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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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