How to use research to improve health programs and services? Lessons from applying a self-assessment
I work for a small private non for profit health research center dedicated to Health Policy and Systems Research-HPSR-, a specific field within Public Health. In 2010 The Colombian Health Association (ASSALUD, by its Spanish acronym), was funded by WHO-AHPSR, in occasion of a call to bridge the gap between knowledge production and knowledge use-.
The project had three pillars:
The application of a self-assessment tool (developed by the Canadian Health Services Research Foundation, translated by Mexican INDESESES and adapted by ASSALUD), to a total of 17 institutions in Bogota D.C (central region), Cali (south west region) and Manizales (coffee growing region). We invited a broad range of organizations: City Health Secretaries, Hospitals, Women´s Organizations, Technical Legislative Units both at Congress and regional bodies, General Comptroller’s Office and Universities.
The development or a course with 120 presential hours conducting to a Diploma Certificate, delivered by seven universities with which we signed agreements for a strategic alliance.
The evaluation and systematization of the experience in the three regions: Bogotá, Cali and Manizales.
The self-assessment tool is divided in three sections. In the first one, members of the organization assess their competencies to ACQUIRE, ANALIZE, ADAPT AND APPLY research results and information in the policy making process. The second section is geared to the identification of the institutional needs in order to stimulate the formulation of a strategic plan to either enhance of acquire those competencies. Last, the third section entails a group discussion, in which we ask participants to pose questions that guide them to formulate institutional plans in order to either enhance or build up their capacities.
One aspect that called my attention was to verify that no matter the level of the institution we applied the instrument on, all face the same difficulties: this is to say professionals and senior officers in institutions have a similar institutional setting in relation to key aspects of the structure that is needed to uptake, update and use information and knowledge in policy making. In other words: they have similar deficits in capacity to access, assess, adapt and apply information-knowledge in their projects.
The organizations have difficulties with their own history of failures and successes. In large organizations like Bogota Health Secretary, serving a city of eight million people, the senior level professionals who participated in the project feel a very strongdisconnection between different parts of the organization. While the discourse on health and the system is ample, the parts that have to put it together in terms of services, regulations and so on, are not connected.
On another note, SCOs have a great capacity to mobilize for change, but a minuscule competence to systematize their experiences, weaknesses and successes. They confront difficulties to keep the history and records of service reports and also of the research that they fund.
Legislative Technical Units at the legislative branches at national and subnational levels have very little stability in their posts and always react to the legislative political agenda. Although they understand that building ties with academia and academics is a good thing in politics, these ties depend mostly both on personal relations and political affinities.
A simple question was made to the institutions: Are you capable of uptaking research results in your program or institution? The responses show that 18% of the institutions believe that they do not use research in the policy making process, 35% believe that they use it very little research or very rarely, and 47% affirmed that they use it sometimes and in an irregular manner. We concluded that none of the institutions considers that research is systematically used in the policy making process. The lack of institutionalization is quite clear.
A big difficulty to use research refers to the weak institutional capacity to analyze and acquire research. For instance, in Bogota D.C. the assessment is that they have poor capacities to analyze and do not have criteria to judge the robustness of the information (even from institutional reports issued by institutions such as National Planning Department, UN bodies, WHO and others).
Another difficulty has to do with the lack of incentives. It was pointed out that attending academic congresses or symposia was almost impossible: people have to take a leave of absence and pay out from their own pockets. The deficit in internet access, bibliographical repositories, lack of adequate spaces and infrastructure such as up to date computers and software is also stated as a big obstacle to use research.
As this study demonstrates, there are some basic misunderstandings between the worlds of knowledge production and knowledge use. One can overcome them not only by recognizing their existence, but also by promoting peer relations, trying to overcome the existing mutual prejudices between those who produce and those who could use the research.