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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
Acknowledgements....................................................................................................................4
Disclaimer..................................................................................................................................4
1.0 Executive Summary ………………………………………………..............……………...5
2.0 Introduction & Background Information……………………..........................……………6
3.0 Establishment of the Health Policy Advisory Committee…….............……………………6
3.1 Origin of the Health Policy Advisory Committee…………….........................……………6
3.2 The purpose and objectives of the Health Policy Advisory Committee…….………………8
3.3 Operation framework and function of the Health Policy Advisory Committee….....………8
4.0 Implementation of the Health Policy Advisory Committee as Knowledge
Translation Platform……………………......................................................................……8
4.1 Overall goal and objectives of the project…………………….....................................……8
4.2 Methodology and implementation strategies (description of major activities) …………..…9
4.2.1 Situation analysis and consultation with several key stakeholders in the health sector:.....9
4.2.2 Meeting of HPAC to discuss the project execution and implementation activities............9
4.2.3 Data collection and production of the policy brief on the free maternal and child
health care programme…………….............................................................…………..…10
4.2.4 Capacity building training using SUPPORT tools…....................…………………….…10
4.2.5 Capacity enhancement mentorship programme…………........................…………….…11
4.2.6 International training workshops and meetings on evidence-to-policy link
attended by the HPAC members……………………..............................................….…14
4.2.7 Publication of a paper on the HPAC………….........................................…………….…15
4.2.8 Policy dialogue………………..........................................................................……….…15
4.2.9 Involvement of journalists and health communications expert…………………….……16
5.0 Findings and lessons learned…………........................................................………….……16
5.1 Significant improvement in knowledge of evidence-to-policy link………………..….……16
5.2 Elimination of mutual mistrust between policymakers and researchers………….…………16
5.3 Increase in the awareness of importance of HPAC…………………...........................……16
5.4 Policy brief/dialogue evaluation outcome…………………….....................................……16
6.0 Proposal for the continuation of the Knowledge Translation Platform ........................……17
6.1 Link with other regions/states in Nigeria…………………….....................................……17
6.2 Continuous training of the HPAC……………………..................................................……17
6.3 Institution of a performance measurement mechanism for the HPAC………………………18
6.4 Production of the HPAC operational document…………….............................……………18
6.5 Strategic Plan for the HPAC sustenance: …………………......................................………18
7.0 References..............................................................................................................................19
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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
(http://www.health-policy-systems.com/supplements/7/S1).
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(c). Development and execution of Strategic/Resource Mobilization Plan for sustaining and
institutionalizing the HPAC: Through high level advocacy, lobbying, demand creation, consensus
building and negotiation.
(ii). To host a multi-stakeholder policy dialogue on the government‟s health priority issue (Free
Maternal Health Care Programme FMHCP) under the auspices of the HPAC based on policy brief
developed by the HPAC.
(iii). To conduct an evaluation of the HPAC‟s activity, disseminate findings and establish
mechanisms to institutionalize and sustain the HPAC.
4.2 Methodology and implementation strategies (description of major activities)
The following is a description of the strategies and major activities conducted to implement the
HPAC as a knowledge translation platform
4.2.1 Situation analysis and consultation with several key stakeholders in the health sector: The
project commenced with a situation analysis and consultation with key stakeholders in the health
sector of Ebonyi State, Nigeria. These activities were conducted in the first month of the project
(July 2012). The situation analysis involved review of documents and publications within and
outside of Nigeria relevant to the project. The documents included health policy reports, policy
briefs, bulletins, journal publications, newsletters, media communications, etc. Consultations were
made to the key policymakers of the health ministry including the Commissioner for health,
Permanent Secretary to the health ministry and other senior policymakers in the health ministry. The
purpose of the consultation was for advocacy and to canvass for their support and participation in the
project.
4.2.2 Meeting of HPAC to discuss the project execution and implementation activities: The first
project implementation meeting of the HPAC was held in July 2012 to harmonize the project
execution activities. The project implementation strategies were discussed and harmonized in line
with the approved project protocol which was submitted to the EVIPNet with only a minor
amendment regarding the time table since the project formally commenced in July 2012 instead of
January 2012 due to the late release of the project funding from WHO as a result of administrative
issues. The various training workshops and specialized meetings were discussed including those that
were to take place within and outside of Nigeria and the arrangements for the full participation of the
members of the committee.
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Figure 2: Cross-section of the members of the Health Policy Advisory Committee for Ebonyi State holding a
meeting in July 2012 to discuss the project implementation.
4.2.3 Data collection and production of the policy brief on the free maternal and child health care
programme: The project team commenced the study for the production of a policy brief on the
Governments free maternal and child health care programme (FMCHCP) of Ebonyi State Nigeria.
Data and documents were collected from various agencies, units and departments of the health
ministry that are involved in the implementation of the FMCHCP. The data were synthesized to
produce a draft policy brief which underwent both internal and external reviews. The policy brief
produced was the key tool used for the policy dialogue which was conducted at the concluding phase
of the project.
4.2.4 Capacity building training using SUPPORT tools: A capacity building training workshop
using the SUPPORT Tools was conducted for the members of the HPAC. The training was
facilitated by Dr. C.J. Uneke and Dr.A. E. Ezeoha. Both facilitators had undergone some training in
the use of the SUPPORT Tools in the previously funded Alliance for Health Policy & Systems
Research Project of WHO.
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Figure 3: Dr. C.J. Uneke as a facilitator during the HPAC capacity building training workshop using the
SUPPORT Tool.
Figure 4: Dr. A.E. Ezeoha as a facilitator during the HPAC capacity building training workshop using the
SUPPORT Tool.
4.2.5 Capacity enhancement mentorship programme: The project team initiated the establishment
of a mentorship training programme on health policy/health systems and knowledge translation in
Ebonyi State University Abakaliki. The University authority on the recommendation of the project
team approved the commencement of the programme as a three-month Executive Basic Certificate
Course. The first batch of participants attended the programme from September 2012-December
2012. A total of 18 senior health policymakers from the ministry of health and members of
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NGOs/CSOs attended and completed the course. Eight members of the HPAC fully participated in
this training course. An outline of the course contents is presented in Table 3 below.
Table 3: Course Outline Executive Basic Certificate Programme on Health Policy & Health Systems
conducted at Ebonyi State University Abakaliki Nigeria
Course/Code/Lecturer Summary of Course content
Introduction to Health Policy
& Health Systems
HPS 101
Dr. C.J. Uneke
-Definition of health policy; -Health policy analysis; -Policy actors
-Focus and forms of policy analysis; Definition & goals of health
Systems; -Elements and characteristics
-Health systems building block: (i). service delivery; (ii). health
workforce; (iii). information; (iv). medical products, vaccines and
technologies; (v). financing; (vi). leadership/governance.
-Multi-levels of operation of health systems
-Macro level ; Meso level ; Micro-level
-Interactions and interrelationships
-Health systems thinking
Research evidence in health
policy making and health
policy implementation
HPS 102
Dr A.E. Ezeoha
-Introduction to research evidence
-Quality and Relevance of the Evidence
-Where does one Find Evidence?
-Role of research evidence in informing health policy decisions?
-Meaning of evidence-informed policymaking?
Managing political and
socio-cultural interferences
in policymaking process
HPS 103
Prof. O. Ogbu
-Policy Process and Interferences
-Ways to Manage Interferences
-Effective communication
-Stakeholder power analysis
-Consensus building
-Getting legal approval/backup
-Inter-ministerial collaboration
Research priority setting for
health policy
HPS 104
Dr. C.J. Uneke
-Introduction to priority setting
-The current state of priority setting in developing countries
-Principles of research priority setting for health policy
-The value of public engagement in health policy research priority
setting process
-Convening a health policy research priority setting exercise
Health policy advocacy,
demand creation, consensus
building and negotiation
HPS 105
Dr A.E. Ezeoha
-Defining policy advocacy
-Policy elite and Interest groups
-The policy triangle
-Principles of advocacy: analysis, strategy, mobilization, action,
evaluation, continuity
- Demand creation
Strengthening policymakers‟
research capacity for
evidence based policymaking
HPS 106
Dr. B.A.F. Ngwu
-Definition of Capacity
-Capacity development
-Components of Capacity Development
-The focus of Capacity Development
-How to create conducive environment for evidence based
policymaking
Health policy monitoring,
evaluation and performance
-Introduction to monitoring & evaluation
-Conducting health policy monitoring and evaluation
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assessment
HPS 107
Dr. C.D. Ndukwe
-Necessity of health policy monitoring and evaluation
-The value of health policy monitoring and evaluation
-Measuring validity; acceptability; feasibility; reliability; sensitivity to
change; predictive validity
Health project proposal
preparation and design
HPS 108
Dr. C.J. Uneke
-Introduction to health project proposal
-Proposal preparation process and design
- What to do before writing a proposal
- Project design and planning considerations
-How to write a project proposal (The proposed format)
Policymakers leadership
capacity development
HPS 109
Prof. O. Ogbu
-Introduction to health sector leadership
-Understanding the contextual issues about health sector leadership
-Leadership Capacity Development
-Need for developing policymakers leadership capacity
-Developing core leadership competencies for policymakers
Establishing organizational
policy advisory committee
HPS 110
Dr. F.E. Iyare
-What a health policy advisory committee is
-Importance/purpose of health policy advisory committee
-Establishing a policy advisory committee
-Operation of a policy advisory committee
-Sustaining a policy advisory committee
Use of ICT in policymaking
process- Part A
HPS 111A
Dr A.E. Ezeoha
-Knowledge and application of information/ communication
technology: (i). Computer appreciation; (ii). Microsoft word; (iii).
Power point; and (iv). Internet use.
(a). Benefits of engaging ICT in running the health sector; (b). The
search protocol for health information and policy relevant research
evidence; (c). Identification of and search strategies for evidence of a
wide range of electronic resources, in addition to the traditional
scientific and clinical databases (eg., MEDLINE, EMBASE, Cochrane
Database, Allied and Complementary Medicine, British Nursing
Index, Social Policy and Practice etc); and (d). Information/ evidence
audit to accompany search strategies.
Use of ICT in policymaking
process- Part B
HPS 111B
Dr. C.J. Uneke
-Introduction to information literacy
-Defining and information problem
-Searching for information online
-Evaluating information
-Science information
-Training skills
-Knowledge sharing interviews
Project/Seminar
Presentations
HPS 199
Mini-research and presentations in various topical areas.
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Figure 5: A cross section of HPAC members and other participants of the Health Policy/Health Systems
Executive training course during the Course completion ceremony.
4.2.6 International training workshops and meetings on evidence-to-policy link attended by the
HPAC members: As a part of the strategies to further enhance the capacities of the members of the
HPAC, selected members of the HPAC attended and participated in a number of international
training workshops and meetings on evidence-to-policy link with presentation of papers on the
activities of the Research Team and HPAC. The outcome of the meetings and lessons learned were
always communicated to other members of the HPAC. The meetings included the following:
(i). The Evidence-Informed Health Policymaking in Low and Middle-Income Countries: an
International Forum. Addis Ababa, Ethiopia, 28-30 August 2012: Four members of the HPAC
attended and participated in this international forum: These included: Dr. C.J. Uneke; Dr. A.E.
Ezeoha, Mrs. N. Obichukwu and Mr. B. Uguru.
(ii). Participation of three members of the HPAC in the Evidence-Informed Health Policymaking
meeting in Congo- Brazzaville, December 5-7, 2012: Three members of the HPAC participated in
this meeting. These included Prof. O. Ogbu; Dr. A.E. Ezeoha; and Mrs. K. Oboke.
(iii). Second Global Symposium on Health Systems Research 31 October – 3 November 2012,
Beijing, China: The HPAC was represented in this meeting by Dr. C.J. Uneke
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(iv). Workshop of summaries of systematic reviews of health system arrangements; Norwegian
Knowledge Centre for the Health Services, Oslo Norway; March 18-22, 2013: The HPAC was
represented in this meeting by Dr. C.J. Uneke
4.2.7 Publication of a paper on the HPAC: The research team produced and published a manuscript
on the HPAC in a reputable international health policy journal:
Uneke CJ, Aulakh BK, Ezeoha AE, Ndukwe CD, Oyibo PG, Onwe F (2012). Bridging the divide
between research and policy in Nigeria: The role of health policy advisory committee. Journal of
Public Health Policy 33(4):423-239.
4.2.8 Policy dialogue: To round off the project, a policy dialogue was conducted on the 3rd
of July,
2013. The policy dialogue was based on the previously produced policy brief entitled: Improvement
of Government’s Free Maternal and Child Health Care Programme using Community-Based
Participatory Interventions in Ebonyi State Nigeria. Of the thirty individuals invited for the policy
dialogue 18 persons attended. A policy dialogue guideline was provided for participants. The
guideline included a description on how to evaluate the policy brief documents in terms of content
quality and relevance, as well as the policy issues presented, the magnitude of the problems to be
addressed and how actionable the policy options recommended are. The policy dialogue was
informed by discussion about the full range of factors that can inform how to approach a problem,
possible options for addressing it, and key implementation considerations. The policy dialogue
brought together many parties who could be involved in or affected by future decisions related to the
issue. The policy dialogue aimed for fair representation among policymakers, stakeholders, and
researchers. The dialogue engaged a facilitator to assist with the deliberations and allowed for frank,
off-the-record deliberations by following the Chatham House rule: “Participants are free to use the
information received during the meeting, but neither the identity nor the affiliation of the speaker(s),
nor that of any other participant, may be revealed.” The policy dialogue did not aim for consensus.
The dialogue lasted up to two hours and the participants made various inputs and suggestions on
how the policy options can be better implemented.
Figure 6: A cross section of participants during the policy dialogue on the Government‟s free maternal &
child health care programme.
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4.2.9 Involvement of journalists and health communications expert: Following the meeting in
Addis Ababa, the HPAC integrated a health communication expert and involved journalists in some
of the meetings. This was a part of the effort to improve the dissemination of the activities of the
HPAC, the research team and in the promotion of evidence-informed policies for the general public.
5.0 Findings and lessons learned
A lot of important findings were made from this project and vital lessons were learned. The
following section describes the details.
5.1 Significant improvement in knowledge of evidence-to-policy link: There was a significant
improvement in the knowledge of Evidence-informed policymaking process and practice by the
policymakers involved in the HPAC, and these individuals are carrying out strong advocacy on the
review of the health policies that are not evidence-based in the Ministry of Health and are leading
the promotion of evidence-informed policymaking in the ministry. The policymakers in the HPAC
are now actively utilizing the knowledge they have acquired in the course of the project. Most of
them have noted that they now use scientific evidence in their presentations in the meetings of the
ministry of health.
5.2 Elimination of mutual mistrust between policymakers and researchers: The mutual mistrust
existing between the researchers and policymakers has been addressed particularly among the
members of the HPAC. It was discovered that the constant contact between the policymakers and the
researchers helped to build trust and friendship; this helped to align the researchers more specifically
to operational problems inherent in the health systems from the policymaking perspective. There is
now a healthy collaboration and partnership between the policymakers in the health ministry and the
HPSR Team of the University. This project has enabled us the researchers and the policymakers to
learn how to work with each other for the purpose of improving the operations of the health systems
through evidence-informed policymaking.
5.3 Increase in the awareness of importance of HPAC: This project improved the awareness on the
importance of the HPAC among key government officials and in the health ministry. The process for
the institutionalization of the committee at the ministry of health has commenced. The major
unanswered question is on how to fund the HPAC. We are addressing the challenge of funding
through advocacy and sensitizing the government, relevant stakeholders and funders to support the
operations of the HPAC.This is being discussed and hopefully a final decision will be reached in no
distant future.
5.4 Policy brief/dialogue evaluation outcome: The policy brief and the policy dialogue were
evaluated using formative evaluation tools developed by Johnson and Lavis (2009) of McMaster
University Canada.
The purpose of the policy brief was to present the available research evidence on a high-priority
policy issue in order to inform a policy dialogue where research evidence would be just one input to
the discussion. The participants noted that this was well achieved.
The purpose of the policy dialogue was to support a full discussion of relevant considerations
(including research evidence) about a high-priority policy issue in order to inform action. The
participants noted that this was well achieved.
The participants judged the following policy dialogue process we adopted as very helpful:
(i). The policy dialogue addressed a high priority policy issue.
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(ii). The policy dialogue provided an opportunity to discuss different features of the problem,
including (where possible) how it affects particular groups.
(iii). The policy dialogue provided an opportunity to discuss three options for addressing the
problem.
(iv). The policy dialogue provided an opportunity to discuss key implementation considerations.
(v). The policy dialogue provided an opportunity to discuss who might do what differently.
(vi). The policy dialogue was informed by a pre-circulated policy brief.
(vii). The policy dialogue was informed by discussion about the full range of factors that can inform
how to approach a problem, possible options for addressing it, and key implementation
considerations.
(viii). The policy dialogue brought together many parties who could be involved in or affected by
future decisions related to the issue.
(ix). The policy dialogue aimed for fair representation among policymakers, stakeholders, and
researchers.
(x). The policy dialogue engaged a facilitator to assist with the deliberations.
(xi). The policy dialogue allowed for frank, off-the-record deliberations by following the Chatham
House rule: “Participants are free to use the information received during the meeting, but neither the
identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed.”
(xii). The policy dialogue did not aim for consensus.
6.0 Proposal for the continuation of the Knowledge Translation Platform
(feasibility and work plans).
6.1 Link with other regions/states in Nigeria: We observed that there is a need to link with other
States in Nigeria and to encourage the States to adopt the strategy we have introduced in Ebonyi
State for evidence-informed policymaking. We have established in this project that HPAC can
bridge the gap between researchers and policymakers and enhance evidence-to-policy link. We
therefore plan to host a key stakeholder meeting in my State and invite key policymakers from the
health ministry of other states in Nigeria and from the Federal Ministry of Health. We had
previously concluded arrangement for the possible funding of this meeting by IDRC late last year.
We hope we will still hold whenever we obtain funding for this event.
6.2 Continuous training of the HPAC: We observed that there is a need for continuous training of
the HPAC members to increase their knowledge on strategies to maintain partnership with each
other. We have therefore planned series training programmes which will focus on policymaking
process and research process. As the committee is made up of both researchers and policymakers,
such training will expose the researchers to the policymaking process and the policymakers to
research process. This is one of the strategies suggested by Choi et al. (2009) that can bridge the
existing gap. According to Choi et al. (2009), scientists could become „„policy sensitive‟‟ through
training and participation in the policy making process, while policy makers could be exposed to
science through training and participation in the research process so they can apply a „„science lens‟‟
to policy making. The benefit of this strategy is that it will enable the researchers and the
policymakers in the committee to know each other‟s strengths and weaknesses, as well as likes and
dislikes and communicate their knowledge effectively to avoid the risks of barriers in language and
understanding. This would promote communication among the policymakers and researchers by
creating a common language and which can help the policymaking process more effective (Choi et
al. 2003,2005,2009).
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6.3 Institution of a performance measurement mechanism for the HPAC: We observed that there
is need to develop a mechanism to measure the performance of the HPAC. According to USGSA
(2011), an important and potentially contentious issue surrounding the use of advisory committees is
how to judge their success. Therefore to ensure the success of the HPAC in Ebonyi State Nigeria, we
plan to conduct a periodic collection and reporting of information regarding the performance of the
Committee. This has been incorporated in the terms of reference. The purpose of this is to enable
the ESHPAC to periodically consider its operational process/strategies and see whether outcomes are
in line with what was intended or should have been achieved by the Committee. In New Zealand the
National Health Committee (NHC) which plays a policy advisory role continually keeps its
performance under review, and refines and improves its processes accordingly; and as a part of its
annual report, the NHC assesses the extent to which it has been effective in contributing to improved
sector performance, value for money and fiscal sustainability (NACHD 2011).
Drawing lessons from the suggestions of Lichiello (1999), we plan to use the performance
measurement exercise to achieve the following: (i). compel the HPAC to reassess its programmes,
goals and objectives; (ii). give the HPAC an opportunity to step back and assess its capacity to
undertake the policy advisory role; (iii). give the HPAC an opportunity to create working
arrangements with other groups, programs, departments, agencies, organizations, and stakeholders;
(iv). give the HPAC an opportunity to evaluate and define the types and levels of contribution it does
or can make to achieving large, overarching public health goals; (v). give the HPAC an opportunity
to assess the quality or effectiveness of its work at the moment; (vi). enable the HPAC to track its
progress over time and can give the Committee an opportunity to assess and improve on practices,
processes, activities, and systems.
6.4 Production of the HPAC operational document: An operational document that will guide the
activities of the Committee has been developed. We plan to use this document to order the
operations of the HPAC. The document will be handed over to the government through the
Honourable Commissioner of health during the presentation of the final version of the policy brief.
6.5 Strategic Plan for the HPAC sustenance: The Health Policy Advisory Committee would be an
independent, not for profit public health advocacy group. It would be sustained principally through
funding/grant from donor agencies both locally and internationally, including the government
through the ministry of health. The secretariat of the ESHPAC would undertake and bear the cost of
organizing each meeting and provide appropriate honorarium for members at each meeting. This has
been captured in the HPAC operational document.
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