Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland.
Health Economics Unit, Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Health Res Policy Syst. 2017 Nov 9;15(1):94. doi: 10.1186/s12961-017-0261-1.
Evidence-informed decision-making for health is far from the norm, particularly in many low- and middle-income countries (LMICs). Health policy and systems research (HPSR) has an important role in providing the context-sensitive and -relevant evidence that is needed. However, there remain significant challenges both on the supply side, in terms of capacity for generation of policy-relevant knowledge such as HPSR, and on the demand side in terms of the demand for and use of evidence for policy decisions. This paper brings together elements from both sides to analyse institutional capacity for the generation of HPSR and the use of evidence (including HPSR) more broadly in LMICs.
The paper uses literature review methods and two survey instruments (directed at research institutions and Ministries of Health, respectively) to explore the types of institutional support required to enhance the generation and use of evidence.
Findings from the survey of research institutions identified the absence of core funding, the lack of definitional clarity and academic incentive structures for HPSR as significant constraints. On the other hand, the survey of Ministries of Health identified a lack of locally relevant evidence, poor presentation of research findings and low institutional prioritisation of evidence use as significant constraints to evidence uptake. In contrast, improved communication between researchers and decision-makers and increased availability of relevant evidence were identified as facilitators of evidence uptake.
The findings make a case for institutional arrangements in research that provide support for career development, collaboration and cross-learning for researchers, as well as the setting up of institutional arrangements and processes to incentivise the use of evidence among Ministries of Health and other decision-making institutions. The paper ends with a series of recommendations to build institutional capacity in HPSR through engaging multiple stakeholders in identifying and maintaining incentive structures, improving research (including HPSR) training, and developing stronger tools for synthesising non-traditional forms of local, policy-relevant evidence such as grey literature. Addressing challenges on both the supply and demand side can build institutional capacity in the research and policy worlds and support the enhanced uptake of high quality evidence in policy decisions.
循证决策在卫生领域远未成为常态，尤其是在许多低收入和中等收入国家（LMICs）。卫生政策和系统研究（HPSR）在提供所需的具有上下文敏感性和相关性的证据方面发挥着重要作用。然而，无论是在供应方面，即生成政策相关知识（如 HPSR）的能力方面，还是在需求方面，即对政策决策的证据的需求和使用方面，都仍然存在重大挑战。本文结合供需双方的因素，分析了在 LMICs 中生成 HPSR 和更广泛地使用证据（包括 HPSR）的机构能力。
本文使用文献综述方法和两份调查工具（分别针对研究机构和卫生部），探讨了增强证据生成和使用所需的机构支持类型。
对研究机构的调查结果表明，缺乏核心资金、HPSR 的定义不明确以及学术激励结构是重大制约因素。另一方面，对卫生部的调查确定了缺乏本地相关证据、研究结果呈现不佳以及机构对证据使用的重视程度低等因素，对证据的采用构成了重大制约。相比之下，研究人员和决策者之间更好的沟通以及更多相关证据的可用性被确定为证据采用的促进因素。
这些发现表明，研究机构需要做出安排，为研究人员的职业发展、合作和交叉学习提供支持，同时建立机构安排和程序，激励卫生部和其他决策机构使用证据。本文最后提出了一系列建议，通过让多个利益攸关方参与确定和维护激励结构、改进研究（包括 HPSR）培训以及开发更强有力的工具来综合非传统形式的本地、政策相关证据，如灰色文献，来建立 HPSR 方面的机构能力。解决供应和需求方面的挑战可以在研究和政策领域建立机构能力，并支持在政策决策中更好地采用高质量证据。
