Knowledge translation strategies in West Africa


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Panel of 4 presentations done at Second Global Symposium on Health Systems Research.
Promoting evidence-based decision-making to improve access to health care
for vulnerable populations: Knowledge translation strategies in West Africa

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  • Citation de Witter : par opposition aux mécanismes d’exemption ciblés prévus dans le cadre des politiques de recouvrement des coûts
  • Citation de Witter : par opposition aux mécanismes d’exemption ciblés prévus dans le cadre des politiques de recouvrement des coûts
  • Citation de Witter : par opposition aux mécanismes d’exemption ciblés prévus dans le cadre des politiques de recouvrement des coûts
  • identifying broadcast channels
  • In 2008, the NGO HELP has conducted a pilot project of subsidizing 100% of the costs of health care in two districts of Burkina Faso. A scientific partnership was created to produce evidence on the intervention, and a knowledge transfer strategy was developed to promote the use of these evidence by stakeholders (decision-makers, people working in the health system, funding partners, etc.). This paper presents the results of the evaluation of this KT strategy
  • The present evaluation has two objectives
  • A questionnaire was used to draw a baseline portrait of users ’ attitude toward research and of their access to research products. This baseline portrait was examined in greater detail through face-to-face interviews with 38 key informants (eight NGO members; seven local and regional decision-makers; four TFP representatives; five CSO representatives; 11 field workers; and three managers at the central level). The results presented are drawn from the analysis of documents (reports of meetings, terms of reference, research notes and reports, etc.) and from a thematic analysis of the qualitative interviews.
  • This Figure presents the conceptual model for this strategy We could see that many activities were planned and that many potentiel users were targeted
  • A. The team produced and distributed widely four policy briefs and an advocacy document that summarizes the key research results The team also organized a number of major activities for sharing research results at the local, regional and national levels (policy dialogues, press conference, etc.) B. Few participants have the skills required to read and understand scientific publications, judge their quality and put them into practice. Few of them read Thus, dissemination workshops is the strategy that seems to have the greatest impact C.
  • When the project began, openness to research was considerably less; it should be noted that, for some of them, their previous contact with researchers had often been limited to data collection KT activities coverage for the different target groups was uneven The analysis highlighted the difficulty of reaching people at the highest levels in the system, as well as front-line workers. It is clear that investing resources in writing documents based on research is not the best strategy to influence change
  • conceptual use of knowledge produced by research refers to changing users ’ frame of reference instrumental use , occurs when users, based on scientific evidence, take a decision or make concrete changes to their practices Finally, persuasive use of knowledge, sometimes called strategic or symbolic use, occurs when decision-makers and professionals use knowledge to legitimize their decisions or actions
  • Ce sont des exercices de capitalisation entrepris dans chaque pays et accompagnés par une équipe externe, où connaissances tacites et scientifiques ont été exploitées par les parties prenantes du processus de capitalisation. Ces exercices ont été basés sur une démarche reflexive et critique avec de nombreuses discussions au sein et entre les groupes de travail par pays;
  • Knowledge translation strategies in West Africa

    1. 1. Promoting evidence-based decisionmaking to improve access to healthcarefor vulnerable populations: Knowledge translation strategies in West AfricaGlobal symposium on health system research (Beijing, 31 oct. – 3 nov. 2012) Chair : Valéry Ridde
    2. 2. 1. Successes and challenges of the Observatory of free healthcare in Mali2. Favoriser la prise de décision fondée sur des données probantes au Burkina Faso: une initiative de courtage de connaissances3. Sharing and using evidence on a free healthcare programme in BurkinaFaso: An evaluation4. Capitalizing on local knowledge about free healthcare policy in West Africa: the experience of 7 countries
    3. 3. Global symposium on health system research (Beijing, 31 oct. – 3 nov. 2012)Producing and transferring local knowledgeSuccesses and challenges of the Observatory of free healthcare in Mali Emilie Robert Dembélé Youssouf
    4. 4. Outline1. Context2. What research knowledge (RK) was transferred?3. To whom was the RK transferred?4. By whom was the RK transferred?5. How was the RK transferred?6. With what effect was the RK transferred?
    5. 5. ContextSeveral free care policies: • Free care for under 5 (NGO) • Distribution of free mosquito bednets (gvt+NGO) • Free malaria treatment (gvt) • Caesarian (gvt) • HIV treatment (gvt)Objectives:To use existing data from theinformation system and toproduce new knowledge tofuel decisions on user feeexemption policies. MALI
    6. 6. 1. What RK was transferred? (1) Dimensions RK produced by the Ministry of RK produced by health University of Montréal - Curative consultation coverage in Kangaba - Effects of free care of - Access to C-section in Bamako. curative care for children - Effects of free ACT on accessibility of under 5 on consultation inUtilization of children living further than 5 km from a Kangabahealth services community health centre (CsCom) - Effects of free mosquito bednets on prenatal care in Sikasso - Effects of free anti malaria on financial - Costs of curative capacity of community health centres consultation for childrenFinancial (CSCom) in Bamako under 5 (scaling up)aspects / costsof UF exemption - Effects of free care on financial capacity ofpolicies community health management (ASACO) in Kangaba - Perception of health staff on free anti malaria in Sikasso and KayesActors’ - Perception of users on free anti malaria inperceptions of Sikassofree care - Opinion of Kangaba population on cessation of free care for children under 5
    7. 7. 2. To whom was the RK transferred?
    8. 8. 3. By whom was the RK transferred?• Supervision team – University of Montreal, researchers with technical expertise – Médecins Sans Frontières – Belgium: coordination of the strategy and fundraising – National Directorate of the Ministy of Health: operational side of the research, access to the health system information
    9. 9. 4. How was the RK transferred?• Modelization of the knowledge translation strategy theory (post-intervention)• Objective: → To evaluate the potential for achievement of the KT strategy• Sources: – Interviews – project documents – KT literature
    10. 10. INPUTS Administrative and financial support during 12 months; UdeM / MoH / MSF-B / ECHO partnership ; human resources; equipments; consumables; infrastructures Participative process Participative process PROCESS Implication of target users in Involvement of local Support to the Adaptation and identifying needs for stakeholders in Observatory to dissemination of knowledge producing knowledge produce knowledge knowledge Preparation of protocoles Building of the teams’ Publication of policy briefs Workshop for the by the Observatory teams technical capacities on new knowledge identification of needs for ACTIVITIES knowledge Presentations at local Conduct of studies by the Supervision of the Observatory teams production of knowledge meetings Prioritizing needs for knowledge with Utilization of HIS data Conduct of independant National dissemination Observatory teams studies by UdeM workshopEXPECTED RESULTS Knowledge is useful to The legitimacy of the The credibility of Knowledge is Process target users. Obs. is established. knowlege is ensured. accessible. utilization Better utilization of knowledge in decision-making on user fee exemption measures OBJECTIVE At the At the At the local At the local At the At the internat. internat. level level national level national level level level© Robert, 2011
    11. 11. 5. With what effect was the RK transferred? Expected Facilitators Obstacles Potential for results achievement1) Knowledge is KT strategy: KT strategy:useful to target • Involvement of potential users in • Poor targeting ofusers. the identification of needs decision and policy makers Context: ++ • Answer to an explicitly formulated need • MDGs context2) The legitimacy KT strategy:of the • Endogeneous process ofObservatory is knowledge productionestablished. • Technical support from partners +++ Context: • Local initiative and institutional anchoring
    12. 12. 5. With what effect was the RK transferred? Expected Facilitators Obstacles Potential for results achievement3) The credibility KT strategy: KT strategy:of knowledge is • Scientific support from partners • Validity of dataensured. Context: produced by the Observatory + • Long-term collaboration between partners • Short-term trainings and one-year strategy4) Knowledge is KT strategy: KT strategy:disseminated and • Workshop and policy briefs • Push strategyaccessible. • No dissemination plan Context: • Participants with low - • Strong involvement of key stakeholder (messenger) leverage5) Process KT strategy: KT strategy:utilization • Better understanding of the ins • No national potential and outs of free healthcare at the users involved in the local level process • Trainings • Life span of the KT + Context: strategy • Mid-term sustainability
    13. 13. Youssouf Dembélé is the Executive Director of the Alliance Médicale Contre lePaludisme au Mali.Emilie Robert is a Ph.D. student in public health at Montreal University (Canada).She is working under the supervision of Dr. Valéry Ridde. She is a senior fellow ofthe Global Health Research Strengthening Program (GHR-CAP), funded by theCanadian Institutes of Health Research and the Population Health ResearchNetwork of Quebec. She holds a scholarship from the Quebec Fund for Nature andTechnology Research. She has a travel grant from the Research centre ofUniversity of Montreal hospital centre (CRCHUM).Contacts: / emilie.robert.3@umontreal.caAcknowledgments to the team: • Dr. Valéry Ridde, Montreal University • Dr. Slim Haddad, Montreal University
    14. 14. Favoriser la prise de décision fondée sur des données probantes au Burkina Faso: une initiative de courtage de connaissances Christian Dagenais Michèle Boileau-Falardeau ValÉry ridde Second global symposium on health system research Beijing, Novembre 2012
    15. 15. Contexte• En Afrique, les coûts d’utilisation représentent une barrière financière importante pour l’accès aux soins de santé• L’utilisation des résultats de recherche: un élément qui favorise l’amélioration des pratiques et de la prise de décision
    16. 16. « Le rapport est disponible, mais il n’a pas encore été exploité … »
    17. 17. Contexte• Cette situation résulte principalement d’un manque d’interaction entre les chercheurs et les utilisateurs potentiels• Les stratégies de transfert de connaisances ayant recours à un intermédiaire, aussi appelé courtier de connaissance (Knowledge broker) représente une solution potentielle à ce problème: c’est précisément cet objectif que vise notre projet
    18. 18. Quelles connaissances font l’objet de la stratégie d’AC? • Données probantes concernant quatre domaines d’intervention dans un district du Burkina Faso: • Nutrition et gratuité des soins • Prise en charge du paludisme • Santé maternelle • Mutuelles de santé
    19. 19. Comment se présente la stratégie?• Activités de planification• Activité de courtage de connaissances• Activités de soutien au courtier
    20. 20. Planification de la stratégieActivités de préparatoire au projet Activités de consultation Construction de la stratégie Atelier participatif de présentation Atelier participatif de présentation d’activités de courtage suggérées d’activités de courtage suggérées Recension des écrits Recension des écrits sur le courtage de sur le courtage de connaissances connaissances Qui a participé? Modélisation de la Modélisation de la Chercheurs stratégie de courtage stratégie de courtage de Planificateur Adaptation du contenu Adaptation du contenu au niveau l’Université sous la forme d’une note sous la forme d’une note national de Montréal de synthèse de synthèse Planificateur Chercheurs niveau burkinabè régional
    21. 21. Activités de courtage Liaison et transfert entre lechercheurs et les utilisateurs Identification des besoins des utilisateurs Intervenants Décideurs: locaux, régionaux, Gestion de l’information nationaux Identification des réseaux de Chercheurs diffusion Préparation de matériel pourdiffusion (résumé synthèse, PPT, etc.)
    22. 22. Activité de soutien au courtier Formation sur le courtage de Formation sur le courtage de connaissances (1 semaine) connaissances (1 semaine) Formation Formation Formation sur l’accompagnement du changement (1 semaine) Soutien technique pour la Soutien technique pour la recherche documentaire Courtier recherche documentaireAccompagnementAccompagnement Supervision Skype Supervision Skype hebdomadaires hebdomadaires Stage d’observation au Canada Stage d’observation au Canada
    23. 23. 5. Évaluation de la mise en œuvre et des effets de la stratégie1. Mesurer les réactions des courtiers de connaissances et des chercheurs après les activités de formation2. Documenter la mise en oeuvre des activités de courtage et les résultats produits3. Identifier les éléments qui facilitent ou gênent la mise en oeuvre de l’intervention4. Mesurer l’attitude et l’intention d’utiliser5. Mesurer les effets de la stratégie de courtage sur les pratiques et la prise de décision
    24. 24. Sharing and using evidence on a freehealthcare programme in BurkinaFaso: An evaluation Christian Dagenais Ludovic Queuille Valéry ridde Second global symposium on health system research Beijing, November 2012
    25. 25. Evaluation objectives1. To evaluate the strategy’s implementation processes2. To document the extent to which the targeted effects were achieved
    26. 26. Methodology (in short)• Questionnaire (n = 50)• Face-to-face interviews(n = 38)• Analysis of documents (reports of meetings, terms of reference, research notes and reports, etc.)
    27. 27. Logic model of the knowledge transfer strategy KNOWLEDGE KNOWLEDGE EVIDENCE DECISIONCOALITION PRODUCTION SHARING/DISSEMINATIO USERS MAKERS Integration of user N Intervention fees exemption for Policy Briefs improvement PNDS PNDS vulnerable Relevance 2011/2020 2011/2020 population in theMINISTRY of District/Regional evidence  Implementors commissions commissions 2011/2020 PNDS Process sharing workshops RHD/DMO knowledge (GO/NGO) HEALTH (MoH) District/Regional/Central National budget Health services MoH Evidence Inter- Inter- communications allocation for user outcomes dissemination ministerial ministerial workshops fees exemptions RHD/HD committee committee partners CSO Financial accessibility about the about the Health Facilities Technical and Financial strategies include in worst-off worst-off outcomes MoH Partners Health District Plans communications INGO International funds workshops SCO SCO for user fees Patients satisfactionUNIVERSITY exemptions  user fees National sharing Technical and exemptions in ECHO Community outcomes experiences workshop Financial MoH and others partners Politicians Politicians Partners projects National Dissemination research (TFP) Household outcomes Formulate a NGOs evidence to CSO, media National strategy and decision-makers  evaluation in ECHO to exemption the Individual outcomes MEDIA and other partners TFP TFP worst-off National/International projects ECHO scientific communications PROJECT Direct and indirect RESEARCHERS Evidence cited byPARTNERS costs Scientific Scientific Increase the level Advocacy publication scientific community community community of researches on user fees Etc. Press conference exemptions INPUTS, ACTIVITIES & OUTPUTS FIRST-LEVEL TARGETS OUTCOMES SECOND-LEVEL TARGETS IMPACTS
    28. 28. RESULTS
    29. 29. 1a. Implementation processes• Broad scope of the efforts invested in KT• Expertise required to use the knowledge• Low interest in reading• Dissemination workshops seem to have the greatest impact
    30. 30. 1b. Implementation processes• Open-minded attitude to research• Difficulty reaching all target groups to the same extent• Presentation of the information in an appropriate format
    31. 31. 2a. Achievement of the targeted effects Three (main) types of research utilization • Conceptual • Instrumental • Persuasive (strategic) 32
    32. 32. 2b. Achievement of the targeted effects• A number of significant efforts were invested in KT activities, and they led to every type of use• However, some tools were more effective than others (for example, the dissemination workshops)• Users developed an increasingly positive attitude toward research and considered it useful
    33. 33. 2c. Achievement of the targeted effects• Additional effort is needed to make information more accessible, to explain how to put knowledge into practice, and to adapt to users’ work calendars• Written documents were not the best means of dissemination• Trying to involve high-ranking officials remains a significant challenge
    34. 34. Types and examples of knowledge use by different target groups Instrumental Conceptual Persuasive NGO • Putting in place a • Reflecting on how they use • Confirming how they do mechanism for more rapid knowledge things reimbursement • Convincing decision makers CSO • Total exemption from • Paiement is recognized as • Utilisation des résultats payment of maternal one of the most important dans les démarches de health care now among its barriers in access to plaidoyer claims maternal healthLocal health workers • Changing practices • Knowing the community • (prescriptions, reception of and its needs better women, etc.) • Becoming aware of priorities (indigents, etc.) Local et regional • Redistributing the workload • Planning certain activities • Using the program as an decision-makers • Changing the allocation of (annual action plans) example resources • Understanding the effects of the intervention TFP • Being concerned about • Using the project as a • Using the program as an obtaining scientific data source of inspiration for example the health insurance program
    35. 35. Key lessons learned (a)• Create homogeneous groups for the dissemination workshops to adapt the content to the audiences• Focus the presentations on a few key messages• Transform and synthesize information
    36. 36. Key lessons learned (b)• Use a specially trained person to present the information• Adjust the knowledge dissemination strategy to suit users’ planning calendars• Train and support “multiplying agents” to retransmit information in the various settings
    37. 37. For more details:• Dagenais C., L. Queuille & V. Ridde (in press). A knowledge transfer evaluation of a user fees exemption intervention in Burkina Faso. Global Health Promotion, Special Issue.• Available at:
    38. 38. Capitalizing on local knowledge about free healthcare policy in West Africa: the experience of 7 countriesSpeakers:Zakillatou ADAM, HIV/AIDS Department, Ministry of Health (Togo )Yamba KAFANDO, IRSS/CNRST (Burkina Faso)Co-authorsLudovic QUEUILLE (NGO HELP, CRCHUM Canada)Valery RIDDE (CR – CHUM/Department of social and preventive health,Montreal University, QUEBEC)
    39. 39. OutlineContextObjective of the presentationWhat research knowledge was transferred?To whom and by whom was the researchknowledge transferred?How was the research knowledge transferred?With what effect was the research knowledgetransferred?
    40. 40. Context• Common problematic on access to health care in West Africa• Implementation of user fee exemption policies in order to improve the coverage of vulnerable population• Limited evidence on these policies• Strong expertise from the in-charge of these policies but not available; no or limited sharing of experience• Regional capitalisation strategy with HELP/CRCHUM• Objective = To transform this expertise into knowledge that can be shared out and to capitalise on field experiences
    41. 41. Objective of the presentationGeneral objective: To describe and analyse this knowledge translation strategy in 7 West-African countries.Specific objectives  To assess the process of capitalisation and its implementation  To analyze the results that were achieved thanks to this KT strategy
    42. 42. What research knowledge was transferred? Subsidizing deliveries and emergency obstetric and neonatal care (Burkina Faso)• Free caesarian and free prevention and treatment of malaria (Mali)• Free caesarian and free care for children under 5 (Niger)• Free care for the elderly (plan Sésame – Senegal)• User fee exemption for HIV care (antiretroviral therapy) (Togo)
    43. 43. Analytical framework Strategies Attitudes and behaviours Outputs- Management - Motivation/satisfaction of - Incidence of health staff catastrophic- Communication expenditures - Relationship between- Monitoring / users and health - Health care seekingevaluation / providers behaviourscoordination - Users’ satisfaction - Utilization of modern- Community health servicesparticipation - Perception of target population on the - Utilization of- Service provision outcomes of the policy traditional healthand referral services - Coping strategies of health staff - Quality of services
    44. 44. To whom and by whom was the research knowledge transferred?Country teams (7 countries)Mixed teams (60 participants)– Policy in-charge or policy makers– Technicians from the Ministries of Health– Members of the national civil society– Researchers– Membres of non-governmental organisations and of international organisations
    45. 45. How was the research knowledge Implementation of transferred?country team in Benin, Burkina, Ghana, Mali, Niger, Togo, Senegal on several topics Knowledge Country case Regional (caesarian, free care studies capitalization dissemination for elderly, etc.) Knowledge synthesis  gaps in knowledge Prerequisite (…) SHARING & CAPITALISING on EXPERIENCES Technical and financial support and supervision Workshop 1 Workshop 2 Workshop 3June-10 July-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 June-11
    46. 46. With what effect was the research knowledge transferred? (1)• Scoping study on public policies and NGOs interventions in participant countries• Knowledge production through participatory case studies• Results of the scoping study and results of the case studies from the countries converge. The credibility of the case studies is ensured.
    47. 47. With what effect was the research knowledge transferred? (2)The knowledge that has been produced is useful to boththe participants and the policy makers: • Better understanding of the policies • Identification of bottlenecksOpportunities for actors: • Capacity building (analytical and writing skills) • Networking • Strengthening of professional skills
    48. 48. ConclusionParticipation in knowledge building in West AfricaThe point of view of « insiders » is as important asthe one of researchers.User fee exemption policies in the participatingcountries face the same challenges and it is crucialthat in-charges of these policies regularly meet toshare their experience.Lessons learns must be shared, disseminated andput into practice.