EVIDENCE Sharing experience on challenges TO POLICY Emilie Robert Université de Montréal 1 © E. Robert, 2014
Moving evidence to policy: sharing experience on challenges
Dec 15, 2014
This presentation was given at the School of Public Health of the University of Western Cape (South Africa) in the frame of the Emerging Voices 2014 (September 2014).
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1
EVIDENCE
Sharing experience on challenges
TO POLICY
Emilie RobertUniversité de Montréal
© E. Robert, 2014
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Some definitions…
• Policyo ‘a definite course or method of action selected from
among alternatives and in light of given conditions to guide and determine present and future decisions’ (Merriam Webster)
© E. Robert, 2014
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Some definitions…
• Policyo ‘a definite course or method of action selected from
among alternatives and in light of given conditions to guide and determine present and future decisions’ (Merriam Webster)
© E. Robert, 2014
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Some definitions…
• Policyo ‘a definite course or method of action selected from
among alternatives and in light of given conditions to guide and determine present and future decisions’ (Merriam Webster)
• Policy vs. politicso ‘Policy is mostly about the design and implementation
of a particular intervention. Politics is about how the decision was made.’ (C. Tyler)
© E. Robert, 2014
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• Policy-makero ‘a person responsible for or involved in formulating
policies, especially in politics.’ (Oxford Dictionaries)
Some definitions…
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• Policy-makero ‘a person responsible for or involved in formulating
policies, especially in politics.’ (Oxford Dictionaries)o ‘the invisible man’ (E. Robert)
Some definitions…
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Two planets: different objectives and constraints
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Researchers are from Venus…• “Publish or perish”• Get funding• Conduct research• Teach• Supervise students• Present in conferences• Etc.
Two planets: different objectives and constraints
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Researchers are from Venus…• “Publish or perish”• Get funding• Conduct research• Teach• Supervise students• Present in conferences• Etc.
Policy-makers are from Mars…• Negociate with stakeholders• Ensure accountability to
population / electorate• Comply with existing
agenda• Integrate policy
recommendations from hierarchy
• Etc.
Two planets: different objectives and constraints
© E. Robert, 2014
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Researchers are from Venus…• “Publish or perish”• Get funding• Conduct research• Teach• Supervise students• Present in conferences• Etc.
Policy-makers are from Mars…• Negociate with stakeholders• Ensure accountability to
population / electorate• Comply with existing
agenda• Integrate policy
recommendations from hierarchy
• Etc.
• Move evidence to policy… • Use evidence for policy…
Two planets: different objectives and constraints
© E. Robert, 2014
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Entering the policy ‘arena’
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Entering the policy ‘arena’
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• Opacity and complexity of the policy process
• Several ‘layers’ of policy-makers
• A more or less shifting policy landscape
• Presence of ‘gate keepers’
• Contestants
Entering the policy ‘arena’
© E. Robert, 2014
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• Opacity and complexity of the policy process
• Several ‘layers’ of policy-makers
• A more or less shifting policy landscape
• Presence of ‘gate keepers’
• Contestants
Entering the policy ‘arena’
© E. Robert, 2014
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No “one-size fits all” strategy
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No “one-size fits all” strategy
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“How do we deal with obesity?”
“Cancer prevalence is
high.”
Congruence with policy-makers’ preoccupations
No “one-size fits all” strategy
© E. Robert, 2014
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“How do we deal with obesity?”
“Cancer prevalence is
high.”
“User fees finance our
health system”
“User fees are a threat to health.”
Congruence with policy-makers’ preoccupations
Congruence with policy-makers’ ideas
No “one-size fits all” strategy
© E. Robert, 2014
19
“How do we deal with obesity?”
“Cancer prevalence is
high.”
“User fees finance our
health system”
“User fees are a threat to health.”
Congruence with policy-makers’ preoccupations
Congruence with policy-makers’ ideas
Networks
No “one-size fits all” strategy
© E. Robert, 2014
20
“How do we deal with obesity?”
“Cancer prevalence is
high.”
“User fees finance our
health system”
“User fees are a threat to health.”
Congruence with policy-makers’ preoccupations
Congruence with policy-makers’ ideas
Networks
Timing
No “one-size fits all” strategy
© E. Robert, 2014
21
“How do we deal with obesity?”
“Cancer prevalence is
high.”
“User fees finance our
health system”
“User fees are a threat to health.”
Congruence with policy-makers’ preoccupations
Congruence with policy-makers’ ideas
Networks
Timing
No “one-size fits all” strategy
© E. Robert, 2014
22
In practice… Example 1
• Aboriginal communities (Canada)
• Mandate from the regional health authority
• Research objective:– To understand successes and challenges
of implementing intervention
• Evaluation objective: – To improve the intervention in
communities where it is already implemented.
– To provide lessons for scaling up the intervention
© E. Robert, 2014
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Facilitators Challenges
Guidelines for Aboriginal research
Several layers of audiences
High stakes
Financial resources
Mandate from policy-makers
In practice… Example 1
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• Realist review on user fee exemption policies in sub-Sahara Africa
• “Hot” topics since 2005…
• “Sexy” method since 2012…
• Doctoral research (Ph.D.) at the University of Montreal starting 2008
In practice… Example 2
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In practice… Example 2
Missed opportunity?
Low involvement
of policy-makers
Long research process
New ‘hot’ topics (UHC,
PBF…) « … It seems fair to say that at least in terms of retrospective studies on the formulation and implementation of country fee exemption policies, we are reaching a data saturation point. » (B. Meessen, 2013)
Health Policy and Planning Debated
« Producing evidence on the complexity of user fees abolition interventions is crucial to support the implementation of universal coverage (…) Calling all young researchers, emerging voices and other people-centred scientists! Could we see some potential solutions at the Third Global Symposium on Health Systems Research? » (V. Ridde and E. Robert, 2014)
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A When there is a will, there is a way...
B The way is far from straightforward...
C … and it is very context-dependent.
Moving evidence to policy is like fishing… You never know if you’ll catch the fish, but
there are hints to approach your goal.
Take home messages
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Emilie Robert is a Ph.D. candidate in public health at the University of Montreal. She is also an evaluation and KT consultant.
Contact: [email protected]
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