1

Is Research Evidence Actually Used for Policy? Reflections from the Case of Lebanon

Lama Bou-Karroum, BS, MPH

On behalf of SPARK and K2P teams American University of Beirut

September 15, 2017

Poor production & alignment of HPSR with regional priorities:

→ Only 8.88% of the 29,126 identified articles published

between 2000 to 2013 match criteria for HPSR.

→ 67.3% of articles do not address identified priorities.

Poor production & alignment of systematic reviews (SR) with

regional policy priorities:

→ Of 1,045 SRs identified, only 200 aligned with policy priorities

of the EMR.

→ Only 3 SRs were produced by at least one author based in

the EMR, and none had EMR as target jurisdiction.

2

SPARK

Evidence-Informed Policymaking in the EMR: Identified Gaps

Poor dissemination of research:

→ 65% of respondents from 11 countries in the EMR indicated

that SRs on high priority issues were rarely disseminated to

policymakers.

→ Very few researchers in the EMR produced policy briefs

(15%), disseminated messages that specified possible actions

(24%), interacted with policymakers and stakeholders in

priority-setting (16%), and involved them in their research

(20%)

3

SPARK

Evidence-Informed Policymaking in the EMR: Identified Gaps

Close collaboration:

→ The Center for Systematic Reviews on Health Policy and

Systems Research (SPARK): Production of policy-relevant

SRs and rapid reviews in HPSR (funded by AHPSR)

→ The Knowledge to Policy (K2P) Center: Knowledge

translation, uptake and impact assessment (Funded by

IDRC). K2P was recently designated as a WHO

collaborating center for Evidence-Informed Policy and

Practice.

4

SPARK

SPARK and K2P Centers at AUB

5

→ The first Center of its kind in Lebanon and the Eastern Mediterranean Region that specializes in the production of systematic reviews and other evidence synthesis products that respond to health policy and systems priorities

→ Founded in 2013, with funding from

the Alliance for Health Policy and Systems Research.

→ Competitively selected to host the Secretariat of the Global Evidence Synthesis Initiative (GESI).

Center for Systematic Reviews of Health Policy and Systems Research (SPARK)

SPARK

Knowledge to Policy (K2P) Center

→ A forerunner in synthesizing evidence, contextualizing knowledge and engaging stakeholders to impact health policy and action in Lebanon and the Region.

→ Modeled after McMaster Health Forum

→ Founded by the Faculty of Health Sciences (FHS) at the American University of Beirut with seed funding from the International Development Research Centre (IDRC)

→ Designated since 2015 as a WHO Collaborating Center for Evidence-Informed Policy and Practice

6

SPARK

7

Example of Knowledge Translation Products

SPARK

8

•Engaging policymakers, stakeholders, civil societies and citizens

•Political context •Formal and informal discussions

Priority Setting

•Systematic reviews •Rapid reviews •Scoping reviews

Evidence Synthesis

•Evidence brief for policy •SUPPORT summaries •Rapid response products •Evidence summary •Media bites

Knowledge Translation

•Policy dialogue •Citizen engagement •Advocacy strategy •Media engagement •Political engagement

Knowledge Uptake

Impact

Integrated Knowledge Translation Process to Promote Evidence-Informed Health Policymaking

El-Jardali, F., & Fadlallah, R. (2015). A call for a backward design to knowledge translation. Int J Health Policy Manag, 4, 1-5. 8

SPARK K2P

SPARK GESI

Receptive Environment for Use of Evidence in Decision-making

Capacity Building at Multiple Levels

→ Establishing a mental health program and a strategy at the Ministry of Public

Health and conducting a campaign to advocate for promulgating a Mental Health

Act (process and outcome published)

→ Strengthening the MOPH national information systems on refugee health and

appointing a national coordinator to assist MOPH in coordinating and

establishing effective partnerships and communication with local and

international agencies, donors, and academic institutions and conducting

monitoring and evaluation

→ Stopping implementation of salt fluoridation law 178 in Lebanon

→ Revising the accreditation system and contractual agreements with health care

organizations; developing a new governance model for hospital accreditation

program; and incorporating patient safety goals, indicators and training

requirement in accreditation standards

→ Stimulating initiatives to integrate HIV care within primary healthcare centers in

Lebanon

9

SPARK

Examples of Impact

10

SPARK

CASE Study: Syrian Refugee Crisis

From Priority Setting to Impact

Priority Setting Meeting → SPARK held a priority setting meeting on

January 7, 2014.

→ Fifty-two policymakers, stakeholders, and researchers from multidisciplinary backgrounds participated.

→ Participants were engaged in identifying and shaping review questions

11

SPARK

Systematic Review

Production

12

SPARK

Knowledge Translation

Findings of the systematic review were incorporated into a Briefing Note

13

SPARK

Knowledge Uptake

→ K2P conducted a policy dialogue meeting in June 2014 about “Securing Access to Essential Health Care Services for Syrian Refugees in Lebanon

→ The policy dialogue hosted 28 key stakeholders in the presence of the Director General of the Ministry of Public Health, UN agencies and governmental bodies involved in humanitarian assistance.

14

SPARK

Outcome

15

SPARK

Based on the recommendations and the next steps agreed upon the policy dialogue:

> Strengthening information systems on refugee health in the MOPH

> A refugee health coordinator was recruited in the Lebanese Ministry of Public Health (MOPH)

> The MOPH asked the SPARK and K2P to draft the TORs of

the coordinator

> Development of Heath Response Strategy and implementation plan

16

SPARK

17

SPARK

Strengths Of the integrated KT process

→ Impact-oriented, where the entire process is driven by the desired end

results

→ Comprehensive, spanning from priority setting to knowledge translation

and impact assessment

→ Provides a platform for researchers, policymakers & stakeholders to

interact at multiple levels

→ Utilizes several KT products, platforms, tools and advocacy framework

as well as engages media to influence policy and practice.

→ Aligns evidence synthesis production with policy priorities as well as

segregates questions into those in need of new systematic/rapid

reviews and those in need of KT products

→ Capacity building initiatives at individual, team, institutional and

systems level

SPARK

18

→ Preparatory phase: Need to increase awareness, ensure buy-in and

raise demand for HPSR evidence, utilize multiple engagement

strategies and build capacity of knowledge users (workshops, surveys,

collaborations)

→ Sustainability: Scaling up and ensuring timely and sustained response

to growing demands require financial and human resources and

capacity-building

→ Timely response: Need to scale up rapid response programs to ensure

timely responses to policy makers’ needs and priorities

→ The political context

→ Collaboration with civil society: Need to engage civil society and

citizens, empower them and build their capacity to better lobby and

advocate for changing policies and impacting actions

Reflections and issues from current experience

Thank you!

For more information visit us at:

www.aub.edu.lb/spark www.aub.edu.lb/k2p

@K2Pcenter

@SPARK_AUB