The Heightening Institutional Capacity for Government Use of Health Research (HIGH-Res)

Evidence plays a crucial role in improving the quality of policy, programme and practice decisions that contribute to improved development effectiveness. However, the decision-making process is often complex, and thus evidence has to compete with many other factors, including the varied interests of policymakers, politics, value systems, technical and institutional capacities, and financial constraints.

The Heightening Institutional Capacity for Government Use of Health Research (HIGH-Res) in Kenya, Malawi and Uganda project brought together various partners under the HIGH-Res East Africa Consortium to design, implement and evaluate innovative and politically responsive interventions to strengthen institutional capacity for use of health research in policymaking in Kenya, Malawi and Uganda. The proposed interventions leveraged and built on existing relationships and collaborations among consortium partners, efforts and mechanisms in the three countries to maximise programme impact on building institutional capacity for evidence-informed decision-making (EIDM).

To achieve its main goal of building institutional capacity for evidence-informed decision-making, the project’s interventions leveraged and built on existing relationships and collaborations among consortium partners, and the efforts and mechanisms in the three countries to further maximise  impact.

The project’s interventions were guided by its five main objectives (in bold):

1. Strengthen the existing structures to institutionalise the mechanisms for evidence synthesis and use in the health sector by enhancing the functioning of technical working groups (TWGs) to focus on evidence; build the capacity of Ministry of Health (MoH) staff in commissioning research and evidence reviews; and support the revival and/or creation of mechanisms and tools for evidence synthesis and application
2. Institutionalise mechanisms needed to enable regular interaction between researchers and health sector decision-makers by enabling sustained interactions in the formulation and implementation of health policies and strategies, and piloting innovative sessions at existing annual conferences that discuss evidence on priority health sector issues with policymakers

3. Institutionalise evidence-informed decision-making (EIDM) training in existing training programmes for health professionals and other civil servants by working with training institutions to introduce EIDM training modules in existing pre-service and in-service training programmes
4. Embed EIDM incentives and innovations into MoH systems and structures by incorporating EIDM requirements, tools and practices in existing routine processes and procedures (including performance contracts where they exist) within the MoH

5. Monitor, evaluate and learn from interventions to provide evidence on what works in strengthening institutional capacity for EIDM

The Heightening Institutional Capacity for Government Use of Health Research (HIGH-Res) project achieved its primary objective of building institutional capacity for evidence-informed decision-making (EIDM) in the health sector through meticulously designed interventions in Malawi, Kenya, and Uganda. Here are the key outcomes resulting from the project:

1. Strengthening Existing Structures

The project significantly improved the functionality of Technical Working Groups (TWGs) by centring their efforts on evidence synthesis. As a result, decision-making processes within the health sector became more evidence based. Ministry of Health (MoH) staff were extensively trained in commissioning research and conducting evidence reviews. This training equipped them to integrate evidence into policy formulation and implementation effectively. Revising and creating essential mechanisms and tools for evidence synthesis ensured that the MoH had the necessary resources to sustain these improvements.

The project supported the Research and Innovation Division at Kenya MoH to develop a strategy to guide its annual work plans and implementation. The Division used the strategy to implement different EIDM activities, such as synthesising evidence for use by senior management concerning evidence-to-policy dialogues and conducting training in rapid evidence synthesis for MoH staff. The Division also revived its Research for Health Technical Working Group, which had been dormant for years. In Malawi, the project supported the Research Department to establish a Health-Research sub-TWG and to strengthen the coordination of evidence generation and synthesis. The Malawi MoH also launched the Health Research Strategic Plan, which promotes and institutionalizes EIDM practices in decision-making.

The project also generated evidence to support MoH’s decision-making. In Kenya, they produced evidence syntheses that guided a breast cancer screening programme and schools’ reopening during the COVID-19 pandemic. In Uganda, the focal persons worked with researchers at Makerere University to design and conduct evidence synthesis, while in Malawi, they supported MoH TWGs to address their evidence needs. The HIGH-Res project sought to leverage and strengthen the EIDM capacity and practice of Kamuzu University of Health Sciences (KUHeS) as one of the consortium partners. The project strengthened MoH leadership, coordination, and strategy for sustained EIDM practice in the countries.

2. Institutionalising Researcher–Decision-maker Interactions

Sustainable platforms were established for regular interactions between researchers and health sector decision-makers. These platforms facilitated continuous engagement in formulating and implementing health policies, effectively bridging the gap between research and practice. Innovative sessions at annual conferences allowed policymakers to discuss evidence on priority health sector issues. This initiative fostered a culture of collaboration and mutual respect, promoting evidence-informed policy discussions and decisions.

Kenya MoH Research and Innovation Division began hosting evidence-to-policy sessions at key health conferences through the project. The Division also introduced bi-annual evidence-to-policy dialogues as part of their annual work plans. In Uganda, decision-making structures in the health sector had EIDM requirements integrated in their formal terms of reference and embedded EIDM champions. EIDM incentives have been embedded in MoH decision-making processes. In Malawi, the Government created a full-time Knowledge Translation Coordinator role on government payroll that leads the implementation of the Knowledge Translation Platform (KTP) in Malawi, further promoting sustainability. KTPMalawi has built capacity in evidence-informed policy development, monitoring and evaluation within Malawi, and has developed evidence briefs for policymakers and convened policy dialogues on high priority topics.

3. Facilitating EIDM Training for Health Professionals

The project embedded EIDM training modules in pre-service and in-service training programmes for health professionals and civil servants. This comprehensive training ensured that future generations of health professionals are well-versed in evidence-based approaches. The institutionalisation of EIDM training within regular curricula created a sustainable pipeline of professionals with the necessary skills to apply evidence in their work.

The HIGH-Res project collaborated with tertiary institutions to develop and integrate EIDM curricula in their programmes. The project collaborated with Kamuzu University of Health Sciences (KUHeS) in Malawi, Jomo Kenyatta University of Agriculture and Technology (JKUAT), and KEMRI Graduate School in Kenya, where EIDM curriculum modules were introduced in their postgraduate courses. The project strengthened the skills of the knowledge management staff of KEMRI in conducting systematic reviews. In 2021, the department was designated as a Cochrane centre for Kenya to lead the review and synthesis of evidence needed for decision-making on health in Kenya and East Africa. The department also promotes EIDM within KEMRI and country health departments through training and webinars, including spearheading the development of a country-level dashboard to enhance access to data needed for decision-making. In Malawi, the project promoted the integration of EIDM content in existing training programmes.

4. Embedding EIDM Incentives and Innovations

EIDM requirements, tools, and practices were integrated into MoH systems and structures, including performance contracts. This systemic incorporation ensured that EIDM became integral to the health sector’s operational framework. Staff was incentivised to prioritise evidence daily, leading to more informed and effective decision-making processes.

Uganda MoH adopted guidelines that ensure its governance and management structures undertake to promote, require, enable, and confirm evidence in decision-making. In Malawi, the MoH included, for the first time, the production of policy briefs supporting decision-making as a required skill in their job adverts for technical positions. EIDM champions and EIDM capacity were embedded in MoH decision-making structures; tools for promoting and guiding EIDM practice were developed and adopted. The project also increased awareness, interest and appreciation of the value of incentivising EIDM through institutional systems and procedures, among others.

Impact and Legacy

The HIGH-Res project has had a profound and lasting impact on the health sector in the target countries. Health policies and strategies are now more evidence-informed, improving health outcomes. The strengthened TWGs and well-trained MoH staff have fostered a culture of evidence use, ensuring that robust data and research findings guide decisions. The project has also set a precedent for effective collaboration between researchers and policymakers, highlighting the value of sustained interactions and evidence-based discussions. The embedded EIDM incentives and innovations within MoH systems have ensured that the use of evidence is not just encouraged but is a fundamental aspect of health sector operations. The HIGH-Res project has built a robust foundation for EIDM practices, leading to better health policies and outcomes.

The project was coordinated by a variety of partners in the three countries:

1. African Institute for Development Policy (AFIDEP) – Lead
2. Ministry of Health – Kenya
3. Ministry of Health – Malawi
4. Ministry of Health – Uganda
5. Kenya Medical Research Institute (KEMRI)
6. The Malawi EVIDENT Network (comprising Malawi Liverpool Wellcome Trust Centre (MLW), and College of Medicine at the University of Malawi)
7. Regional East African Community Health Policy Initiative (REACH-PI) Uganda Node, Makerere University (Collaborator)

The HIGH-Res project received financial support from the Alliance for Health Policy and Systems Research (the Alliance) at the World Health Organisation, and Wellcome Trust. The Alliance is able to conduct its work thanks to the commitment and support from a variety of funders. These include its long-term core contributors from national governments and international institutions, as well as designated funding for specific projects within its current priorities. For the full list of Alliance donors, please visit: https://www.who.int/alliance-hpsr/partners/en/