movers, shakers, and gatekeepers: the role of intermediaries in evidence-informed decision making
TRANSCRIPT
MOVERS, SHAKERS, AND GATEKEEPERS:
THE ROLE OF INTERMEDIARIES IN EVIDENCE-INFORMED DECISION MAKING
Nasreen Jessani, DrPH
Presentation for: Johns Hopkins Centre for AIDS Research
Implementation Science Scientific working group
13 April 2016
OVERVIEW • Evidence-informed decision making
• The focus on intermediaries/knowledge brokers
• Academic knowledge brokers in Kenya: A mixed methods study of relationships, characteristics and strategies
• Adapting the study to USA (and JHSPH)
• Relevance to CFAR
HOW ARE DECISIONS MADE?
WHAT INFLUENCES DECISIONS?
Political complexities
Party preferences
Other evidence Social, religious and cultural norms (acceptablity)
Relative benefit/harms of other options – cost, impact, equity, speed
etc…
Ecological impacts
Other actors – lobbyist, activists, media,
epistemic communities, stakeholders, funders
Operational practicality
EVIDENCE INFORMED DECISION MAKING • “purposeful and systematic use of the best available
evidence to inform the assessment of various options and related decision making in practice, program development, and policy making (OAPN Canadian Centre of Excellence, 2010)
• “a continuous interactive process involving the explicit,
conscientious and judicious consideration of the best available evidence to provide care” (Canadian Nurses Association, 2010).
• policy should be informed by a wide breadth of evidence,
not just hard research. Key issues include the quality, credibility, relevance and the cost of the policy.
MODELS DEPICTING RESEARCH TO ACTION
GrahamID,LoganJ,HarrisonMB,etal.Lostinknowledgetranslation:timeforamap?JContinEducHealthProf2006;26:13–24.
Lavis,Lomas,Hamid,etal.“Assessingcountry-leveleffortstolinkresearchtoaction.”BulletinoftheWHO.August2006.p.622
BUT: - transactional not relational - Assumes homogeneity of actors
!
!!
CONTEXT'
CONTEXT'
Other'influences'
PUSH'FACTORS'!
PULL'FACTORS!"!!!
LINKAGE'AND'EXCHANGE'FACTORS!!
Academic!Institutions!
Unidimensional Gatekeepers Unskilled Outsource to specialists
ACADEMIC KNOWLEDGE BROKERS
Photo credit : http://bit.ly/1sHMceE Photo credit : http://bit.ly/1ruaULZ Photo credit : http://bit.ly/1rub5XB Photo credit : http://bit.ly/1plaeoN
Invisible Uniquely positioned
Skilled Credible
ACADEMIC KNOWLEDGE BROKERS
Picture credit: www.zizaza.com
Academic researchers Policymakers
Academic Knowledge Brokers: HYBRID/
BLENDED/EMBEDDED
Connected to policymakers as conduit to policy influence AND
Advisors to academic peers on evidence to policy
WHAT DID WE WANT TO LEARN?
Mapping the networks
Do academic knowledge brokers exist? An exploration of research-to-policy networks of faculty from six Schools of Public Health in Kenya
Understanding the brokers
The human capital of knowledge brokers: An analysis of attributes, capacities and skills of academic faculty at Kenyan schools of public health
Strategies for engagement
Navigating the academic and political environment: Strategies for engagement between public health faculty and policy makers in Kenya
HOW DID WE FIND OUT?
THE ACADEMIC CONTEXT IN KENYA KEY FACTS • 39 Universities
• 6 Schools of Public Health
‒ 5 with presence in Nairobi
• Revenues from non-governmental sources: 16.4% to
31.6% of total income
• Research not confined to traditional academic bodies
MAPPING THE NETWORKS DO ACADEMIC KNOWLEDGE BROKERS EXIST? AN EXPLORATION OF RESEARCH-TO-POLICY NETWORKS OF FACULTY FROM SIX SCHOOLS OF PUBLIC HEALTH IN KENYA
• 16 Ministries
• 6-10 Ministries per SPH (range of connections)
• Unique interplay between each SPH and government
• All SPHs connected to MOPHS and MOMS
• Some “Monopoly” relations
• Several overlapping or shared connections
INSTITUTIONAL RELATIONS
LegendAcademic Faculty Policymaker (various ministries) Academic Knowledge Broker Academic Faculty – externally influential Academic Faculty – internally trusted
WHOLE NETWORK: KENYATTA UNIVERSITY SPH
IDENTIFICATION OF KNOWLEDGE BROKERS
2
2
2
1
x
• 124 Academic faculty surveyed
• 5 Schools of Public Health with presence in the Capital
• 7 Knowledge Brokers Identified
• 4 Schools of Public Health with Knowledge Brokers
• Potential KBs across all 6 SPHs
Number of KBs in specific SPH
INDIVIDUAL ACADEMIC-POLICYMAKER NETWORKS RANGE IN SIZE, PREVALENCE, DEPTH AND BREADTH
Institution No. of respondents
No. of Policymakers by respondent
No. of unique contacts No. % Max. Avg.
No, Shared %.
PM relation Prevalence1
PM relation Depth3
PM relation Breadth2
22 43 36 16 72% 7 1.95 5 14%
15 34 27 12 80% 4 2.27 4 15%
29 49 27 16 55% 7 1.69 9 33%
24 21 16 13 52% 3 0.88 4 25%
17 17 15 7 41% 6 1.00 2 13%
17 40 31 12 71% 7 2.35 5 16%.
124 204 109 (unique) 76 61% n.a. n.a n.a. n.a. 1 Prevalence of academic-policymaker relations: absolute no. of faculty connected to >=1 policymaker; Proportion of same (Col 4/Col 2) 2 Breadth of academic-policymaker relations: maximum no. of PM contacts mentioned by any one faculty at the SPH; Avg no. of relations (Col 2/Col 1) 3 Depth of academic-policymaker relations: total no. of shared PM contacts in network; Proportion of relations shared (Col 6/Col 3)
CONCLUSION • SNA is a useful tool to:
Map location and distribution of
• academic expertise • SPH connections to ministries (and others)
Enhance visibility of
• existing KBS • “potential” KBs
Identify
• Unique connections • Overlapping/ shared connections • Gaps
UNDERSTANDING THE KBS THE HUMAN CAPITAL OF KNOWLEDGE BROKERS: AN ANALYSIS OF ATTRIBUTES, CAPACITIES AND SKILLS OF ACADEMIC FACULTY AT KENYAN SCHOOLS OF PUBLIC HEALTH
COMMON ATTRIBUTES AND CHARACTERISTICS OF KBS FALL UNDER 5 MAJOR CATEGORIES
Socio-demographics
Professional competence
Experiential knowledge
Interactive skills
Personal disposition
COMMON ATTRIBUTES AND CHARACTERISTICS OF KBS FALL UNDER 5 MAJOR CATEGORIES
Key elements
• >45yrs, majority male • PhD or equiv. degree
• >=1 foreign degree
• Academic position varied, history of admin responsibility
Socio-demographics
• Practical experience • Policy insights
Experiential knowledge
• Technical expertise • Relevant research focus
• Leadership experience
Professional competence
“be focused in an area of expertise because then you become visible.…and therefore to be sought after when there're issues that require policy engagement…regardless of who is in [office], or what the political structure is like”
-Leadership, KB, GLUK
“…the more senior one is, the greater will be the opportunity to engage in policymaking”
-Leadership, KB, GLUK
“ [Academics] have theory [but] when we deal with an outbreak, which requires more practical input….We have other organizations which are very good like the WHO, UNICEF, CDC”
-Policymaker, MOPHS
COMMON ATTRIBUTES AND CHARACTERISTICS OF KBS FALL UNDER 5 MAJOR CATEGORIES
Key elements
• Creation and maintenance of networks
• Communication skills, Interpersonal skills
Interactive skills
Personal disposition
• Social and moral conscience
• Determined and unrelenting
• Respectful, team player
“with presidents - both Moi and later Kibaki.… gave me the platform and confidence when I moved to the university that, I knew where to get certain support or help.”
-Leadership, KB, MUSOPH
“We had to get somebody who can lead this team, who is well known in the government circles, who knows politicians quite well, that is also quite conversant with the health situation in the country”
-Policymaker, PresOffice
“…sometimes you have these pushy characters who think they can push their way into Government... Present the good results and wait for change to happen in its own good time…It is a process...”
-Policymaker, MoLD
CONCLUSION
Unique combinations of sociodemographic attributes, professional competencies, experiential knowledge, interactive skills and personal disposition facilitate KB activities
Individual attributes, capacities and skills of KBs are not unique in and of themselves, but are advantageous when employed strategically and collectively.
Direct experience with policymaking arena enhances appreciation and navigation of political structures and processes. Leadership position facilitatory, not sufficient
Personal networks provide credibility, perceived power to influence, preferential political access
While some characteristics may be innate, others can be learned.
STRATEGIES TO ENGAGE NAVIGATING THE ACADEMIC AND POLITICAL ENVIRONMENT: STRATEGIES FOR ENGAGEMENT BETWEEN PUBLIC HEALTH FACULTY AND POLICY MAKERS IN KENYA
CURRENT STRATEGIES FOR FACULTY-POLICYMAKER ENGAGEMENT
Expert invitations
Deliberative dialogues
Initiated by National Level Government
Initiated by Schools of Public Health
Direct dissemination
Leveraging student
professionals
Honorary appointments
Mediated engagement
COMMON THREAD: RELATIONSHIPS
“the most important one is of course one on one connection. If you know somebody at a certain government department or ministry and they know me and they know my capabilities, they would be able to quickly pick a phone and say: ‘we are doing this. Can you join us on this and this day? We are starting to work on this”
-Leadership, KEMU
UNDERAPPRECIATED AND/OR UNDERUTILISED STRATEGIES FOR ENGAGEMENT
Initiated by Government OR Schools of Public Health
Face to face individual
interactions
Institutionalized Collaborations
Mediated engagement
Enhanced visibility
PROACTIVE IN-PERSON INTERACTIONS
• “Face to face..is practical and feasible, because if it is somebody outside of Nairobi, chances are that I may not do it. When there is face to face interaction, chances are that that network will stay for some time.”
Policymaker, MoLD
• “If they sit and say ‘Oh if the government wants our advice, let them come!’ that is not going to work really…just visit me …”
Policymaker, MOPHS
• “You see, its just a matter of writing a letter…to the officer and he responds and tells you ‘On this date we are ready for you. Come!”
Policymaker, MoMS
INSTITUTIONALIZED COLLABORATION
• “the clever universities have always tried to consult with the government, to find out about the relevancy of the programs that they are initiating at the university.”
Policymaker, MoPHS
• “If dialogue had taken place between academicians, at the curricular development (stage) with the policy makers…then we would have produced medical officers who are …also capable of taking care of these facilities.”
Leadership, KEMU
• “unless we collaborate…we’ll never make it, so that if a university comes up with a major project, you can now bring on board other experts from the sister universities”
Leadership, Knowledge Broker, KUSPH
MEDIATED ENGAGEMENT
• “When I do research, it doesn't mean I have to go to the ministry... I can also [ask] a colleague who is better placed as a communicator to go and present.”
Faculty member, Knowledge Broker, MUSOPH
• “When you don’t know [the policymaker], you create a medium to that person, you create a third party who will know them...”
Leadership, GLUK
• “if you have new research findings…put it in the newspapers. [Policymakers] don't read the journals, they may not attend the conferences…but they are going to read it in the papers”
Policymaker, MOPHS
ENHANCED VISIBILITY - ADVOCACY
• “Between 1990 to 1999 we [academics] kept on telling the government that AIDS is going to kill. But the President had not listened to us for a long time. Most of us had to go to the activists, from academia to activism for anybody to hear us.”
Leadership, GLUK
• “You might see me in the corridors and then I happen to bump into ‘so-and-so’ …someone might say, “You must be associated with so-and-so’ And I don’t want to be associated with anyone. I mean, you want to be as independent as you can be.”
Knowledge Broker, SPHUoN
• “don’t just stop at the PS…or your Minister, go out to other ministers, members of parliament - Make sure that they are also aware of this issue so that they can support you in it.”
Policymaker, MoLD
CONCLUSIONS
Academic faculty as well as policymakers utilize a variety of strategies for engagement – some more effective and utilised than others
The perceived responsibility for engagement continues to lie with academia. KBs appeared distinct amongst their peers
Delicate balance between leveraging personal individual relationships and establishing more sustained institutional partnerships.
Combination of deliberate and opportunistic strategies required.
Increased chance of uptake when tailored to policymaker preferences, responsive to current political requirements, and personalized.
RECOMMENDATION: INDIVIDUAL
• Existing KBs should
• nurture existing relations with policymakers as well as peers • tailor strategies for policy engagement to the context and
audience
• Non-KB faculty should
• consult with existing KBs for support and advice
• increase capacity to understand and navigate the policy environment
• enhance tangible skills
• SPH leadership should
• recognize the value of intangible KB characteristics • create opportunities for networking and learning
RECOMMENDATION: INSTITUTIONAL
• SPHs should use SNA to understand competition, mobilise collective action, enhance their visibility and relevance
• SPHs should not only passively support KB activities but also actively invest in individual KB endeavors
• Recognize and leverage existing KBs, support emergence of potential KBs, and systematically recruit faculty with KB-specific characteristics
• Institutionalize processes for sustained engagement to accelerate information flow
• Invest in technological solutions to overcome barriers to communication and networking
RECOMMENDATION: NETWORK
• Collaborate with other SPHs and academics for a unified voice
• Build institutional relations with policymakers
• Involve policymakers in SPH curricula design, research formulation
• Leverage media as a key conduit for raising political profile of public health issues, spotlighting key researchers, gaining policymaker attention
ADAPTING THE KENYAN STUDY TO USA The influence of JHSPH faculty on public health decision-making: A mixed methods study exploring networks, relationships and engagement strategies
STUDY OBJECTIVES
• Understand the network of relationships that faculty at JHSPH foster at the city, state, federal and international levels in order to contribute to public health decision-making.
Networks
• Explore how JHSPH faculty play a role in bringing evidence to bear on city, state, federal government and/or global level public health decision-making.
Strategies for evidence informed decision making
• Uncover the perceived attributes and capacities of SPH faculty (that make them effective) in bridging the evidence-to-policy divide.
Faculty attributes and capacities
• Identify the organizational and environmental factors that facilitate or hinder JHSPH faculty engagement with decision makers
Proximal & distal determinants of engagement
RELEVANCE:
LINKS WITH APPROACH: • Implementation research that uses SNA as well as qualitative
approaches to map as well as interrogate HIV/AIDS networks • Eg: Latkin, C et al (1995): Using social network analysis to study
patterns of drug use among urban drug users at high risk for HIV/AIDS • SNA: Network density and size of drug subnetworks were positively associated
with frequency of drug injection • USING SNA TO IDENTIFY INTERMEDIARIES: are these subnetworks
linked by key brokers? Is there a strength in weak ties? Are there key people linking different networks – the movers and the shakers? Are there key people who can help break these links – the gatekeepers? Who are the influencers?
• QUAL: Why is this case? How do these networks get built/maintained? What factors facilitate or hinder these relations? What is the relative contribution of the network structure to the patterns of drug use seen?
• SO WHAT?: What kind of interventions could therefore mitigate the impact of this association? Who can be leveraged to assist with this?
LINKS WITH IMPACT: • Implementation research with results that have policy and/
or practice implications so as to contribute to evidence-informed decision making
• Observational, experimental etc… • Understanding the dynamics of disease transmission AND identifying
possible areas for intervention and control
• Mapping influential peer/social networks AND identifying ways of affecting the structure of the network to mitigate (or enhance) such influence
• Establishing key interventions amongst populations of interest and mapping the change of network structure over time as a result.
“You build a staircase of convincing people to change a policy…you don’t carry out the burden as if it’s yours of changing the policy. The burden has to be shared and that’s why networks and multiple approaches are so important to change policy”
-Leadership, GLUK
THANK YOU!