaison units,etc. Skills required of policy-makers in the future will likely bedifferent because the world of public administration ischanging. The idea of a “chief knowledge officer” 11,12 hasbeen put forward and there are suggestions that thisindividual should actually be the chief medical officer of acountry. In an attempt to “do the science within government”,the World Health Organization has launched an initiativecalled EVIPNet (Evidence-informed Policy Networks) 13 whichaims to establish national mechanisms and structures tofacilitate better linkages and dialogue between researchersand policy-makers. WHO followed a model recentlyestablished in East Africa where Tanzania, Kenya and Ugandahave jointly established the REACH-Policy (Regional EastAfrican Community Health-Policy) initiative, which has as itsgoal the more effective use and application of knowledge tostrengthen health policy and practice.A broader definition of researchIf research is defined more broadly, it may be easier to arguethat research is an investment, not a cost; that all countriesshould have a health-research system that drives healthsectorreform; that research should be applied to improvehealth equity; that research must be conducted according touniversal ethical standards; and that the results of researchshould be accessible to all. A key challenge in public healthis the use of knowledge in strengthening health systems 4 . Tostrengthen health systems, there is a need for humanresource development through, among other things,strengthening capacity for operational research in healthGlobal Forum Update on Research for Health Volume 4 ✜ 157
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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IntroductionType IType IIType IIIPr
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Introductionmaking), takes account
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Access to healthintegrating individ
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InnovationFinancing of vaccine R&D-
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InnovationChild immunization:accele
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