Support for Health Research Evidence Synthesis: Missed Priority
Development partners continue to recognise the role of primary research and systematic reviews research, within the wider framework of health policy and health systems research, in improving universal health coverage and the attainment of Sustainable Development Goals. This has been demonstrated by increased support of new, ongoing interdisciplinary and multidisciplinary research that leads to the scaling-up of more efficient health interventions. However, there still remains a huge gap in low resource settings in health research synthesis and uptake in policy and practice. Several important structural, institutional, resource and other challenges remain and better coordination of current initiatives is required.
The Zimbabwe Evidence Informed Policy Network (ZeipNET), with support from the World Health Organisation Alliance for Health Policy and Systems Research (AHPSR), has been providing technical support to the Zimbabwe Ministry of Health and Child Care to institutionalise a rapid evidence synthesis platform within the ministry under the Embedding Rapid Reviews in Health Systems Decision Making in Zimbabwe (ERAZ) project. Other organisations like Cochrane South Africa, Africa Centre for Evidence, and Makerere University College of Health Sciences Africa Centre for Systematic Reviews & Knowledge Translation (ACRES) also provided various forms of technical assistance to the platform. Evidence Aid has been crucial in providing access to its systematic review databases particularly the Covid-19 reviews relevant to low resource settings. In this blog, ZeipNET Director, Ronald Munatsi shares the increasing need for more evidence synthesis support to strengthen evidence informed decision making in low resource settings.
Evidence synthesis is where findings from peer-reviewed and grey literature are integrated to summarize applicable but diverse bodies of research evidence and is typified by its systematic, transparent and replicable approach to framing research questions, searching, assessing, synthesizing and presenting the evidence to provide a more comprehensive summary than a single study could do. Evidence synthesis identifies, evaluates, combines and summarises information from a range of sources to provide decision makers with the best possible information about the effects of tests, treatments and other interventions used in health and social care.
This process is particularly fundamental for health policy makers because they normally urgently require research evidence to make informed health policy and health systems decisions while at the same time they rarely have the time nor skills to skim through and quickly assess lengthy research articles or reviews. The ERAZ project sought to develop, embed and sustain a rapid evidence synthesis platform within the ministry through strengthening individual systematic review skills and knowledge so as to produce rapid evidence synthesis products such as policy briefs and other evidence summaries that are easy to use and written in an easily accessible way to help health policy makers make informed decisions, strengthen the wider ecosystem or institutional landscape to support the platform and develop a continuously updated online knowledge repository of policy relevant evidence.
The relevance of the ERAZ evidence synthesis platform proved especially relevant at the advent of the Covid-19 pandemic considering this was a new phenomenon and policymakers wanted to make quick policy decisions. The platform managed to produce a number of Covid-19 rapid evidence products around issues like mandatory quarantine and public face masks that have informed national policy. The platform also produced Mandatory Institutional Quarantine National Guidelines that have since been adopted at national level. Besides being used for making policy and health systems decision making, for example in this Covid-19 pandemic, these products are also feeding into primary research and re-purposed for use in other situations like assessing what is already known about a policy or practice and to give an insight into emerging research topics and to update guidelines. The ERAZ project demonstrated that policymakers have a huge appetite for rapid reviews and friendly research evidence summaries but glaring capacity gaps still exist.
Most support from development partners is concentrated on producing primary evidence and systematic reviews but very little is being done to support evidence synthesis so that this primary research and systematic reviews are taken up and inform health policy and health systems decision making. Although it is now a requirement to have a research uptake component in these research projects, proper evidence synthesis and other supporting activities are not being done in most of the projects. More support is required for greater cross-institutional collaborations, as well as capacity strengthening to promote research synthesis and uptake by policymakers. As demonstrated by the ERAZ project, the political, economic, social and cultural context is usually conducive in the health sector, but there still exists a lack of co-ordination of funding sources and streams, partners and research priorities. There is need for a better evidence institutional landscape that prioritises evidence synthesis through connecting evidence synthesis communities, primary research communities, health policy makers and other stakeholders in the health research-to-policy mix. Such an institutional landscape requires funders to re-think their funding models and priorities.
By Ronald Munatsi