Aku Kwamie at The Conversation: “The big question is: how can countries strengthen their health systems to deliver accessible, affordable and equitable care when they are often under-financed and governed in complex ways?
One answer lies in governments developing policies and programmes that are informed by evidence of what works or doesn’t. This should include what we would call “traditional data”, but should also include a broader definition of evidence. This would mean including, for example, information from citizens and stakeholders as well as programme evaluations. In this way, policies can be made more relevant for the people they affect.
Globally there is an increasing appreciation for this sort of policymaking that relies of a broader definition of evidence. Countries such as South Africa, Ghana and Thailand provide good examples.
What is evidence?
Using evidence to inform the development of health care has grown out of the use of science to choose the best decisions. It is based on data being collected in a methodical way. This approach is useful but it can’t always be neatly applied to policymaking. There are several reasons for this.
The first is that there are many different types of evidence. Evidence is more than data, even though the terms are often used to mean the same thing. For example, there is statistical and administrative data, research evidence, citizen and stakeholder information as well as programme evaluations.
The challenge is that some of these are valued more than others. More often than not, statistical data is more valued in policymaking. But both researchers and policymakers must acknowledge that for policies to be sound and comprehensive, different phases of policymaking process would require different types of evidence.
Secondly, data-as-evidence is only one input into policymaking. Policymakers face a long list of pressures they must respond to, including time, resources, political obligations and unplanned events.
Researchers may push technically excellent solutions designed in research environments. But policymakers may have other priorities in mind: are the solutions being put to them practical and affordable?Policymakers also face the limitations of having to balance various constituents while straddling the constraints of the bureaucracies they work in.
Researchers must recognise that policymakers themselves are a source of evidence of what works or doesn’t. They are able to draw on their own experiences, those of their constituents, history and their contextual knowledge of the terrain.
What this boils down to is that for policies that are based on evidence to be effective, fewer ‘push/pull’ models of evidence need to be used. Instead the models where evidence is jointly fashioned should be employed.
This means that policymakers, researchers and other key actors (like health managers or communities) must come together as soon as a problem is identified. They must first understand each other’s ideas of evidence and come to a joint conclusion of what evidence would be appropriate for the solution.
In South Africa, for example, the Department of Environmental Affairshas developed a four-phase process to policymaking. In the first phase, researchers and policymakers come together to set the agenda and agree on the needed solution. Their joint decision is then reviewed before research is undertaken and interpreted together….(More)”.
