This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Bennett presented on the role of learning networks in scaling up.
2. Quotes from yesterday
We need new ways of facilitating rapid learning
between countries and within countries
“Adaptive governance” - building learning within the
system itself
Knowledge translation is the driver behind the shift
from knowledge to policy to practice
The evidence-accountability continuum is a powerful
tool
There is an unwillingness to listen to scientific
evidence
3. Why evidence/learning is key to
this discussion
Health systems – and the organizations within them - need to be
intelligent and adaptive ones
able to identify, analyse and respond to emergent behaviors, phase
transitions, feedback loops
understand and predict pathways of change
Shift from two player (policy maker and researcher) to “multi-player”
systems in E-to-P
Complex policy problems - any one actor alone unlikely to have
sufficient resources to address
Role of non-government players in examining evidence, asking the
questions, enforcing accountability
Social system innovation - rise of non-traditional players:innovation
may come from
BRICs
Commercial sector actors
4. Policy Networks
Resources of multiple players are required to address policy
issue (technical knowledge, financial resources,
organizational capacity, legitimacy, political power)
Networks take varied forms from:
Small tightly integrated communities capable of collective
action (policy community); to
Extensive, loosely-affiliated “issue networks”
Epistemic communities (experts)
Advocacy coalitions (shared beliefs)
Audiences for evidence will depend on the issue to hand,
may include: multiple govt departments, service providers
(public/private), advocacy NGOs, international agencies
Each of these groups needs skills to acquire, assess and
apply evidence (not necessarily collect it)
5. What are the right institutions to
promote learning across networks?
Growth of entities seeking to promote synthesis and
sharing of learning
Health systems observatories
Learning platforms
Knowledge translation platforms
Think tanks/health policy analysis institutes
Health technology assessment units
Rapid response units
1000 flowers blooming…but little learning
6. Will try to divide by..
Regional – country to country learning
Largely policy related
National policy related learning
Sub-national practice related
7. Regional institutions for learning
Demand – real demand for learning from other countries, typically
government to government
particularly “reference countries”
Opportunity to discuss how to manage change (which researchers often
don’t document)
Supply
In many regions primary mechanisms are informal – sharing of TA
Formal include:-
study tours:
regional observatories/learning platforms
Questions
Need to get reference countries right
How to create conditions that inspire trust and openness
How much do we really understand policy maker evidence needs
How to sustain communities of practice
Too government focussed
8. National Policy
Demand - clear evidence on what policy makers value
Personal contact and trust
Timeliness and relevance of findings
Clear summary messages
Supply
Think tanks/Health policy analysis insitutes (about 78 in LMICs)
Health technology asssessment units (small but growing movement)
Knowledge translation platforms (small but growing)
Questions
Unclear how stable many of these bodies are – HPAIs often “surviving on a shoe
string”
Optimal institutional arrangements unclear
what is the appropriate distance from government?
Are different types of institutions better able to offer real time learning?
Existing HPAIs good at conducting and communicating research – but not good
convenors
How to build trust with government while still engaging a broader set of actors?
9. Practice
Demand
Perhaps less clearly articulated than at policy level
Investments in information systems often identify lack of
“evidence-informed culture” as obstacle
Supply
Localized efforts largely in public sector to promote use of evidence
among practitioners (eg. TEHIP)
Very isolated efforts to create learning communities across different
actors
No clear institutional body involved – though many could be
Questions
How do we weight different types of learning – particularly formal
and tacit?
What kind of mechanisms can be used effectively to bring together
actors who may be mutually distrustful
How can interventions, slowly over time build trust?
10. Take away messages
Need to invest more in local institutions that support learning
and advocacy:-
Should be part of all health research grants
Capacity development within institutions
Preferably existing rather than new institutions
We need a much better evidence base to guide investments in
this field :-
What types of institutional structures are best suited to different
types of learning and evidence dissemination across networks?
What types of mechanisms are best suited to transferring learning
Social networks (web based)
Moving away from hub and spoke networks to true S-S networks
Mixing face-to-face with internet based learning platforms.
Focus more on the practice level - working across a range of
traditional and non-traditional actors to promote social
innovation
