1 HEALTH POLICY AND SYSTEMS RESEARCH PROJECT EBONYI STATE UNIVERSITY ABAKALIKI NIGERIA & EVIDENCE AND NETWORKS FOR HEALTH UNIT, KNOWLEDGE MANAGEMENT & SHARING (KMS/IER) WORLD HEALTH ORGANIZATION & INTERNATIONAL DEVELOPMENT RESEARCH CENTRE (IDRC) CANADA PROJECT TITLE: Promoting innovative approach in evidence-informed policymaking in Nigeria: Implementing and evaluating newly established Health Policy Advisory Committee as a Knowledge Translation Platform. PROJECT REPORT: COVERING THE PERIOD JULY 1, 2012-JUNE 30, 2013. WHO Reference WHO Registration 2012/237192-0 Purchase Order 200571438 Reg. File SPHQ12-APW-1364 Unit Reference KMS/ENH 21/07/2013 Dr. Chigozie Jesse Uneke Principal Investigator & Project Director Health Policy & Systems Research Project (Knowledge Translation Platform) Ebonyi State University Abakaliki, Nigeria
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HEALTH POLICY AND SYSTEMS RESEARCH PROJECT
EBONYI STATE UNIVERSITY ABAKALIKI NIGERIA &
EVIDENCE AND NETWORKS FOR HEALTH UNIT, KNOWLEDGE MANAGEMENT & SHARING (KMS/IER)
WORLD HEALTH ORGANIZATION &
INTERNATIONAL DEVELOPMENT RESEARCH CENTRE (IDRC) CANADA
PROJECT TITLE:
Promoting innovative approach in evidence-informed policymaking in
Nigeria: Implementing and evaluating newly established Health Policy
Advisory Committee as a Knowledge Translation Platform.
PROJECT REPORT:
COVERING THE PERIOD JULY 1, 2012-JUNE 30, 2013.
WHO Reference
WHO Registration 2012/237192-0
Purchase Order 200571438
Reg. File SPHQ12-APW-1364
Unit Reference KMS/ENH
21/07/2013
Dr. Chigozie Jesse Uneke
Principal Investigator & Project Director
Health Policy & Systems Research Project
(Knowledge Translation Platform)
Ebonyi State University Abakaliki, Nigeria
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Table of content
Research Team & list of HPAC membership............................................................................3
Table 1. Health Policy & Systems Research Project Team of Ebonyi State University Nigeria
S/No Team member Specialty Designation
1. Dr. C.J. Uneke Infectious disease/Epidemiology/Public health Principal investigator/director
2. Dr. A. Ezeoha Economics/Finance Policy & Strategy Deputy PI (I)
3. Dr. C.D. Ndukwe Community health/ Health Resources
Management
Deputy PI (II)
4. Dr. P.G. Oyibo Community health/Epidemiology Deputy PI (III)
5. Mr. F. Onwe Sociology/Anthropology Coordinator
logistics/programmes
6. Mrs. E. Igbinedion Epidemiology Project Secretary
7. Mr. P.N. Chukwu Public administration/Political science Assistant Project Secretary
8. Mr. E.E. Igwe Health technology/Infectious diseases Research/Logistic Assistant I
9. Mr. J.U. Paul Health education/human kinetics Research/Logistic Assistant II
Table 2. List of the members of the Health Policy Advisory Committee of Ebonyi State Nigeria
S/No Name of participant Designation Organization
1. Dr. Chris Achi Director of Public Health Ebonyi State Ministry of Health
2. Mr. Ignatius Unah Director of Finance Ebonyi State Ministry of Health
3. Mr. Chika Nwankwo Health Management Information
Systems Officer
Ebonyi State Ministry of Health
4. Pharm. Victor Chukwu Director of Pharmaceutical Services Ebonyi State Ministry of Health
5. Mr. C.A. Nsi HOD Administration Ebonyi State Ministry of Health
6. Dr. I.N. Echiegu Director of Medical Services Ebonyi State Ministry of Health
7. Mr. J. Igboji Director of Nursing Services Ebonyi State Ministry of Health
8. Dr. Gabriel Onwe Chief Executive Hospital
Management Board
Ebonyi State Ministry of Health
9. Mr. Boniface Uguru Director Planning, Research and
Statistics
Ebonyi State Ministry of Health
10. Mrs. Kate Oboke Coordinator Reproductive Health
Services
Ebonyi State Ministry of Health
11. Mr Sampson Alo Director Primary Health Local Government Service
Commission
12. Pst. Gabriel Odom Executive Director Agape Foundation (NGO)
13. Mr. Austin Nwazunku Executive Secretary Ebonyi State Action Committee on
AIDS
14. Prof. Ogbonnaya Ogbu Director Consultancy Services Ebonyi State University
15. Dr. A.E. Ezeoha HPSR Project Team Member Ebonyi State University
16. Dr. C.D. Ndukwe HPSR Project Team Member Ebonyi State University
17. Mr. F. Onwe HPSR Project Team Member Ebonyi State University
18. Dr. C.J. Uneke Director HPSR Project Ebonyi State University
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Acknowledgements
The Health Policy & Systems Research Project Team (HPSRPT) is grateful to Dr. Ulysses Panniset
for his valuable suggestions/guidance and the Evidence and Networks for Health Unit, Knowledge
Management & Sharing (KMS/IER) World Health Organization & International Development
Research Centre (IDRC) Canada for the provision of financial support for this project. The Team is
also grateful to Sandy Campbell (a knowledge translation specialist) and Dr. Fadi El-Jardali for the
technical assistance and advice they provided to the Team in this project. We wish to thank The
Vice-Chancellor Ebonyi State University (EBSU) Abakaliki Nigeria, Prof. Francis Idike, for his
support, and the Honourable Commissioner of Health Ebonyi State Nigeria, Dr. Sunday Nwangele
for his interest and support to this project. The Team appreciates the participation of all the
policymakers, researchers, and other stakeholders in the Nigeria health sector and their various
organizations and institutions for participating in this project.
Disclaimer
All views expressed in this document are those of the authors and do not necessarily reflects the
views of WHO.
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1.0 Executive Summary
Recently, there has been a growing demand internationally to base health policies on reliable
research evidence. There is therefore a need to strengthen institutions and mechanisms that can
more systematically promote interactions between researchers, policy-makers and other stakeholders
who can influence the uptake of research findings. One of the mechanisms that can serve as an
excellent platform for the interaction of policymakers and researchers is the health policy advisory
committee (HPAC). Efforts have been made to bring together researchers and policy makers through
mechanisms like conducting one time policy dialogue in many countries but the question of
sustainability remains unanswered. Therefore the need to have a long term mechanism that allows
for periodic interactions between researchers and policymakers within the existing government
system necessitated our implementation of a newly established HPAC in Ebonyi State Nigeria, as a
knowledge translation platform (KTP). The key project objective was to enhance the capacity of the
HPAC and equip it with the skills/competence required for the committee to effectively promote
evidence informed policy making and function as a KTP.
Among the major activities undertaken were: (i). capacity building training of the HPAC using
EVIPNet SUPPORT tools; (ii). capacity enhancement mentorship programme of the HPAC through
a three-month executive training programme on health policy/health systems and knowledge
translation in Ebonyi State University Abakaliki; (iii). participation of selected members of the
HPAC in various evidence-to-policy meetings held in Addis Ababa, Ethiopia, Congo- Brazzaville,
Beijing, China and Oslo Norway; (iv). publication of a scientific paper on the HPAC; (v). Policy
dialogue based on the produced policy brief on the Government‟s Free Maternal and Child Health
Care Programme in Ebonyi State Nigeria. The project findings indicated a significant improvement
in knowledge of evidence-to-policy link among the HPAC members; the elimination of mutual
mistrust between policymakers and researchers; increase in the awareness of importance of HPAC in
the ministry of health. To ensure the continuation of the HPAC‟s work as a KTP an operational
document for HPAC was developed, and there are plans to link with other regions/states in Nigeria;
conducting continuous training for the HPAC and institution of a performance measurement
mechanism for the HPAC.
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2.0 Introduction & Background Information
Nigeria is among the increasing number of countries world-wide that are recognizing the importance
of research evidence in the development of effective health policy that can strengthen the health
systems (NEHSI 2007; Uneke et al. 2010). There are numerous reports that are of the consensus that
evidence from research can enhance health policy process and development by identifying new
issues for the policy agenda and informing decisions about policy content and direction (Campbell et
al. 2009; Dobrow et al. 2004; Hanney et al. 2003; Innvar et al. 2002). It is pertinent to state
however, that in spite of the global recognition of the importance of research evidence in
policymaking, there is widespread evidence of failure to implement health interventions that have
been demonstrated to be cost-effective by high-quality research in both high-income and low-income
countries (Haines et al. 2004). This is largely because getting research evidence into policy remains
a daunting task and huge gaps still exist (Young 2005, Jönsson et al. 2007).
To address this challenge, Haines et al. (2004) suggested that there is a need to strengthen
institutions and mechanisms that can more systematically promote interactions between researchers,
policy-makers and other stakeholders who can influence the uptake of research findings. Stressing
on the need to promote the interaction between researchers and policymakers, According to Choi et
al. (2009), it is desirable that scientists and policy makers communicate their knowledge effectively
or run the risks of barriers in language and understanding. They further noted that more incentives
and opportunities to collaborate will help scientists and policy makers appreciate their different
goals, career paths, attitudes towards information, and perception of time.
One of the mechanisms that can serve as an excellent platform for the interaction of policymakers
and researchers is the health policy advisory committee (HPAC). The HPAC has been described as a
forum for the Government, and other stakeholders (policymakers, researchers, civil society
organizations, funders, etc), to discuss health policy and to advise on the implementation. The HPAC
is thus a donor/ stakeholder coordination mechanism that provides a forum for information and
experience sharing, and resolution of disagreements or conflicts among health sector stakeholders
(MOHU 2010). In this report we describe the establishment of a HPAC in Ebonyi State Nigeria, its role as a
mechanism to bridge the divide between researchers and policymakers and the its implementation as
a knowledge translation platform.
3.0 Establishment of the Health Policy Advisory Committee 3.1 Origin of the Health Policy Advisory Committee
The Health Policy Advisory Committee was established in Ebonyi State South Eastern Nigeria in
August 2011. It was the first HPAC to be established at the state level in Nigeria out of the 36 states
and the Federal Capital Territory Abuja. The establishment of the HPAC was one of the products of
the Alliance for Health Policy & Systems Research (AHPSR) of World Health Organization funded
project (Supporting National Processes for Evidence-Informed Policy in the Health Sector of
Developing Countries) in Ebonyi State University Nigeria. The project was focused on improvement
of the skills of policy makers in evidence-informed policy making and the establishment of enabling
environments and capacity for health policy and systems research (HPSR) for policymakers,
researchers and other stakeholders in the health sector.
The interventions to enhance capacity for evidence informed policy in the project consisted of series
of six training workshops and a mentorship programme of which the overriding goals were
categorized into two as follows:
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(1). Enhancing pull factors: (a) Establishment of rapid response mechanisms or policy advisory
units within Ministries of Health and/or other policy-making bodies or strengthening existing
capacity with additional training; (b) Technical support and or training to help policy makers to
facilitate commissioning of appropriate research or syntheses; and (c) Training policy makers in
identifying and applying evidence to decision making.
(2). Supporting exchange efforts: (a) Supporting forums, meetings, workshops, or conferences to
facilitate exchange between researchers and research users; (b) Encouraging the establishment of
mechanisms which allow for ongoing exchange between researchers and research users, such as
research priority setting committees; (c) Supporting secondment of trusted researchers, who already
have established links with policy makers into policy making units.
Following series of meetings and contacts between the policymakers, other key stakeholders and
researchers during the project intervention workshops and mentorship programme, there was a
unanimous consensus for the establishment of a platform where policymakers and researchers can
permanently collaborate. With the advice of the AHPSR the establishment of the HPAC was
initiated as the forum/platform that can provide the mechanism for collaboration between researchers
and policymakers. Following the approval of the proposal for the establishment of the HPAC by the
Honourable Commissioner for Health of Ebonyi State, the HPAC was inaugurated and had its first
meeting on August 2011.
This led to the initiated the establishment of the platform known as Ebonyi State Health Policy
Advisory Committee (ESHPAC). The Research Team developed a proposal for the establishment of
the Health Policy Advisory Committee which was submitted to the Honourable Commissioner for
Health of Ebonyi State. Thirteen individuals participated in the first meeting of the Committee and
these included six policymakers (Snr. Directors in the health ministry), five researchers (from
Ebonyi State University), a Director of an NGO. At the end of the first meeting, members resolved
to include six other key directors from the Health Ministry to bring the membership to 18. An
operational document for the HPAC was developed by the Research Team and this document was
extensively deliberated on by the committee and made some revisions on the document to produce
the final operational document.
Figure 1: Cross-section of the members of the Health Policy Advisory Committee for Ebonyi State with
Honourable Commissioner for Health, Dr. Sunday Nwangele (7th from left) and Dr. Fadi El-Jardali on
August 19, 2011 at the Ministry of Health Secretariat
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3.2 The purpose and objectives of the Health Policy Advisory Committee The ESHPAC is an innovative approach towards bridging the gap between researchers and
policymakers permanently and promoting evidence-informed policymaking in Nigeria. The purpose
of the ESHPAC is to provide health content expertise and to make recommendations to the
government, health ministry, and other stakeholders regarding issues related to the WHO health
systems building blocks (health workforce, health finance, medical products and technology, service
delivery and leadership/governance) and the health sector development.
The overarching objectives and the mandates of the ESHPAC include: (a). To identify critical health
issues of highest concern in Ebonyi State, evaluate health research findings and make appropriate
recommendations regarding their reliability in health policy formulation; (b). To stimulate public
policy dialogues based on policy briefs and make evidence informed recommendations to the
government of Ebonyi State and other relevant bodies. (c). Advocate for routine analysis of Ebonyi
State health policy implications at the State and Local Government levels through evidence informed
process.
3.3 Operation framework and function of the Health Policy Advisory Committee
The operation framework of the ESHPAC is anchored on the principles of innovation, collaboration,
accountability, accessibility, global standard, and recognition of Ebonyi State‟s uniqueness. The
function of the ESHPAC is summarized into three broad areas as follows: (a). To offer evidence-
informed advice to the Government and Health Ministry regarding policy matters affecting health of
Ebonyi State residents vis-à-vis the proposed priorities of Ebonyi State Government; (b). To
provide evidence-informed options and guidance to Ebonyi State Government and other
stakeholders in the health sector on the WHO Health Systems building blocks (Health finance,
Service delivery, Health workforce, Information and evidence, Medical products and technology,
Leadership and governance); (c). To facilitate the development of policy briefs and the promotion of
multi-stakeholder policy dialogues in order to bridge the gap between research and implementation;
and (d). Serve as a bridge between policymakers and researchers.
4.0 Implementation of the Health Policy Advisory Committee as Knowledge
Translation Platform
4.1 Overall goal and objectives of the project
The overall goal of this project is to implement and evaluate the Health Policy Advisory Committee
(HPAC) as a Knowledge Translation Platform (KTP).
The objectives were:
(i). To enhance the capacity of the HPAC and equip it with the skills/competence required for the
committee to effectively promote evidence informed policy making and function as a KTP through
the following strategies:
(a). To conduct a mentorship programme for the HPAC: For the enhancement of HPAC competence
that is relevant to knowledge translation, these include: fostering research capacity, nurturing
leadership development in the context of limited resources; and enhancing capacity for evidence
informed policymaking.
(b). To conduct capacity enhancement training workshops for HPAC: On policy briefs and policy
dialogues, priority setting, and production of policy documents based on the SUPPORT tools