Researchers are from Venus, policy makers from Mars

Researchers are from Venus, policy makers from Mars Professor Wendy J Graham Wellcome Trust International Public Engagement Workshop: 3-5 December 2008, Africa Centre, UKZN

Researchers are from Venus. Policy makers are from Mars. Different worlds, different “communities”

The University of Aberdeen established the First Chair of Medicine in the English-speaking world, in 1497.

DR ALEXANDER GORDON (1752-1799) A Treatise on the Epidemic Puerperal Fever of Aberdeen: 1795

~99.2% of maternal deaths occur in developing countries ~0.8% of maternal deaths occur in developed countries Estimated 536,000 maternal deaths each year: 98% preventable “ Maternal deaths: deaths during pregnancy, delivery, or up to 6 weeks after the end of pregnancy or delivery”

Millennium Development Goal 5 is off-track MDG5: 75% reduction in maternal mortality between 1990-2015 MDG 5 Target

“ The role of the scientist is to use research to ascertain the effectiveness of innovative policies and programs. This is in contrast to {their} role as advisor in which the scientist can indulge in over-advocacy ...”. Donald T Campbell 1988 The experimenting society.

Immpact is the international research I nitiative for M aternal M ortality P rogramme A ssessment Purpose: to improve the evidence-base for policy-makers through comprehensive evaluations of safe motherhood intervention strategies www.immpact-international.org

Immpact in brief

Sept 1 st 2002 – Aug 31 st 2008

Funded by DFID, EC, Gates Foundation, UNFPA, USAID, & WHO

7 partner research institutions in North and South (University of Aberdeen is co-ordinating centre)

OUTPUT 2 New knowledge to design & implement strategies OUTPUT 3 Stronger capacity for evidence-based decision-making and outcome evaluation OUTPUT 1 Enhanced methods for evaluating strategies

Burkina Faso Ghana Indonesia Nepal Nicaragua Senegal Uganda Zimbabwe

Developed & tested measurement “tools”

Synthesized existing evidence

Undertook major evaluations in 3 countries (Burkina Faso, Ghana & Indonesia), plus 5 other collaborations

Strengthened research teams in partner institutions

Immpact activities

Immpact “closing the loop” Assessing policy-makers’ priorities for evidence Gathering & synthesizing evidence Translating & communicating evidence for decision-making Using evidence to inform the design, implementation & evaluation of enhanced strategies

Crucial translation step Research priority-setting Knowledge-generation & dissemination Evidence filtering & amplification Policy-making processes Adapted from: Alliance for Health Policy and Systems Research. 2007. “ Translation { evidence filtering & amplification } is the conversion of findings from basic, clinical or epidemiological research into information, resources or tools that can be used to improve health.”

“ One of the big changes in the research-policy interface is the shift from the two community approach to what might be called the network approach”.

Source: Alliance for Health Policy and Systems Research. 2007. Sound Choices: Enhancing capacity for evidence-informed health policy. WHO: Geneva. p25.

Demand for evidence is now more diverse Researchers “need” to work with and for a broader constituency – not just the Ministry of Health Media Advocates, civil society, NGOs, parliamentarians Research institutions Think tanks Funding bodies Government bodies

Networks also bring opportunities

..policy-makers are more likely to use evidence in political systems that call them to account through strong networks and an active media.”

Source: Alliance for Health Policy and Systems Research. 2007.

Creating an enabling environment for translation

Start from the perspective of decision-makers

Ensure continuity of linkages and exchange

Promote multiple pathways to translation & form strategic alliances

Capitalise on personal contacts, trust & credibility

Timely findings (planning or budget cycles; reforms)

Communicate effectively (filtered/amplified evidence; tailored messaging)

Researchers are from Venus. Policy-makers are from Mars. Communicators are from Pluto.

“ Tell us the good news”

“ Tell us the certainties – not the complexities” There is no magic bullet – or “shot in the arm” - for maternal mortality reduction

Serang and Pandeglang (2004-2006) * based on enumeration of all deaths (n= 474) and expected number of births in each village Relationship between maternal mortality & skilled attendant: Indonesia Richest Upper middle Low middle Poorest Wealth quartile No 29% Yes 71% No 67% Yes 33% No 83% Yes 17% No 90% Yes 10% Proportion attended by skilled attendant 257 (181-351) 202 (107-334) 280 (195-388) 778 (541-1076) 278 (201-373) 1218 (773-1830) 541 (420-684) 2303 (1487-3292) Maternal deaths per 100,000 live births* (95% CI)

“ Four births and a funeral” (or children sitting on their mother’s grave) WHO, 2004 “ We need powerful messages and imagery”

Tackling the burden in the poorest women will achieve the greatest reduction in maternal

mortality overall.

2. Financing mechanisms can be used to facilitate universal access to skilled care at delivery, including emergency care.

“ Give us evidence to support our policies”

Who should do translation of research evidence?

Knowledge brokers work at the interface between research organizations and their target audiences.

http://www.research-transfer.org

Knowledge brokers aim to provide evidence that is accessible, timely, credible and trusted, and packaged in user-friendly format, relevant to the local context.

Researchers are from Venus. Policy-makers are from Mars. Communicators are from Pluto. Knowledge brokers are from……..?

QUESTIONS FOR DISCUSSION?