Nelson K. Sewankambo

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Bridging the Worlds of Research and Policy in
Kenya, Tanzania and Uganda The Regional East
African Community Health (REACH) Policy Initiative

• Nelson K. Sewankambo
• Dean, Makerere University, Faculty of Medicine
• May 18, 2007, Hamilton, Canada

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Because professionals sometimes do more harm
than good when they intervene in the lives of
other people, their policies and practices should
be informed by rigorous, transparent, up-to-date
evaluation

• Chalmers I Trying to do more good than harm in
  policy and practice The role of rigorous,
  transparent, up-to-date evaluations.
• Ann Am Polit Soc Scien 2003 58922-40

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Background Global Perspective

• Events in the recent years
• Many policy dilemmas regarding scaling up global
  health initiatives
• WHO Ministerial Summit and Global Forum on Health
  Research (Mexico, November 2004)
• know-do gap
• Recommended knowledge observatories

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The Changing Global Environment
Bridging the know-do gap
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The Problem- Know-Do Gap
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• Use of evidence in WHO recommendations
• Andrew D Oxman, John N. Lavis, Atle Fretheim
  www.thelancet.com Published online May 9 2007
• Leading by example a culture change at WHO
• Tikki Pang WWW.thelancet.com, Published on line
  May 9 2007
• Scientific evidence is often not used
  systematically in the development of
  recommendations
• The needs of end-users are often not taken into
  account
• There is limited consideration of how to
  implement global recommendation in a local
  context.
• WHO does not always follow its own requirements
  for development of guidelines

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An East African ProposalREACH Policy Initiative

• Regional East African Community Health Policy
  Initiative

Time is right to test a dedicated, credible,
professional institutional mechanism to bridge
this gap.
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Goal

• To improve peoples health and health equity in
  East Africa through more evidence-based health
  policies

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Vision To be the East African centre of
excellence for knowledge translation to support
formulation of health policy and research
agendas.   Mission To access, synthesise,
package and communicate evidence-based health
information for influencing policy and practice
and for influencing policy relevant research
agendas for improved population health and health
equity.
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Background Regional Perspective

• A regional initiative
• Country consultations Tanzania, Uganda, Kenya
• Synthesis meeting led to institutional design
• Sounding board meeting to test-drive ideas and
  package proposal
• Approval of proposal by EAC Ministers of Health
• Finalize funding proposal
• Meeting of potential funding partners
• Dec 2006 establish Secretariat, implementation
  starts

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Starting point

• The Duluti Lake Consultation, Tanzania (2001)
• Brainstorming convened by MOH Tanzania
• Discuss the gaps between research-policy-practice
• Conclusions
• Knowledge translation gap is real and harmful
• Push and Pull systems have not worked well
• Need for a new model Credible Knowledge Broker
• Ideas for an institutional solution were proposed
• Skills and functions were identified
• Outcome IDRC approached to support development
  of the concept towards such an institutional
  solution

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Why is a mechanism needed?

• The Know-Do Gap.
• Sufficient evidence, knowledge, and financial
  resources exist now to reduce substantially the
  intolerable burdens of disease carried by the
  region.
• Rapid and efficient translation of knowledge to
  policy and action is weak.
• Researchers have been relatively ineffective in
  pushing their evidence to policy, and
• Policy makers have been relatively inefficient in
  pulling evidence into policy and practice.

It has been concluded that a dedicated, credible,
professional institutional mechanism is needed to
bridge this gap.
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Steps in the process

• Initially for a national mechanism (Tanzania)
  (Dec 2001)
• TZ NIMR commissioned a consultation to examine
  options models 03
• IDRC provided funding for concept development
  2004
• Regional case studies prepared as base for
  country consultations (2004)
• Series of country design workshops (December 04
  -January 05)
• Tanzania, Uganda, Kenya
• Workshops focused on the need, function,
  institutional structure, autonomy, resources,
  country recommendations.

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Country Consultations

• 3 countries Tanzania, Uganda, Kenya
• 20 researchers, policy makers and synthesis group
• Focus of discussions
• The need
• Institutional autonomy/relationship
• Structure (regional and national
• Resources
• Country recommendations

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Tanzania Consultative meetingBagamoyo, 7-8
December 2004
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Kenya Consultative MeetingNaivasha 13-14 January
2005
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Steps in the process

• Synthesis for regional institutional design
• Health Ministers endorsed the approach in Arusha
  (Feb 05)
• Prospectus tested by international sounding board
  (March 05)
• Regional Council of Ministers endorsed prospectus
  (July 05)
• Funding proposal finalized (June 2006)
• Meeting of potential funding partners (Oct 06),
  selection of Steering Committee and Interim
  Executive Director

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Implementation strategy

• The centre shall act as an independent knowledge
  broker between researchers and policy makers
• Obtain research findings in the region and beyond
  especially for key priority regional health
  challenges
• Synthesize the information
• Package the synthesized information for
  influencing health policy and practice
• Communicate the policy briefs.
• Monitor the impact on policy change and trends of
  key indicators
• Formulate research priorities based on policy
  concerns

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Start Up Interim Mechanism

• Interim regional tripartite committee made up of
  representatives of Ministries of Health,
  Research and Academic institutions by end of July
  2005
• Each country appoints three individuals
  representing the above named stakeholders to the
  interim committee.
• Interim committee must serve until the
  substantive holders of the posts take over
• Suitable individual with visionary leadership be
  hired through a competitive process. The
  non-voting secretary to the interim committee
  will be the Health Coordinator of EAC.

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Regional Hub

• Permanent Governance Structure a tripartite
  committee with 3 members from each country
  representing the stakeholders
• Substantive chief executive of the institution
  who will be assisted by technical officers the
  number which will be determined by the governance
  committee
• Lean secretariat with flexibility for continued
  consultant utilization

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East African Community Health Research Council
Policy Makers
Tripartite Stakeholders Committee 9 members
External reviews
Donors
REACH Executive Director
National Research Bodies, Organi- sations under-
taking priority research
Administrative Support
Technical Core Team
Regional and International Centres of Excellence
for Technical Assistance Back-stopping
Kenya Node
Tanzania Node
Uganda Node
National, Regional, International Initiatives
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Country Nodes

• Country nodes needed to coordinate and facilitate
  country level activities of REACH and link with
  the REACH regional hub
• Coordinate, dynamize and catalyze the flow of
  information, knowledge and products of REACH
• Channel national demands to the REACH hub
• Liaise with related national initiatives and
  partners
• REACH Hub to develop common TORs for the
  establishment and detailed functions of national
  nodes through a broad consultative process

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Staffing of National Nodes

• To avoid country-level duplication of effort and
  resources, national nodes will be established and
  hosted by an institution with adequate physical
  infrastructure. To function efficiently, the node
  will be independent with its own identity and not
  answerable to the head of the hosting
  institution. The staff will work with a national
  multi-sectoral steering committee.

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Main constituencies in the process

• Chief medical officers of Ministries of Health
  for Kenya, Tanzania and Uganda
• D-Gs of National Health Research Institutes
• KEMRI, NIMR, UNHRO
• Leaders of academic and NGO health research
  communities of Kenya, Tanzania and Uganda
• East African Community headquarters
• International sounding board

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Sounding Board Meeting Nairobi, 7-8 March 2005
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Dr. Hassan Mshinda Ifakara Centre, Tanzania

• So if you are poor actually you need more
  evidence than if you were rich